title: Robotic-assisted laparoscopic partial nephrectomy for a 7-cm mass in a renal allograft.
abstract: Treatment options for a suspicious renal mass in a renal allograft include radical nephrectomy or nephron-sparing surgery (NSS). To our knowledge robotic-assisted laparoscopic partial nephrectomy (RPN) as treatment for a renal mass in a transplant kidney has not been previously reported. We report the case of RPN for a 7-cm renal mass in a transplanted kidney. A 35-year-old female with reflux nephropathy received a living-related donor kidney transplant in 1986. At 24 years after transplantation she had a 7-cm Bosniak III cystic mass of the allograft detected on computerized tomography (CT) scan. Preoperative creatinine was 2.2 mg/dL with an estimated glomerular filtration rate (eGFR) of 25 mL/min/1.73 m(2) . RPN was performed with bulldog clamping of the renal vessels, the graft was left in situ and immunosuppression was maintained postoperatively. Tumor diameter was 7.3 cm with a nephrometry score of 10a. Warm ischemia time (WIT) was 26.5 min. Estimated blood loss was 100 mL. There was no change between pre- and postoperative eGFR. There were no operative complications. Histology was papillary renal cell carcinoma type 1, nuclear grade 2. Margins were negative. RPN is a technically feasible treatment option for a suspicious renal mass in renal allografts.
authors.affiliation: Glickman Urological Institute Cleveland Clinic, Cleveland, OH, USA. kaoukj@ccf.org
authors.forename: J H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: G
authors.initials: G
authors.lastname: Spana
authors.forename: S P
authors.initials: SP
authors.lastname: Hillyer
authors.forename: M A
authors.initials: MA
authors.lastname: White
authors.forename: G-P
authors.initials: GP
authors.lastname: Haber
authors.forename: D
authors.initials: D
authors.lastname: Goldfarb
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics; D014057:Tomography, X-Ray Computed