Single-Institution Experience with Robotic Partial Nephrectomy for Renal Masses Greater Than 4 cm.

PURPOSE: To review our institution's experience with robotic partial nephrectomy (RPN) for T1b and greater renal masses (>4 cm [T1b+]) in terms of perioperative and oncologic outcomes relative to a contemporary cohort of patients with T1a renal masses (<4 cm). PATIENTS AND METHODS: 232 patients underwent RPN at our institution between 2008 and 2014. Demographics, R.E.N.A.L. nephrometry score, and operative, pathologic, and renal function outcomes, as well as complications, were compared between the two groups (T1a vs T1b+). RESULTS: A total of 168 and 64 patients underwent RPN for T1a and T1b+ renal masses, respectively. T1b+ patients had a higher mean nephrometry score (8.2 vs 6.9), median pathologic tumor size (4.8 vs 2.6 cm), median blood loss (200 vs 100 mL), median warm ischemia time (23 vs 21 minutes), rate of conversion to radical nephrectomy (7.8% vs 1.2%), and rate of Clavien grade III or higher complications (14% vs 4.2%) compared with T1a patients. One patient was found to have disease recurrence in the T1a group, and no patients experienced recurrence in the T1b+ group. No patient died from the disease. CONCLUSIONS: The current series represents the largest single-institutional report of RPN for tumors >4 cm. The higher complexity of tumors resected in this series did not preclude a safe and oncologically efficacious operation; however, Clavien grade III complications were more common in patients with tumors >4 cm, likely from a higher rate of pseudoaneurysm. These data should be considered in preoperative counseling with patients before RPN for tumors >4 cm.

Practical tips for safe and efficient robotic cystectomy.

Robotic-assisted radical cystectomy (RARC) is a challenging procedure that potentially offers the patient decreased perioperative morbidity. With careful patient selection and attention to surgical detail, one can learn to efficiently and safely perform RARC with extracorporeal diversion. As one develops further expertise with RARC, patient selection criteria can be liberalized and intracorporeal diversion can be performed. The accumulated experience of our institution and other high-volume institutions are reviewed with attention to the technical details that yield a safe and efficient robotic cystectomy.

Early prenatal detection of an intra-abdominal cryptorchid testicular teratoma.

Intra-abdominal prenatally detected testicular neoplasms are rare; however, increased use of prenatal ultrasonography has led to the discovery of these uncommon neoplasms. We report the fifth case of a prenatally detected intra-abdominal testicular teratoma, which, in this instance, was detected early in pregnancy as a cystic mass within the fetal abdomen that subsequently underwent torsion later in pregnancy before delivery.

Supernumerary kidney in a child with OEIS complex.

Supernumerary kidney and cloacal exstrophy are rare anomalies of the genitourinary tract. We present an exceedingly rare case of a supernumerary third kidney discovered by antegrade nephrostography of a 6-month-old child with OEIS complex (omphalocele, exstrophy, imperforate anus, spinal defects).