Performing a re-do renal surgery in those patients who have already undergone partial nephrectomy presents a unique and challenging scenario. It necessitates careful consideration of several factors, including the anatomical changes resulting from the previous surgery and management of potential complications. Here we present a case of robot-assisted partial nephrectomy for a right renal tumour post laparoscopic right partial nephrectomy. We demonstrated another case of a complex recurrent renal mass in the right kidney detected eight years after the partial nephrectomy, who underwent robot-assisted radical nephrectomy.

1. A 66-year-old diabetic hypertensive dyslipidemic male presented with a right lower polar mass. He had a h/o laparoscopic right partial nephrectomy six months back for two renal masses in the same kidney, a 3.4 x 2.8 cm upper polar mass and another 2.5 x 2.6 cm lower polar mass. Robotic assisted right partial nephrectomy was done. The operating time, console time and warm ischemia time were 156 minutes, 116 minutes and 24 minutes, respectively. The blood loss was 100 ml. On histopathology, it was a clear cell carcinoma, pT1a, WHO/ISUP grade III with all margins negative. 2. A 63-year-old hypertensive male with a h/o laparoscopic right partial nephrectomy eight years back from other hospital for a right upper pole renal cell carcinoma, with Fuhrman grade III, and a clear surgical margin of four mm. He now presented with right flank pain with a right kidney mass measuring 4.5 cm arising from posterior mid pole close to the hilum, suggestive of recurrence. Adding to the complexity was the anatomical variations including one accessory right renal artery and retro aortic left renal vein. Robot assisted right radical nephrectomy was done. We encountered dense desmoplastic reaction. The right renal vein was injured and a small rent was made in the diaphragm inadvertently which were managed properly. The operating time, and the console time were 164 minutes, and 126 minutes, respectively. The blood loss was 200 ml. On histopathology, it was a clear cell carcinoma, pT1a, WHO/ISUP grade II with all margins negative.

Both the patients had uneventful postoperative recovery. They were discharged w=on postoperative day-3. Both of them are doing well without any clinical and radiological evidence of the disease and have completed one-year follow-up.

Both partial and radical nephrectomy following prior partial nephrectomy pose a peculiar challenge with anticipation of post operative anatomical changes and possible complications. In such complex situations, robot assisted minimally invasive surgery offers several advantages like enhanced precision allowing meticulous dissection improved visualisation, greater dexterity to surgeon and reduced blood loss. Patient experiences shorter hospital stay, early recovery and early return to normal activity.