Robot-assisted partial nephrectomy with calicolithotomy

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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.

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About the authors

Mkrtich S. Mosoyan

Almazov National Medical Research Centre; Academician I.P. Pavlov First St. Petersburg State Medical University

ORCID iD: 0000-0003-3639-6863
SPIN-code: 5716-9089
Scopus Author ID: 57208982777

Dr. Sci. (Med), Head of the Department of Urology with the Course of Robotic Surgery and the Clinic, Head of the Center for Robotic Surgery, Professor of the Department of Urology

Russian Federation, Saint Petersburg; Saint Petersburg

Gocha Sh. Shanava

Almazov National Medical Research Centre; I.I. Dzhanelidze St. Petersburg Institute of Emergency Care

SPIN-code: 1706-7410

Cand. Sci. (Med.), MD, Associate Professor of the Department of Urology with the Course of Robotic Surgery and the Clinic, Urologist

Russian Federation, Saint Petersburg; Saint Petersburg

Arthur M. Simonyan

Almazov National Medical Research Centre

Author for correspondence.

Postgraduate Student of the Department of Urology with the Course of Robotic Surgery and the Clinic

Russian Federation, Saint Petersburg

Nadezhda A. Aysina

Almazov National Medical Research Centre

SPIN-code: 3168-2228

Assistant of the Department of Urology with the Course of Robotic Surgery and the Clinic

Russian Federation, Saint Petersburg


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Supplementary files

Supplementary Files
1. Fig. 1. Мultislice computed tomography. The white and black arrows indicate the mass of the right kidney and the calculus in the lower group of calyces of the right kidney, respectively

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2. Fig. 2. Мultislice computed tomography. One accessory renal artery (a) and one accessory renal vein (b) on the right are identified

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3. Fig. 3. 3D reconstruction of the right kidney using the 3D Slicer modeling software. Anterior (a) and posterior (b) surface of the right kidney. The white and black arrows indicate the accessory renal artery and the accessory renal vein, respectively

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4. Fig. 4. An intracavitary ultrasound probe was used to determine the boundaries of kidney’s resection. The arrow indicates the calculus in the lower group of calyces

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5. Fig. 5. Calicolitothomy was performed from the lower group of calyces. The arrow indicates the calculus

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6. Fig. 6. Мultislice contrast-enhanced computed tomography. The renal collecting system was not damaged. The area of resection is indicated by an arrow

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