Panel discussion of clinical cases on localized RCC with focus on partial nephrectomy and ischemia techniques
Case Presenter: Riccardo Campi (Florence, Italy)
Panel: Geert De Naeyer (Aalst, Belgium), Karim Touijer (New York, US), Thomas Lynch (Dublin, Ireland)
After brainstorming on the contemporary key topics in partial nephrectomy (PN) from a surgical point of view, the panel discussed 3 real-life clinical cases:
- A case of elective PN for a highly complex renal mass in a patient with preserved baseline renal function and two kidneys;
- A case of imperative PN for a highly complex renal mass in a patient with single kidney and preoperative chronic kidney disease;
- A case of robotic PN for a complex T3a renal mass with tumour thrombosis extending into a renal vein branch.
The session concluded with a panel discussion on the current techniques employed by surgeons to minimize ischemia during partial nephrectomy with a special emphasis on different selective clamping strategies (e.g. use of intraoperative duplex ultrasound, 3D models and fluorescence vascular imaging).
The cases allowed an interactive discussion on key aspects of PN techniques such as:
- Technical / oncological limits of PN
- Decision-making regarding partial vs radical nephrectomy in patients with highly complex renal masses
- Intraoperative decision-making in case of infraction of the tumour during excision
- Role of preoperative and/or postoperative nephrological consultation in patients with preoperative chronic kidney disease (CKD) who are eligible for PN
- Management of severe postoperative complications after PN
- Safety of PN in case of tumour thrombosis
- Impact of 3D models and extended-reality technologies on PN planning
- Surgeon factors influencing PN outcomes
- Surgical approach and access (trans- vs retro) for PN
- Strategies and techniques for tumour excision (enucleation vs minimal-margin PN)
- Ischemia techniques (off-clamp vs on-clamp, selective clamping, etc.)
- Strategies and techniques for renorrhaphy
- Nephrometry scores for PN planning
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