Robotic-Assisted Partial Nephrectomy in a Solitary Kidney in a von Hippel-Lindau Renal Cell Carcinoma.
Mahmoud Farzat, Ibrahim Al-Taie, Florian M Wagenlehner
✦ AI-curated · Sources linked
Case in brief
A 37-year-old man with von Hippel-Lindau disease and a solitary right kidney after left radical nephrectomy had three progressive clear cell renal cell carcinoma lesions, the largest 4.8 cm, despite belzutifan. Transperitoneal robotic-assisted partial nephrectomy revealed a fourth tumor; all were excised with negative margins. Severe postoperative acute kidney injury required continuous renal replacement therapy, and he also developed forearm necrosis from calcium-substitution extravasation and a right pneumothorax. With intensive care and pleural drainage, renal function recovered sufficiently to stop renal replacement therapy on postoperative day 8.
What made this case unusual
A fourth tumor was discovered intraoperatively, and the nephrectomy in a solitary kidney was followed by severe acute kidney injury requiring temporary renal replacement therapy, alongside complications including forearm necrosis from calcium-substitution extravasation.
Diagnostic / clinical pearl
In VHL-associated multifocal renal tumors, preoperative imaging may not identify every lesion; intraoperative assessment can reveal additional tumors. Partial nephrectomy may achieve excision with negative margins, but severe postoperative kidney injury can require temporary renal replacement therapy.