Purely Off-clamp RAPN for cT2b renal mass

Description

We described our surgical technique of purely off-clamp robot-assisted partial nephrectomy (RAPN) applied to a complex case of cT2b renal mass.
Patient was placed in extended flank position. A transperitoneal six-port access was used with a four-arm configuration. Crucial surgical steps included straight access to the tumor, avoiding hilum isolation, tumor identification and margins scoring, enucleation/enucleoresection, selective control of all arterial feeders, hemostasis of resection bed with “sutureless technique”.
Tumor margins were scored with monopolar coagulation. An enucleation plane was progressively developed, taking care of all arterial feeders which were controlled.
Two suction devices with irrigation were used simultaneously to maximize the visualization of the enucleation plane. Monopolar coagulation of the resection bed started from the upper part of the resected area, moving towards the bottom until optimal hemostasis was reached.
Hem-o-lok previously placed during enucleation phase were removed and any unintended violation of renal calyces were repaired contextually.