AB002. 221. Robotic radical nephrectomy during pregnancy: case report and review of the literature

Background: To report a case of robotic radical nephrectomy (RRN) during pregnancy and review the existing literature on the topic.

Methods: A 36-year-old pregnant woman at 18 weeks gestation was found to have a large 10 cm mass in the left kidney during ultrasound assessment of kidneys for hypertension. Limited contrast CT scan demonstrated a 10-cm right solid-enhancing mass involving lower half of left kidney. Radiologically the lesion was highly suspicious of renal cell carcinoma without evidence of local extension or metastases. After counselling the patient elected to proceed with RRN. A multidisciplinary approach was undertaken perioperatively. Coordination between obstetrics, anesthesia, and urology were vital to this undertaking. We describe operative details and our technique in video.

Results: The patient was seen and assessed by obstetrician preoperatively. Fetal heart tones were monitored immediately before and after surgery and each day of hospitalization. Total operating time was 160 minutes with an estimated blood loss of less than 100 cc. The patient’s creatinine and hemoglobin did not change significantly during operation. She was discharged on postoperative day 4 in excellent condition.

Conclusions: RRN during pregnancy is feasible but requires perioperative planning, multidisciplinary coordination, and careful operative decision-making to ensure optimal safety of mother and fetus. Herein, we report the first described case of RRN for renal neoplasm during pregnancy.

Keywords: Pregnancy; hypertension; robotic; radical nephrectomy