Totally endophytic renal tumours are challenging cases for Urologists to tackle. This video illustrates the ‘Wheelbarrow’ Dissection technique that aids in the resection/enucleation of these tumours.
A 57 year old gentleman with a right completely endophytic 3.7cm renal tumour underwent robot-assisted partial nephrectomy. He recovered well postoperatively, histology revealed pT1a Grade 2 Clear cell RCC with clear resection margins.
Patient profile
55 year old male. Nil past medical history. Normal renal function Tumour profile
Right upper pole posterior bi-lobed tumour
Nephrometry: R2 N2 N3 P L3 = 10p Kidney anatomy
Single renal artery, small upper pole accessory. Surgical lessons
In event of excessive bleeding, reinspect hilum for renal arterial branches or accessory branches. Final histology
pT1b (5cm) cc RCC. Margins negative.
60 year old male. Normal renal function
Previous robotic right partial nephrectomy Now with synchronous 2cm bosniak IV cyst – completely endophytic.
Gold seeds were inserted percutaneously by DVIR to improve visualisation using intra-operative ultrasound. Hilar dissection was challenging due to previous partial nephrectomy.
Tumour was identified and scored with diathermy.
“Wheelbarrow” technique was used to complete the enucleo-resection. Histo – clear cell RCC with negative margins.
