CASE REPORTS : Zero Ischemia Robotic Laser Partial Nephrectomy : Use of the Thulium laser in Renal Cell Carcinoma

Objective To describe use of a robotic-assisted laparoscopic partial nephrectomy technique utilizing the thulium laser for tissue welding without clamping the hilar vessels. Materials and Methods A Thulium laser at 30W and a 400 micron fiber placed through a robot arm to excise and achieve hemostasis during resection of renal masses. The masses were localized intraoperatively with a 10mm laparoscopic renal ultrasound probe. At no point during the procedure were the renal hilar vessels clamped. There was minimal blood loss during the operation. Following resection, the base of the tumor resection bed was oversewn with a running 2-0 Vicryl suture and secured with LapraTy clips. The renal capsule was then closed with 0 Vicryl over a Surgicel bolster together with Floseal for an additional degree of hemostasis. Results The robotic partial nephrectomies were completed without complication, with complete tumor excision confirmed by negative pathologic surgical margins. Final pathology demonstrated clear cell cell carcinoma. Patients were discharged on postoperative day 2, and have had no long term complications. Conclusions Partial nephrectomy continues to grow in application for treatment of T1 renal cell carcinoma. We present a technique for zero-ischemia robotic laser partial nephrectomy, which addresses current concerns focusing on renal ischemia during surgery.