Robotic-Assisted Right Radical Nephrectomy for a Large Renal Mass: A Case Outcome

Patient Details
Age/Sex: 50-year-old male
Diagnosis: Right Renal Mass (cT3a)
Comorbidities: None

Overview

The patient presented with right flank pain and hematuria for 10 days. Abdominal examination was unremarkable, with a soft, non-tender abdomen and no palpable mass.
Ultrasound revealed a heterogeneous mass measuring 4.6 × 4.5 cm arising from the mid and lower pole of the right kidney with internal vascularity. The right renal vein appeared involved, with no extension into the IVC.
PET CT scan showed a 56 × 62 × 54 mm, well-marginated, mildly FDG-avid soft tissue lesion arising from the anterior/lateral interpolar cortex of the right kidney, with perirenal extension, subtle perifocal fat stranding, and infiltration of the underlying renal pelvis.
Adjacent liver, duodenum, and colon were uninvolved, and no metastatic disease was detected elsewhere.

Why Robotic Surgery Was Chosen

Robotic surgery was selected for better cancer control, reduced warm ischemia time, minimal surrounding tissue injury, and faster recovery with less pain.

Surgery Performed: Robotic-Assisted Right Radical Nephrectomy

Key Steps and Robotic Advantages:

• 3D visualization and precision for a large, difficult-to-access posterior mid-pole renal
  mass
• Minimally invasive approach: Four 8 mm robotic ports and two assistant ports (5 mm and 10 mm)
• Operative time: 2 hours 10 minutes
• Estimated blood loss: 20 mL

Postoperative Outcomes

• Hospital stay: Discharged on postoperative day 4
• Pain management: Oral analgesics twice daily for 6 days; returned to normal activity from postoperative day 1
• Short-term functional outcomes: No complications; full recovery by postoperative day 2

Key Takeaways / Learning Points

• Clinical significance: Robotic surgery provides excellent oncological control, reduced warm ischemia time, minimal tissue damage, less pain, and faster recovery, even in large renal masses.
• Lessons learned: Large renal masses can be safely and effectively managed with robotic-assisted surgery, achieving favorable oncological and functional outcomes.