VM43 - Simultaneous Robotic Right Nephrectomy and Right Colectomy for Concurrent Renal Cell Carcinoma and an Ascending Colon Mass

Purpose/Background: Synchronous primary malignancies are rare, with the incidence of synchronous colorectal and renal cancers estimated at 0.03-0.5%. Previous case series and reports describe simultaneous robotic operations to treat synchronous cancers, which expedites treatment and avoids a second operation. However, surgical approaches, including the use of port-sharing, are not standardized. We present a case of a patient with concurrent right renal cell carcinoma (RCC) and an ascending colon mass treated with simultaneous Xi robotic right nephrectomy and right colectomy using shared ports without the need for robot retargeting.

Methods/Interventions: A 78-year-old man with history of left nephrectomy for RCC and dialysis dependent end-stage-renal disease was diagnosed with an endoscopically unresectable >5cm polypoid mass of the right colon. Biopsy showed tubular adenoma. CT scan demonstrated a right renal mass concerning for RCC. PET scan demonstrated no metastatic disease. After medical optimization and multidisciplinary discussions, the patient underwent a simultaneous robotic right nephrectomy and right colectomy.

The patient was positioned in the left lateral decubitus position. The table was positioned 15 degrees right side down. Four robotic trocars were positioned in a soft hockey stick configuration: an 8mm at Palmer’s point, 12mm in the left mid abdomen, 8mm in the left lower quadrant and an 8mm in the hypogastrium, just right of midline. The robot was targeted to the hepatic flexure and the camera was placed in arm 2, the left lower quadrant port. This positioning facilitated a complete lateral to medial mobilization of the right colon. After right colon resection with high ligation of the ileocolic pedicle, the urology team performed a right nephrectomy. They placed an additional 8mm robotic trocar near the epigastric midline. The camera was repositioned through this trocar and attached to arm 3. The table was repositioned left side down. The original 12mm port was used as an assist port through which the stapler was used to transect the renal artery and vein. Once the kidney was free, the bed and arm 3 were returned to the original configuration for the isoperistaltic side-to-side stapled ileocolic anastomosis. Both specimens were removed through a left upper abdominal transverse incision via extending the 12mm port site incision.

Results/Outcomes: Total operative time was 380 minutes, of which the robotic console time was 245 minutes. The patient recovered well without complications. Bowel function returned on post operative day two and he was discharged home on post-operative day three. Final pathology demonstrated a large tubular adenoma of the right colon without invasive carcinoma and renal cell carcinoma of the right kidney.

Conclusion/Discussion: This case demonstrates simultaneous robotic ipsilateral nephrectomy and hemicolectomy for synchronous renal and colorectal malignancy is safe and technically feasible. A collaborative approach between colorectal and urological surgeons can facilitate the use of shared ports, minimize the need for robotic redocking and potentially reduce total operative time.