V10-02: Robotic partial nephrectomy with reversible selective artery endoluminal balloon occlusion on a kidney graft

Patrick-Julien Treacy*, Nice, France, Severine Lagarde, AL EMADI Ibrahim, Thomas Prudhomme, Marine Lesourd, Toulouse, France, Rayan Atme, Matthieu Durand, Imad Bentellis, Nice, France, Michel Soulié, Nicolas Doumerc, Toulouse, France

Introduction: Small kidney tumors on renal grafts are accessible to partial nephrectomy surgery, but expose to clamping difficulties due to challenging access to graft vessels. Endoluminal balloons provide a reversible alternative to clamping of the graft artery. The objective of this video was to show the safety and efficiency of this technique for robot-assisted partial nephrectomy on kidney graft.

Methods: 69-year-old patient, transplanted in 2012, with extensive cardiovascular history. Discovery on follow-up ultrasound of a 2.5x2.3 cm tumor, confirmed by CT scan. Decision of robot-assisted partial nephrectomy after the multidisciplinary consultation meeting. An endoluminal balloon was placed in the segmental artery vascularizing the tumor after ponction of the femoral artery in interventional radiology. The patient was then installed in a supine position in the operating room for robotic-assisted partial nephrectomy, with trocar positioning similar to pelvic robotic surgery (assistant on the left side of the patient, two assistant trocars in the left iliac fossa and between the optical trocar and arm #1).

Results: The operative time in interventional radiology was 25 minutes, performed under local anesthesia. The operative time of the partial nephrectomy was 45 min, with a 10 min occlusion of the segmental artery. Blood loss was 200 cc. The postoperative period was uneventful, with the patient being discharged on day 2 after surgery. The serum creatinine level at discharge was 80 micromol/L , and the 3-month level was similar . Histopathologic analysis confirmed the malignant nature of the tumor, with clear cell renal cell carcinoma classified as pT1a Nx MO, nucleolar grade 3 (WHO 2018), with negative margins. 2 additional patients were performed using this technique, with similar results.

Conclusions: Selective and reversible endoluminal balloon occlusion of  segmental arteries appears to be a safe and effective alternative in arterial clamping for robotic-assisted partial nephrectomies on kidney grafts. A larger cohort will allow us to confirm our hypothesis.

Source of Funding: none