AB003. SOH26AB_0223. Robotic adhesiolysis and complex partial nephrectomy in a hostile abdomen 4-week post-left hemicolectomy: a case report

Background: Concurrent presentation of a left renal tumour and descending colon carcinoma presents a unique challenge surgically with regards to the timing of surgery, and the condition of the abdomen after a hemicolectomy.

Case Description: A 68-year-old man underwent a computed tomography (CT)-renal triphasic confirming a 3.4 cm left lower pole exophytic mass as well as a 6 mm left ureteric calculus, subsequently underwent a robotic left hemicolectomy and omentopexy. He was counselled on robotic partial nephrectomy. In this video, we exhibit the surgical technique using a transperitoneal approach. We did a ureteroscopic laser fragmentation of the stone and JJ stent insertion, followed by robotic adhesiolysis and left partial nephrectomy. Due to the location of the tumour, a transperitoneal approach was chosen on the Da Vinci Xi platform. Dense adhesions in the left upper and lower abdomen were managed with meticulous robotic adhesiolysis, allowing safe exposure of the kidney and isolation of the tumour. The renal mass was excised with macroscopic negative margins. The duration of surgery was 200 minutes with an estimated blood loss of 100 mL. Recovery was uneventful. The JJ stent was removed after 3 weeks. His renal function remains stable post-operatively.

Conclusions: Robotic nephron-sparing surgery is a safe option for patients in the early post-hemicolectomy period, given that a multidisciplinary approach is taken and surgical planes are somewhat preserved in the index procedure despite having a hostile abdomen in the subsequent procedure.

Keywords: Adhesiolysis; colorectal cancer; kidney cancer; robotic surgery; case report