LAUSR

INTRODUCTION AND OBJECTIVE: This case illustrates the difficulty of a salvage PN after cryoablation. The objective is to show that Image Guided Robot-Assisted Partial Nephrectomy (IGRAPN) with 3D model assistance, intraoperative US, and indocyanine green, as a salvage treatment, allows an excellent renal function preservation without morbidity METHODS: The surgery was performed with the Da-Vinci surgical robot, by using 3 operatives arms, a 30-degree endoscope and 2 ports for the assistant. We used a 3D model image, intraoperative ultrasound (US) and indocyanine green fluorescence. Clinical data, collected after consent, were extracted from the french national database on kidney cancer UroCCR. RESULTS: A 5cm upper and mid pole, posterior and mostly endophytic tumor was discovered in a 72 years old woman with CDK (GFR 34mL/min MDRD) and anticoagulant treatment, and treated by cryoablation. 4 months CT scan showed an extended residual disease in sinusal part of the tumor. It was a highly complex tumor: RENAL score 10ph, PADUA score 12p. Ablated zone was very difficult to dissect because of a sticky fat. Hilum was deeply dissected to enable selective clamping, arterial branchs were encircled with vessel loops. We made hemostasis of feeding tumor veins with Hemolocs. It was difficult to find the tumor plan around the hilum. Intraoperative US was performed to identify the limits of the tumor. An anterior feeding arteria was clamped and the tumorectomy started, dissecting step by step, with no real enucleation plan because of cryoablation. To continue the dissection, we practiced sequential clampage, taking off the bulldog clamp on anterior artery to clamp a more posterior arterial branch. Collecting system was opened, necessary step to permit a complete excision. The tumor was finally removed, and put in an endobag. Collecting system was closed with 4.0 PDS and the tumor bed with a 3.0 Veloc overlock. Patient was discharged at home post-operative day 2, with an unchanged renal function. Tumor was a Renal Cell Carcinoma of 3,5 cm Fuhrman grade 3 staging pT3aR0. 8 months later, renal function was still stable, with no recurrence on CTscan. CONCLUSIONS: A complex PN would become even more complex if performed as a salvage indication. Elect the right treatment option at first. In situations with risk factors for ablation failure, even in case of comorbidities or CKD, PN remains standard treatment Source of Funding: 0 V01-11 ROBOT-ASSISTED LEVEL II AND III INFERIOR VENA CAVA THROMBECTOMY: STEP-BY-STEP OF TWO DIFFERENT TECHNIQUES