Robotic excision of recurrent renal cell carcinomas with laparoscopic ultrasound assistance

To report our experience with the first application of minimally invasive robotic resection of solitary recurrences of renal cell carcinoma (RCC) and our use of laparoscopic ultrasound to localize such tumors.

Three patients presented with isolated retroperitoneal recurrences of RCC on surveillance imaging up to 5 years after previous nephrectomy. One patient who originally had caval extension of RCC to the right atrium presented with retrocaval lymphadenopathy consistent with RCC on biopsy. The second patient had a growing lesion in the renal fossa that could not be found during open exploration before referral. The third patient had an enlarging retroaortic mass resected 2 years after left nephrectomy with negative lymphadenectomy. A transperitoneal robotic approach was used in all cases with laparoscopic ultrasound localization.

Procedures were completed robotically in 194, 191, and 85 minutes. Recurrent RCC tumors were resected with negative margins. The first patient had 10 benign nodes removed, the second patient underwent robotic mesh repair of a flank hernia, and the third patient had a retroaortic lesion excised despite benign pathology on prior biopsy. Both ambulated and tolerated diet immediately and were discharged on the first postoperative day without complications. Neither patient had recurrence with at least 2 years of follow-up.

Isolated RCC recurrences are rare with the limited available data advocating surgical resection. We describe the first report of robotic resection of these tumors with excellent surgical and midterm oncologic outcomes.