Robot-assisted partial nephrectomy with zero ischemia in comorbid patients.

Introduction. Nephron-sparing surgery is the current gold standard for the surgical treatment of localized renal cell carcinoma (RCC). Partial nephrectomy can be performed by off-clamp or on clamp techniques. It is especially important to preserve renal function during partial nephrectomy in comorbid patients. Objective. To evaluate the perioperative results of robot-assisted partial nephrectomy with zero ischemia in comorbid patients with RCC. Materials and Methods. At the Almazov Center we retrospectively studied the results of 11 comorbid patients who underwent robot-assisted partial nephrectomy with zero ischemia from 2019 to 2022. In 3 (27.3%) of them, renal mass was detected in a solitary kidney. In preoperative period 3D reconstruction was performed using the 3D Slicer modeling program. For rapid mobilization of the renal vessels we used «method of safe exposure of renal pedicle vessels during endovideosurgical resection of the kidney and radical nephrectomy during laparoscopic and robot-assisted operations» (patent RU 2742367). The boundaries of resection were determined with an intracavitary ultrasound probe BK Flex Focus 800. Renal function was assessed by glomerular filtration rate (GFR) using the Chronic Kidney Desease Epidemiology Collaboration (CKD-EPI) formula. Results. There were no intraoperative and postoperative complications. The median console operation time was 110 min [58–130]. Median estimate blood loss was 100 ml [50-280]. No cases had a positive surgical margin. In the postoperative period, GFR was comparable to preoperative values. Conclusion. Robot-assisted partial nephrectomy with zero ischemia for comorbid patients is more expedient to be performed in a multidisciplinary center of competence. The effectiveness of perioperative results of robot-assisted partial nephrectomy with zero ischemia is achieved by using highly informative diagnostic imaging methods and performing a safe method of isolating renal vessels during the operation with rapid renorrhaphy performed by an experienced surgeon.