Application of retrograde resection technique in robot assisted laparoscopic partial nephrectomy for large complex kidney cancer

doi:10.3877/cma.j.issn.1674-3253.2025.01.005

Abstract

Abstract:

Objective

With the continuous development of robotic minimally invasive technology，the indications for nephron-sparing surgery have gradually expanded to include large and complex renal tumors at T_2a and T_2b stages. However， during the dissection of large tumors， the difficulty of exposure often leads to significant compression of the tumor by surgical instruments. This study explores the feasibility of the retrograde resection technique to address this issue.

Methods

A retrospective analysis was conducted on the clinical data of 2 patients with large complex renal cancer admitted to the First Affiliated Hospital of Sun Yat-sen University. Both patients were male. Case 1 was 35 years old with clinical staging of T_2aN₀M₀ and a CT scan showing a 7.2 cm cystic renal tumor in the upper pole of the left kidney， case 2 was 41 years old with clinical staging of T_2bN₀M₀ and a CT scan showing a 10.8 cm cystic-solid renal tumor in the upper pole of the right kidney. In robotic-assisted laparoscopic partial nephrectomy， the retrograde resection technique was employed to avoid compressing the large renal tumor by first separating the tumor from the normal renal parenchyma at the interface， and then freeing the tumor away from the normal renal parenchyma after completing the partial nephrectomy.

Results

The retrograde resection technique was applied in the two cases of renal cancer during robotic-assisted laparoscopic partial nephrectomy. The surgeries were performed smoothly， with operation time of 188 minutes and 215 minutes， and warm ischemia time of 23 minutes and 15 minutes （the second warm ischemia time was 33 minutes）， respectively. No intraoperative or postoperative complications occurred， and postoperative pathology confirmed both cases as renal clear cell carcinoma.Regular follow-up showed no recurrence or metastasis of the tumors.

Conclusions

The retrograde resection technique is convenient and feasible in robotic-assisted laparoscopic partial nephrectomy for large complex renal cancers. Compared to conventional methods， it allows for complete resection of large tumors without significant compression， reducing the risk of tumor implantation and metastasis， and aligns with the principle of tumor-free surgical operation.

Key words: Renal tumor, Retrograde resection technique, Robotic， Laparoscopic， partial nephrectomy

Jinhuan Wei, Xu Chen, Jun Lu, Wei Chen, Junhang Luo. Application of retrograde resection technique in robot assisted laparoscopic partial nephrectomy for large complex kidney cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 27-30.

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References 25

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