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73 Robot-assisted intracorporal radical cystectomy, lymph node dissection, and fully intracorporal ileal conduit reconstruction
videos / european urology supplements 10 (2011) 557–566
71 Technical features of robotic retroperitoneal approach in urological pathology – experience of Robotic Urologic Surgery Center, Cluj-Napoca, Romania I. Coman1 , N. Crisan1 , C.N. Manea1 , C. Neiculescu1 , Y. El Aidi1 , C. Lapusan1 . 1 Robotic Surgery Center, Clinical Municipal Hospital, Cluj-Napoca, Romania Introduction and Objectives: This study wants to evaluate the implementation of retroperitoneal robotical approach in a highly experienced center in laparoscopy and lumboscopic surgical approach. Material and Method: Between November 2009–June 2011, 80 robotic assisted urologic surgeries were performed in our department, 20 of this by retroperitoneal approach: three simple nephrectomy, two partial nephrectomy, three adrenalectomy, 11 pyeloplasty and one nephropexy. We performed a particular surgical approach, which consisted of a triangle placing of the trocars and the placement of the robot at the patient’s head. Results: The retroperitoneal space was prepared in 10 minutes and the insertion of the four trocars took 17 minutes, with an 8 minutes docking. The operating time varied from 50 minutes for simple nephrectomy to 180 minutes for partial nephrectomy. None of the surgeries were converted. The blood loss was minimal. All of the patients recovered the intestinal transit in the first postoperatory day. The hospital length of stay was 48 hours for simple nephrectomy and 5 days for partial nephrectomy. We use triangle placing of the trocars, placement of the robot at patient’s head and in this way we avoid conflict between the robot arms. Conclusions: Although our surgical team has recently started learning and performing the robotic assisted surgery, our previous experience in laparoscopy and retroperitoneoscopy, the triangle arrangement of the trocars and the particular placement of the robotic system facilitated the retroperitoneal robotic approach. 72 Intrafascial nerve sparing robot-assisted laparoscopic radical prostatectomy performed without opening endopelvic fascia A.I. Tasci1 , V. Tugcu1 , A. Bitkin1 . 1 Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey Purpose: In this video we present intrafascial nerve sparing robot-assisted laparoscopic radical prostatectomy performed without opening endopelvic fascia in a patient with localised prostate cancer. Method: 51 years old, male patient, transrectal ultrasound guided biopsy of the prostate, performed for elevated PSA (5.1 ng/ml) revealed prostatic adenocarcinoma with Gleason score 3+3 = 6. DRE (digital rectal examination) was normal, IIEF and PV were 23 and 25cc, respectively. We performed robotassisted laparoscopic radical prostatectomy with transperitoneal approach using 5 ports with 4-arm da Vinci® SI HD system. Results: We did not observe perioperative complications. Operation time and blood loss during the operation were 120 minutes and 110 cc, respectively. Patient was discharged following the removal of drain on postoperative day 2. Urethral catheter was removed on postoperative week 1. Conclusion: Robot-assisted laparoscopic radical prostatectomy is a safe and minimally invasive method in the treatment of patients with localised prostate cancer. Magnification and three-dimensional high definition vision allow the urologist to perform nerve sparing surgery successfully.
