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110
29
th
CONGRESS OF THE ESPU
08:24–08:29
S13-5 (VP)
ROBOT-ASSISTED LAPAROSCOPIC
NEPHROURETERECTOMY FOR WILMS' TUMOR :
PRELIMINARY RESULTS
Thomas BLANC
1
, Luca PIO
1
, Yves HELOURY
1
, Daniel ORBACH
2
, Véronique
MINARD-COLIN
3
, Pauline CLERMIDI
1
and Sabine SARNACKI
1
1) Hôpital Necker - Enfants Malades, Department of Pediatric Surgery and Urology, Paris, FRANCE - 2) Institut Curie,
Centre oncologie SIREDO (soins, innovation, recherche autour des tumeurs de l'enfant, l'adolescent e, Paris, FRANCE
- 3) Gustave-Roussy, Département de cancérologie de l'enfant et l'adolescent, Villejuif, FRANCE
PURPOSE
The role of minimally invasive surgery for the treatment of Wilm’s tumors has been limited to pioneer
groups.
The purpose of this prospective study is to present the preliminary results of robot-assisted laparo-
scopic (RAL) nephrectomy for Wilms’ tumor in the first year of a robotic program.
MATERIAL AND METHODS
Children with unilateral non-metastatic Wilms’ tumor were preoperatively treated according to the
SIOP 2001 protocole, and afterwards were submitted to RAL nephrectomy and lymph node sam-
pling. A four-trocar transperitoneal approach was used. The tumor was extracted inside a plastic
bag and without morcellation through a Pfannenstiel incision.
RESULTS
4 children underwent right RAL nephrectomy at a mean age of 4.6 years (3.7–5.2).
The first patient was converted due to renal vein injury. The third patient had a misdiagnosed renal
vein tumor thrombus found during the procedure. The nephrectomy was performed with the RAL
technique. The thrombus could not be treated robotically, with conversion to open procedure.
In all patients the tumor was completely removed, as well as lymph node samples and no ruptures
occurred.
The staging was: 2 stage I; 1 stage 2, 1 stage III (lymph nodes involvement). Three patients had
a standard histology and 1 a diffuse anaplasia.
The postoperative course was free of complications and all the patients were discharged from
day 2 to day 7. No recurrences or long-term complications have been detected in 1–10 months of
follow-up.
CONCLUSIONS
RAL nephrectomy for Wilms’ tumor is a feasible and safe procedure in a selected group of children
after chemotherapy. It reproduces all the steps of the open surgical approach required to treat the
tumor in order to maintain an excellent oncological result, with the advantages of a short hospital
stay and cosmetically more acceptable incisions.