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Resumen Introduccion y objetivo El manejo de tumoraciones renales ≤ 4 cm en poblacion anciana o con comorbilidades supone un reto, constituyendo las terapias ablativas una alternativa interesante. El objetivo es evaluar la radiofrecuencia percutanea en el tratamiento de masas renales pequenas en nuestro centro, las complicaciones asociadas y los resultados obtenidos. Material y metodos Evaluacion retrospectiva de las radiofrecuencias realizadas entre abril de 2010 y abril de 2020 en nuestro centro. Se revisaron datos demograficos, comorbilidades asociadas, caracteristicas tumorales, complicaciones y resultados oncologicos y funcionales. Resultados Se trataron 57 tumores en 53 pacientes. Seguimiento medio de 48,2 meses. Se obtuvo un 89,5% de ablaciones completas. Hubo un 19,3% de complicaciones. Fueron catalogadas como mayores un 3,5% y un 5,3% segun Clavien-Dindo y SIR. Se encontro asociacion estadisticamente significativa entre el resultado inicial de la ablacion y la edad (p = 0,047), el score RENAL modificado (RENAL-m) (p = 0,044), la presencia de componente quistico (p = 0,049) y el tamano tumoral (p = 0,01). El punto de corte de tamano quedo establecido en 25 mm (p = 0,012). En el analisis multivariante, unicamente el tamano permanecio como predictor de resultado inicial de ablacion (p = 0,01; OR 1,183; IC 95% 1,041-1,345). La supervivencia cancer especifica y supervivencia libre de recurrencia a cinco anos fueron del 98,1% y del 89,5% respectivamente. Se observo una disminucion media del MDRD-4 de 6,59 mL/min (p = 0,005) en los seis primeros meses tras radiofrecuencia (RFA). Conclusiones Dados los excelentes resultados oncologicos y funcionales demostrados, la radiofrecuencia percutanea guiada por ecografia es una terapia eficaz y segura en el tratamiento de masas renales pequenas en pacientes seleccionados.

Introduction and objective The management of renal tumors ≤4 cm in elderly population or patients with comorbidities is a challenge, for which ablative therapies are an interesting alternative. The objective is to evaluate in our center the role of percutaneous radiofrequency in the treatment of small renal masses, the associated complications and the results obtained. Material and methods Retrospective evaluation of the radiofrequency treatments carried out between April 2010 and April 2020 in our center. Demographic data, associated comorbidities, tumor characteristics, complications and oncological and functional outcomes were reviewed. Results Fifty-seven tumors were treated in 53 patients. Mean follow-up of 48.2 months. The percentage of complete ablations obtained was of 89.5%. There were 19.3% of complications. According to Clavien-Dindo and SIR classification systems, 3.5% and 5.3% were major complications. A statistically significant association was found between the initial result of ablation and age (p = 0.047), RENAL-m (p = 0.044), the presence of cystic component (p = 0.049) and tumor size (p = 0.01). The cut-off point for size was established at 25 mm (p = 0.012). In multivariate analysis, only size remained as a predictor of initial ablation result (p = 0.01 OR = 1.183 CI 95% = 1.041–1.345). Cancer-specific survival and 5-year recurrence-free survival were 98.1% and 89.5%, respectively. A mean decrease of MDRD-4 of 6.59 mL/min (p = 0.005) was observed in the first 6 months after RFA. Conclusions Given the excellent oncological and functional results demonstrated, ultrasound-guided percutaneous radiofrequency ablation is an effective and safe treatment for small renal masses in selected patients.

Resumen Objetivo Describir nuestra experiencia en los primeros casos de cirugias urologicas realizadas mediante el puerto unico robotico da Vinci. Material y metodos Se realizaron 5 cirugias roboticas por puerto unico (R-LESS) entre mayo y octubre de 2014. Se realizaron 3 reimplantes ureterales, una ureteropieloplastia en un rinon invertido y una nefrectomia parcial. Se recogieron los resultados peri- y postoperatorios asi como un informe de las complicaciones segun la clasificacion de Clavien. Resultados De los 5 procedimientos, 4 se realizaron completamente por LESS, mientras que uno se reconvirtio a cirugia robotica multipuerto. No hubo complicaciones intraoperatorias. Se observaron complicaciones perioperatorias en 4 pacientes, siendo todas de grado 1 o 2. El tiempo operatorio medio fue de 262 min (rango 230-300). Discusion En nuestra experiencia inicial con el dispositivo da Vinci, la cirugia R-LESS es factible y segura. Persisten algunas limitaciones en su uso, que requieren de nuevas plataformas R-LESS mejoradas.

To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform.We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system.Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262minutes (range, 230-300).In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms.