Locations:
Search IconSearch
June 12, 2018/Cancer

Robotic Partial Nephrectomy for Tumors that Invade Sinus Fat (Video)

Achieving local cancer control without radical nephrectomy

By Jihad Kaouk, MD

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

In this era of robotic surgery, indications for partial nephrectomy (PN) are being widened to more complex renal masses.

In this video, we provide technical hints for achieving local cancer control during transperitoneal robotic PN (RPN) for T3 tumors that invade the sinus fat.

Technique

Our refined robotic technique entails a thorough examination of preoperative imaging and intraoperative renal ultrasound. Excision of the tumor is planned in such a way to shift retraction to the sinus fat. Such retraction allows for delineation of the fat involved with the tumor versus normal sinus fat away from the tumor.

We base our enthusiasm for this technique on a study of masses that underwent RPN at our institution. Of the 1,497 renal masses, 512 were suspected to have sinus fat invasion (RENAL score 3 for nearness to the sinus). Of these, 69 (13.5 percent) had pT3a tumor involving sinus fat at final pathology, representing the analyzed cohort. Twenty-four robotic transperitoneal PN were performed by our refined technique described in this video and 45 PNs were performed by our standard institutional technique.

Overall positive surgical margin (PSM) rate for the analyzed cohort (69 patients) was 11.6 percent. In patients operated on by our standard technique, the PSM rate was higher (0 percent versus 17.8 percent, P = 0.031). We were able to practically eliminate positive margins by refining our technique (P = 0.031). In patients operated on with the revised robotic technique presented on this video, trifecta achievement (no positive margins, no complications and excellent kidney function) was even higher compared to the standard technique (54.2 percent versus 20 percent, P = 0.005).

Advertisement

Differences in PSMs were not reflected in early oncological outcomes. Retrospective analysis and limited follow-up represent study limitations.

Conclusion

With consistent experience in robotic surgery, optimal cancer control can be achieved with this customized robotic approach, especially in cases when tumors involve the renal sinus, which would otherwise require a radical nephrectomy.

Clinical fellow Juan Garisto, MD, and research fellow Riccardo Bertolo, MD, assisted in the production of this video.

Advertisement

Related Articles

CAR T cell
March 28, 2025/Cancer/News & Insight
What’s New and on the Horizon for Treating Multiple Myeloma?

Making sense of the fast-moving treatment landscape

Myelofibrosis cells
March 18, 2025/Cancer/News & Insight
Personalizing Treatment of Myelofibrosis-Associated Anemia

Combination therapy may help address underlying disease

Basal cell carcinoma
March 14, 2025/Cancer/News & Insight
Definitive Radiation Therapy Effective for Treating Locally Advanced Basal Cell Carcinoma

Major study demonstrates importance of having a multidisciplinary approach to treatment for large, locally advanced tumors

PET scan
March 4, 2025/Cancer/News & Insight
Case Study: First Patient at Cleveland Clinic Treated with Tumor-Infiltrating Lymphocyte Therapy

Highly personalized treatment shrinks tumors resistant to immunotherapy

cells with idiopathic multicentric Castleman Disease
February 20, 2025/Cancer/News & Insight
Study Offers New Insights into Idiopathic Multicentric Castleman Disease

Highlighting treatment gaps and challenges in the management of rare condition

CAR T-cell therapy
February 18, 2025/Cancer/News & Insight
Top Myths About CAR T-Cell Therapy for Multiple Myeloma

Explaining common misconceptions about chimeric antigen receptor therapy

Silhouettes of man and woman
February 7, 2025/Cancer/News & Insight
Pharmacokinetics of Many Anticancer Drugs Differ Among Sexes

Slower drug elimination from the body among females may impact safety and efficacy

Ad