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73 Robot-assisted intracorporal radical cystectomy, lymph node dissection, and fully intracorporal ileal conduit reconstruction A. Alexandrov1 , B. Kassabov1 , S. Buse1 . 1 Alfried Krupp Hospital, Department of Urology, Essen, Germany In this video, we describe step-by-step our technique of robot-assisted intracorporal radical cystectomy, lymph node dissection, and fully intracorporal ileal conduit reconstruction in men with muscle-invasive urothelial urinary bladder cancer. This video shows in detail all steps of the procedure from port placement (seven-port transperitoneal approach), over the ablative steps (bladder and prostate resection and pelvic lymph node dissection) to the fully intracorporal robot-assisted ileal conduit reconstruction. 74 Technique of robotic distal ureterectomy C.V. Bishop1 , T. Lane1 , J.M. Adshead1 . 1 Hertfordshire Robotic Centre, Lister Hospital, Stevenage, United Kingdom This video demonstrates the technique of a robotic distal ureterectomy. The patient is an 80 year old man with a 3 cm obstructing right distal ureteric TCC. Due to multiple comorbidities, the patient is not fit for a formal nephroureterectomy. We demonstrate how the da Vinci robot may be used for a minimally invasive solution. 75 Technique of a robotic partial cystectomy for a urachal tumour C.V. Bishop1 , G.B. Boustead1 , J.M. Adshead1 . 1 Hertfordshire Robotic Centre, Lister Hospital, Stevenage, United Kingdom This video demonstrates the technique of a partial cystectomy for a urachal tumour with the da Vinci Robot. Our patient is a 78 year old woman presenting with macroscopic haematuria. CT demonstrates a large urachal mass with no evidence of metastatic disease. Cystoscopic resection of the mass at the dome of the bladder revealed mucinous adenocarcinoma. The patient has ischaemic cardiomyopathy and was not fit for a radical cystectomy. Node dissection was not performed due to the high risk nature of the anaesthetic. The da Vinci Robot offers a minimally invasive option for this patient. 76 Robot-assisted simple prostatectomy M. Gamarra Quintanilla1 , J.G. Pereira Arias1 , A. Leibar Tamayo1 , A. Astobieta Odriozola1 , G. Ibarluzea Gonzalez ´ 1 . 1 Urologia Clinica. Clinica Virgen Blanca. Bilbao. Spain Purpose: Minimally invasive approaches for large symptomatic benign prostatic hyperplasia are replacing the gold standard open surgical approach, duplicating its results with lower morbidity. We describe our initial experience with robotic simple prostatectomy preliminary technique in order to reduce perioperative bleeding, hospital stay and avoid continuous bladder irrigation. Material and Methods: We present in this video a laparoscopic robot-assisted simple prostatectomy. Under general anesthesia and Trendelenburg position, using the 4-arm da Vinci Surgical System, a 6 port transperitoneal approach as in robotic radical prostatectomy was performed. Once entered in Retzius space, anterior surface of the prostate capsule is cleaned of overlying fatty tissue. A transverse capsulotomy incision is performed proximal to bladder neck junction. Adenoma was freed from capsule by dissecting subcapsular plane using a combination of blunt and electrocautery dissection. Urethral transection by direct view is made without electrocautery to preserve rhabdosphincter. Lateral intracapsular stitches were placed with
71 Technical features of robotic retroperitoneal approach in urological pathology – experience of Robotic Urologic Surgery Center, Cluj-Napoca, Romania I. Coman1 , N. Crisan1 , C.N. Manea1 , C. Neiculescu1 , Y. El Aidi1 , C. Lapusan1 . 1 Robotic Surgery Center, Clinical Municipal Hospital, Cluj-Napoca, Romania Introduction and Objectives: This study wants to evaluate the implementation of retroperitoneal robotical approach in a highly experienced center in laparoscopy and lumboscopic surgical approach. Material and Method: Between November 2009–June 2011, 80 robotic assisted urologic surgeries were performed in our department, 20 of this by retroperitoneal approach: three simple nephrectomy, two partial nephrectomy, three adrenalectomy, 11 pyeloplasty and one nephropexy. We performed a particular surgical approach, which consisted of a triangle placing of the trocars and the placement of the robot at the patient’s head. Results: The retroperitoneal space was prepared in 10 minutes and the insertion of the four trocars took 17 minutes, with an 8 minutes docking. The operating time varied from 50 minutes for simple nephrectomy to 180 minutes for partial nephrectomy. None of the surgeries were converted. The blood loss was minimal. All of the patients recovered the intestinal transit in the first postoperatory day. The hospital length of stay was 48 hours for simple nephrectomy and 5 days for partial nephrectomy. We use triangle placing of the trocars, placement of the robot at patient’s head and in this way we avoid conflict between the robot arms. Conclusions: Although our surgical team has recently started learning and performing the robotic assisted surgery, our previous experience in laparoscopy and retroperitoneoscopy, the triangle arrangement of the trocars and the particular placement of the robotic system facilitated the retroperitoneal robotic approach. 72 Intrafascial nerve sparing robot-assisted laparoscopic radical prostatectomy performed without opening endopelvic fascia A.I. Tasci1 , V. Tugcu1 , A. Bitkin1 . 1 Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey Purpose: In this video we present intrafascial nerve sparing robot-assisted laparoscopic radical prostatectomy performed without opening endopelvic fascia in a patient with localised prostate cancer. Method: 51 years old, male patient, transrectal ultrasound guided biopsy of the prostate, performed for elevated PSA (5.1 ng/ml) revealed prostatic adenocarcinoma with Gleason score 3+3 = 6. DRE (digital rectal examination) was normal, IIEF and PV were 23 and 25cc, respectively. We performed robotassisted laparoscopic radical prostatectomy with transperitoneal approach using 5 ports with 4-arm da Vinci® SI HD system. Results: We did not observe perioperative complications. Operation time and blood loss during the operation were 120 minutes and 110 cc, respectively. Patient was discharged following the removal of drain on postoperative day 2. Urethral catheter was removed on postoperative week 1. Conclusion: Robot-assisted laparoscopic radical prostatectomy is a safe and minimally invasive method in the treatment of patients with localised prostate cancer. Magnification and three-dimensional high definition vision allow the urologist to perform nerve sparing surgery successfully.
