Selective clamping robotic renal enucleoresection: A step-by-step procedure

Objective: we aim to illustrate step by step the technique of enucleoresection of renal mass during robot-assisted partial nephrectomy (RAPN). Patient and surgical procedure: 72-year-old man affected by asymptomatic and incidental small renal mass in the middle third of the left kidney. The diameter of the renal mass was 3 cm on preoperative imaging, with a PADUA score of 7. We performed left transperitoneal RAPN with selective clamping. After the enucleoresection, medullary and cortical sutures were performed. A hemostatic agent was applied at the end of the procedure. Results: Intraoperative blood loss was 50 ml, with an ischemia time of 15 min. Postoperative hemoglobin was 14.8 g/dL and the creatinine was 0.69 mg/dL. On the third post-operative day, the drain was removed and the patient was discharged on the same day. No postoperative complications or recurrences were found during the 6-month follow-up. Conclusion: partial nephrectomy maximizes the amount of healthy renal parenchyma spared. Evidence supports the adoption of this technique whenever feasible.