# Retroperitoneoscopic robot-assisted laparoscopic partial nephrectomy during the second trimester of pregnancy: a case report and literature review

## TL;DR

A rare case of kidney cancer during pregnancy was successfully treated with a robotic surgery that preserved the kidney and ensured a safe birth.

## Contribution

Demonstrates the safety and effectiveness of retroperitoneoscopic robot-assisted partial nephrectomy during the second trimester of pregnancy.

## Key findings

- rRAPN was successfully performed at 26 weeks of gestation without complications.
- The patient delivered a healthy baby at 38 weeks, confirming the procedure's perinatal safety.
- rRAPN is a viable option for treating gestational renal tumors when carefully planned.

## Abstract

The incidental discovery of renal tumors during pregnancy necessitates a tailored treatment that carefully balances the health and well-being of both the mother and the developing fetus.

The patient accidentally found a renal mass on abdominal ultrasound in the second trimester, and following MRI diagnosed cT1bN0M0 renal cancer. Following a multidisciplinary consultation and taking into account the patient's clinical status and preferences, retroperitoneoscopic robot-assisted laparoscopic partial nephrectomy (rRAPN) was successfully performed at 26 weeks of gestation. The procedure was completed without any postoperative complications and clear cell renal cell carcinoma was confirmed by histopathology. The postoperative recovery of the patient was uneventful and the baby was born safely at 38 weeks of gestation.

Gestational renal tumor is usually detected by routine antenatal ultrasonography incidentally without any typical symptoms, of which 50 % are malignant. The clinical decision-making process poses significant challenges, necessitating meticulous risk-benefit analysis to balance tumor control efficacy with perinatal safety. The two principal surgical approaches for renal tumor resection are the transperitoneal and retroperitoneoscopic routes, with selection guided by tumor location, surgeon expertise, and patient-specific anatomical considerations.

rRAPN is safe and effective in the second trimester. Personalized treatment should be made for each gestational RCC by a multidisciplinary team.

•The incidence of renal tumors during pregnancy is rare.•A tailored treatment that carefully balances the health and well-being of both the mother and the developing fetus.•Retroperitoneoscopic robot-assisted partial nephrectomy is safe and effective in the second trimester.

The incidence of renal tumors during pregnancy is rare.

A tailored treatment that carefully balances the health and well-being of both the mother and the developing fetus.

Retroperitoneoscopic robot-assisted partial nephrectomy is safe and effective in the second trimester.