Robot-assisted radical nephrectomy (RARN) is a standard procedure in urology that can occasionally lead to severe intraoperative complications, highlighting the importance of precise anatomical identification and careful vascular management. This case study describes a 45-year-old woman undergoing RARN for a rapidly expanding Bosniak IV complex cyst in her left kidney. The patient had prior medical history of multiple sclerosis and breast cancer, adding to her surgical complexity. During surgery, while isolating the left renal vascular pedicle, the surgical team inadvertently clipped what was initially thought to be the left renal artery, which was actually the Superior Mesenteric Artery (SMA), a major vessel supplying the intestines.
Upon realizing the mistake, the surgeons quickly took action to remove the clip using laparoscopic scissors, as no specific clip-removal device was available. The SMA was only closed off for a brief period (40 minutes), and fortunately, it sustained no permanent damage. The total operative time was 160 minutes, and the patient’s postoperative recovery proceeded smoothly, with bowel function returning by day three and discharge on day five. Follow-up at nine months revealed no recurrence of the kidney tumor and no gastrointestinal complications, marking a successful outcome.
This case highlights several crucial points in robotic-assisted urological surgery. First, it underscores the need for meticulous vascular pedicle isolation and proper identification of renal vessels, particularly in cases with unusual anatomy. Second, it shows that prompt recognition and careful management of surgical errors can prevent catastrophic outcomes. Finally, it demonstrates that tools like ultrasound could further enhance anatomical accuracy, reducing risks in complex cases. By prioritizing thorough vascular assessment and using ultrasound guidance, surgical teams can improve safety and mitigate risks in robotic kidney surgeries.
