Robot-assisted renal tumor enucleo-resection in patients with a solitary kidney

Nephron-sparing surgery is most crucial for patients with a small renal mass in a solitary kidney. Historically, a minimally invasive approach in this setting has been discouraged. Tumor enucleo-resection, long established in the management of hereditary renal tumor syndromes, is currently being evaluated as a viable surgical technique in the sporadic renal cell carcinoma (RCC) population. This approach may significantly reduce or eliminate the need for hilar clamping. We sought to evaluate our experience with robot-assisted enucleo-resection partial nephrectomy (EN-RAPN) in patients with solitary kidneys.

Records of patients with a solitary kidney requiring partial nephrectomy performed with robot-assisted enucleo-resection technique at four academic institutions between 2010 and 2013 were reviewed. Baseline demographic, perioperative and pathological data were collected. Functional and early operative outcomes were analyzed.

Twelve patients underwent EN-RAPN with a median age of 68 years (range 55-80) and follow up duration of 12.55 months (IQR: 5.25, 18.88). Median warm ischemia time was 5.5 minutes (IQR: 0, 13.25) with 6/12 (50%) done off-clamp (zero warm ischemia). Ten (83.3%) patients were pT1a and clear cell was the predominant pathology (9 patients, 75%). Surgical margins were negative in all patients. No patient experienced renal loss or required dialysis. Pre and postoperative estimated glomerular filtration rate (eGFR) at last follow up was similar (54.3, 48.9, Δ-7.0%; p = 0.313).

Robot-assisted enucleo-resection partial nephrectomy in patients with a solitary kidney appears safe and feasible in our early experience. This approach may be utilized to maximize renal preservation and minimize hilar clamping in this setting.