1新光吳火獅紀念醫院 外科部 泌尿科，2放射科，3輔仁大學醫學院，2台北醫學大學泌尿科
Case report: a giant pseudoaneurysm after robotic-assisted laparoscopic partial nephrectomy
Chao-Yen Ho1, Yi-Chia Lin1,3, Ta-Nien Lu2, Thomas I.S. Hwang1,3,4
1Division of Urology, Department of Surgery, 2Department of Radiology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan, 3School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, 4Department of Urology, Taipei Medical University
Partial nephrectomy (PN) is the standard treatment option for patients with small renal mass, such as clinical T1a to T1b renal tumors. Compared with radical nephrectomy, PN is a more complicated procedure with involvement of both vascular and collecting systems, and complications can occur. The incidence of renal artery pseudoaneurysm(RAP) after PN is between 0.4% and 2%. Minimally invasive procedures, such as laparoscopic or robotic-assisted approaches have a higher incidence of RAP when compared with open PN.
Here we present a 63-year-old male with incidentally finding of a right renal tumor, clinical stage of T1bN0M0. He underwent a robot-assisted laparoscopic partial nephrectomy (RAPN). The patient tolerated the procedure well and was discharged uneventfully. The pathology report showed a papillary renal cell carcinoma, pT1bNxMx, Fuhrman grade II, with a negative surgical margin. However, the patient presented to ER with intermittent gross hematuria aggravated since one month after the operation. Contrast enhanced computerized tomography (CT) scan demonstrated a large pseudoaneurysm of 5 × 4.4 × 3.9 cm in size over the posterior part of the right kidney at the incision site. Transfemoral renal angiography performed by a radiologist demonstrated a huge pseudoaneurysm from the posterior branches of the right renal artery. Selective embolization was performed with coils, glue and gel-foam cubes. The patient tolerated the procedure well and was discharged uneventfully.