Simultaneous Robot-Assisted Surgical Treatment of a Patient with an Abdominal Aortic Aneurysm and a Right Renal Tumor

Objective : Surgical treatment of patients with concomitant cardiovascular disease, abdominal aortic aneurysm, and renal tumor presents a significant clinical challenge due to the increased complexity of procedures. The use of simultaneous surgical treatment employing robotic technologies represents a minimally invasive and optimal approach that reduces the risks of intraoperative and postoperative complications and positively influences therapeutic outcomes. Clinical case : Patient M., 73 years old, was admitted for elective surgical treatment to the Department of Vascular Surgery at the State Budgetary Healthcare Institution “Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1” in April 2025. According to the medical history, in October 2024, he experienced an episode of ischemic stroke in the territory of the anterior cerebral artery (October 20, 2024), resulting in an ischemic lesion in the right cerebral hemisphere (parietal and frontal lobes). In December 2024, he was hospitalized in the Department of Vascular Surgery, where multislice computed tomography (MSCT) revealed critical bilateral stenosis of the internal carotid arteries. Subsequently, the patient underwent staged procedures (December 26, 2024 and January 24, 2025): glomus-sparing carotid endarterectomies of the left and right common, external, and internal carotid arteries, respectively. MSCT performed on December 2, 2024, also revealed an abdominal aortic aneurysm without signs of dissection or rupture, classified as a type 2 according to A.V. Pokrovsky’s classification, as well as a right renal tumor. Following a multidisciplinary consultation involving cardiovascular surgeons, urologists, anesthesiologists-intensivists, interventional radiologists, and cardiologists, a combined robot-assisted surgical treatment was considered. Due to the specific anatomy of the aneurysm neck, the endovascular techniques for correcting abdominal aortic aneurysm was impossible. The patient was recommended to undergo a simultaneous robot-assisted procedure, including resection the aneurysmal segment of the aorta, implantation of an aortic graft, and nephrectomy with tumor removal. The surgery was performed in April 2025. The total duration of the procedure was 370 minutes, with an estimated intraoperative blood loss of approximately 200 mL. The patient was extubated 120 minutes after completion of the operation directly on the operating table and was subsequently transferred to the intensive care unit. On the second postoperative day, the patient was mobilized and transferred from the intensive care unit to a general ward. By the eighth postoperative day, he was stabilized, and discharged home in stable condition. Histopathological examination confirmed a diagnosis of highly differentiated clear cell renal cell carcinoma, nuclear grade 1, with complete excision achieved within the boundaries of healthy tissue.