Robot assisted laparoscopic precise enucleation for complex central located renal hilum tumors: feasibility and outcomes

Objective To investigate the safety and feasibility of robot assisted laparoscopic precise enucleation for complex central located renal hilum tumors. Methods From July 2017 to October 2018, a single surgeon completed seven robot assisted laparoscopic precise enucleations for complex central located renal hilum tumors. There were five males and two females with an average age of 56.5 years (45-68 years), an average body mass index of 25.1 kg/m2(19.8-29.2 kg/m2), four cases on the left side and three cases on the right side. The average tumor diameter was 3.5 cm, ranging(2.2-4.5 cm). The R. E.N.A.L. score was 9.7 (9-11). The average preoperative GFR was 44.5 ml/min (36.5-51.7 ml/min). The surgery was completed step by step as follow: the renal hilum was fully dissociated.The arteries, veins and collective system were completely freed. After blocking the renal artery, the renal hilum was completely dissected again. The tumor was enucleated precisely, and the wound was given a point-to-point suture. Results All operation were completed safely and successfully without conversion to nephrectomy and open surgery. The average operative duration was 175.0 min (133-224 min). The average warm ischemia time was 27.3 min (22-38 min) and the intraoperative blood loss was 155.7 ml(50-250 ml). One patient had gross hematuria after surgery. Postoperative pathology showed clear cell carcinoma and the margins were negative. After three months, the average GFR was 29.3 ml/min (23.9-33.2 ml/min). There was no tumor recurrence and metastasis. Conclusions Robot assisted laparoscopic precise enucleation is a safe and feasible surgery for complex central located renal hilum tumors, and it is worth further promotion. Key words: Hilar tumor; Endophytic tumor; Partial nephrectomy; Robot