Abstract
The combination of renal cell carcinoma and urolithiasis in the same kidney is rare. The management of patients who have two such diseases simultaneously is primarily determined by renal cell carcinoma as the dominant disease. To date, modern diagnostic and surgical technologies make it possible to perform partial nephrectomy with simultaneous removal of a calculus from the pelvicalyceal system using minimally invasive endovideosurgical methods.
This study aimed to demonstrate the possibility of performing robot-assisted nephrectomy with calicolithotomy in a patient with abnormalities of renal vessels.
This work presents a clinical case of a 36-year-old man hospitalized with a neoplasm of the right kidney measuring 38 35 35 mm, detected during multislice computed tomography. In the lower group of calices of the kidney, a 5 4 mm calculus with a density of 1200 HU was found. The presence of anomalies of the renal vessels served as the basis for a three-dimensional (3D) reconstruction of the right kidney using the 3D Slicer modeling program. The patient underwent a robot-assisted kidney resection with calicolithotomy on a da Vinci SI robot. Intraoperatively, an ultrasound examination of the kidney was performed using an intracavitary sensor BK Flex Focus 800.
The console operating time of the operating surgeon was 110 min. Blood loss was approximately 100 ml. The warm ischemia time was 20 min. The postoperative period proceeded without complications. At 3 weeks postoperatively, nephrogenic arterial hypertension disappeared. Laboratory studies conducted 3 months after surgery indicated an increase in the glomerular filtration rate compared with preoperative results.
3D reconstruction allows rational planning of the scope of surgical intervention during preoperative preparation. Kidney resection with calicolithotomy is optimally performed using the da Vinci robot, which allows complex surgical techniques to be performed using endovideosurgical methods.