Case report: robot-assisted extended radical nephrectomy with removal of conglomerate of the lymph nodes

Abstract

Introduction. The article presents a clinical case of a robot-assisted extended left-sided radical nephrectomy with removal of conglomerate of the lymph nodes with preliminary renal artery embolization in a patient with histologically verified papillary kidney cancer; the technique of the operation is described, the main perioperative indicators are presented. The purpose of the study is to share the experience gained from a unique case. Materials and methods. Patient 21 years old, female. The patient had a history of macrohematuria in October 2018, and therefore was hospitalized in a city hospital, where examination, according to ultrasound, CT, revealed the formation of the left kidney. In November 2018, a targeted biopsy of a tumor of the left kidney was performed under ultrasound control; pathomorphological examination revealed papillary carcinoma. According to CT: In the upper and middle third of the left kidney, there wsa hypervascular, heterogeneous cystic-solid formation with an uneven contour, 52 × 44 × 49 mm in size, spreading into the abdominal system of the kidney, compressing the tail of the pancreas (without distinct signs of invasion), also the thrombosis of the branches of the renal vein pathomorphological was determined. A robot-assisted extended left-sided radical nephrectomy with removal of conglomerate of the lymph nodes with preliminary renal artery embolization was performed. Results. The duration of the first stage of the operation (endovascular embolization of a. renalis sinistra) was 50 minutes. The duration of the second stage of the operation (robotic radical nephrectomy) was 225 minutes. Console time is 180 minutes. The volume of blood loss did not exceed 100 ml. There were no major complications during postoperative period. Conclusions. The combination of preliminary renal artery embolization and a robot-assisted extended radical nephrectomy is an effective and safe method of surgical treatment in high-risk patients. Case report: robot-assisted extended radical nephrectomy with removal of conglomerate of the lymph nodes