Robotic-Assisted Partial Nephrectomy in a High-Risk Elderly Patient

Lead Surgeon: Dr. Devendra Sharma
Director – Department of Urology & Renal Transplant
CK Birla Hospitals, Jaipur
Dr. Devendra Sharma is credited with performing the first robotic kidney transplant in Rajasthan, a landmark achievement in the state’s medical history.

Patient Profile

A 72-year-old female presented to the outpatient department with mild, intermittent left flank pain for three months. An ultrasound performed during evaluation incidentally detected a mass in the right kidney. The patient was a known case of hypertension for six years and had a prior surgical history of left laparoscopic-assisted partial nephrectomy in 2014 for angiomyolipoma.

Diagnostic Evaluation

Contrast-enhanced CT urography revealed a 4 × 3.3 × 3.2 cm heterogeneously enhancing mass arising from the anterior aspect of the mid-pole of the right kidney, causing compression over the renal pelvis and renal vein. The right kidney demonstrated dual arterial supply, with no evidence of renal vein involvement. The left kidney appeared shrunken with a scarred outline, along with a 10 mm calculus in the lower calyx. Routine blood investigations were within normal limits.
Given the patient’s advanced age, previous renal surgery, compromised contralateral kidney, and tumour complexity, the case was categorised as high risk, where nephron preservation was of paramount importance.

Treatment Strategy

Following multidisciplinary evaluation, the patient was planned for a robotic-assisted partial nephrectomy under the leadership of Dr. Devendra Sharma. The primary objective was complete tumour excision while preserving maximum renal function. The robotic approach was selected due to its advantages in precision, control, and suitability for complex renal anatomy.

Robotic Platform Advantages

The robotic surgical platform offered significant advantages in this case, including:

• High-definition 3D magnified vision for accurate tumour delineation
• Superior instrument articulation enabling meticulous dissection and intracorporeal suturing
• Enhanced vascular control, particularly important due to dual arterial supply
• Nephron-sparing capability, crucial in a patient with limited renal reserve

These advantages contributed to improved surgical precision, reduced operative risk, and favourable functional outcomes.

Surgical Outcome

The tumour was excised successfully with clear margins. Renorrhaphy was completed efficiently with optimal warm ischemia time and minimal blood loss. The patient had an uneventful postoperative recovery, maintained stable renal function, and was discharged in stable condition. She continues to do well on follow-up.

Conclusion

This case underscores the effectiveness of robotic-assisted nephron-sparing surgery in managing complex renal tumours, especially in elderly patients with compromised renal function. Advanced robotic technology, combined with experienced surgical leadership, enables safe, precise, and kidney-preserving outcomes, reinforcing its role in modern urological and renal transplant practice.