title: Image-Guided Embolization Coil Placement for Identification of an Endophytic, Isoechoic Renal Mass During Robotic Partial Nephrectomy.
abstract: BACKGROUND
  Intraoperative ultrasonography has proven to be a useful tool for tumor identification during robot-assisted laparoscopic partial nephrectomy (RALPN). However, its utility is limited in renal tumors that are completely endophytic and isoechoic in nature. We present a novel approach to intraoperative tumor identification using preoperative percutaneous intratumoral embolization coil placement that may be utilized in the management of such cases.
  
  
  METHODS
  A 42-year-old Caucasian male was referred with an incidentally discovered right renal mass that was posterior and completely endophytic. He desired a RALPN; however, preoperative renal ultrasound demonstrated an isoechoic lesion. Thus, the patient underwent preoperative image-guided placement of an embolization coil within the tumor. This facilitated identification of the tumor intraoperatively using intracorporeal ultrasound centered on the coil and enabled resection with negative margins.
  
  
  CONCLUSIONS
  Utilizing a novel approach analogous to preoperative localization of other solid malignancies, such as breast cancer, we were able to effectively identify and resect an isoechoic renal mass during RALPN.
authors: Geisel School of Medicine, Dartmouth College , Hanover, New Hampshire.
authors: James Jeffery
authors: JJ
authors: Reeves
authors: Division of Vascular and Interventional Radiology, Department of Radiology, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.
authors: Andrew
authors: A
authors: Forauer
authors: Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center , Lebanon, New Hampshire.
authors: John D
authors: JD
authors: Seigne
authors: Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center , Lebanon, New Hampshire.
authors: Elias S
authors: ES
authors: Hyams