Introduction: Partial nephrectomy is not recommended in kidney urothelial carcinoma, but may be considered in exceptional cases, mainly in case of poor nephronic capital or a genetic disease with high risk of recurrence. We selected for this video one of these exceptional cases, performed by minimally invasive robotic approach. Methods: The case is a 55-year-old patient in good general state followed for Lynch syndrome, with a history of subtotal colectomy. History of 2 localizations of low-grade urothelial carcinoma. The first one was in the upper calyx of the left kidney, treated conservatively with laser. The second one was in the bladder, treated by resection and mitomycin instillations. During follow-up, he presented with a recurrence in the superior calyx of the left kidney, which had become inaccessible endoscopically due to post-treatment stenosis. In this patient at high risk of recurrence, we performed a 3D image guided left robot-assisted upper pole heminephrectomy, with anatomical devascularisation and without opening of the excretory tract. The procedure was performed using the Da Vinci surgical robot (Intuitive Surgical) and the 3D model was created with Synapse 3D. Results: The procedure begins with the complete release of the kidney and the precise dissection of the pedicle. The 3D model was used to perform the anatomical devascularization of the upper pole of the kidney. The tumor calicium stem was excluded before it section. The section of the parenchyma was performed without arterial clamping. Hemostasis of the renal slice was performed with V-lok wire, and Tachosyl sponge. The urinary tract was closed with absorbable monofilament, without drainage. Operative time was 5h45 and estimated blood loss was 250ml. Patient discharge at post-operative day 1. Pathology report showed a high grade pT1 urothelial papillary carcinoma of complete resection. No upper tract recurence was observed at 7 months endoscopic control. Conclusions: Standard treatment of high-risk kidney urothelial carcinoma is radical nephroureterectomy. Partial nephrectomy and other conservative treatments may be considered in exceptional cases or poor nephronic capital, or high risk of recurrence (Lynch). In any case, the opening of the excretory tract must be avoided in order to avoid the risk of tumor dissemination. Moreover, all conservative treatment must require very regular and close endoscopic follow-up. SOURCE OF Funding: None.