559
73 Robot-assisted intracorporal radical cystectomy, lymph node dissection, and fully intracorporal ileal conduit reconstruction A. Alexandrov1 , B. Kassabov1 , S. Buse1 . 1 Alfried Krupp Hospital, Department of Urology, Essen, Germany In this video, we describe step-by-step our technique of robot-assisted intracorporal radical cystectomy, lymph node dissection, and fully intracorporal ileal conduit reconstruction in men with muscle-invasive urothelial urinary bladder cancer. This video shows in detail all steps of the procedure from port placement (seven-port transperitoneal approach), over the ablative steps (bladder and prostate resection and pelvic lymph node dissection) to the fully intracorporal robot-assisted ileal conduit reconstruction. 74 Technique of robotic distal ureterectomy C.V. Bishop1 , T. Lane1 , J.M. Adshead1 . 1 Hertfordshire Robotic Centre, Lister Hospital, Stevenage, United Kingdom This video demonstrates the technique of a robotic distal ureterectomy. The patient is an 80 year old man with a 3 cm obstructing right distal ureteric TCC. Due to multiple comorbidities, the patient is not fit for a formal nephroureterectomy. We demonstrate how the da Vinci robot may be used for a minimally invasive solution. 75 Technique of a robotic partial cystectomy for a urachal tumour C.V. Bishop1 , G.B. Boustead1 , J.M. Adshead1 . 1 Hertfordshire Robotic Centre, Lister Hospital, Stevenage, United Kingdom This video demonstrates the technique of a partial cystectomy for a urachal tumour with the da Vinci Robot. Our patient is a 78 year old woman presenting with macroscopic haematuria. CT demonstrates a large urachal mass with no evidence of metastatic disease. Cystoscopic resection of the mass at the dome of the bladder revealed mucinous adenocarcinoma. The patient has ischaemic cardiomyopathy and was not fit for a radical cystectomy. Node dissection was not performed due to the high risk nature of the anaesthetic. The da Vinci Robot offers a minimally invasive option for this patient. 76 Robot-assisted simple prostatectomy M. Gamarra Quintanilla1 , J.G. Pereira Arias1 , A. Leibar Tamayo1 , A. Astobieta Odriozola1 , G. Ibarluzea Gonzalez ´ 1 . 1 Urologia Clinica. Clinica Virgen Blanca. Bilbao. Spain Purpose: Minimally invasive approaches for large symptomatic benign prostatic hyperplasia are replacing the gold standard open surgical approach, duplicating its results with lower morbidity. We describe our initial experience with robotic simple prostatectomy preliminary technique in order to reduce perioperative bleeding, hospital stay and avoid continuous bladder irrigation. Material and Methods: We present in this video a laparoscopic robot-assisted simple prostatectomy. Under general anesthesia and Trendelenburg position, using the 4-arm da Vinci Surgical System, a 6 port transperitoneal approach as in robotic radical prostatectomy was performed. Once entered in Retzius space, anterior surface of the prostate capsule is cleaned of overlying fatty tissue. A transverse capsulotomy incision is performed proximal to bladder neck junction. Adenoma was freed from capsule by dissecting subcapsular plane using a combination of blunt and electrocautery dissection. Urethral transection by direct view is made without electrocautery to preserve rhabdosphincter. Lateral intracapsular stitches were placed with