Hand-assisted retroperitoneoscopic radical nephrectomy

v34

v33 ROBOT

ASSISTED

RETROPERITONEAL

KIDNEY TRANSPLANTATION

Hoznek A., Gettman M., Antiphon Lobontiu A.. Abbou C.

P., De la Taille A., Salomon

L., Saint F.,

LAPAROSCOPIC

Katz R., Hoznck A., Antiphon

PYELOPLASTY

P., Borkowski

T’., De la Taille A., Salomon L..

Abbou C. CHU Henri Mondor, Service d’urologie,

Crt%eil, France CHU Henri Mondor, Service d’urologie,

INTRODUCTION & OBJECTIVES: Robotic technology has a long established role in several fields of industry. One advantage of robots is their ability to place humans at a safe distance from hazardous material. In urology, in addition to dexterity enhancement and motion scaling, this new technology opens the horizon of remote surgery. This latter advancement has potential use during surgery involving a high risk of patient-to-professional or professlonalto-patient virus transmission. This film presents the first case of robotic assisted kidney transplantation.

INTRODUCTION

obstruction.

With the introduction

transperitoneal functional

Operative time was 178 minutes. Robotic assistance made possible by its unique ability of stereoscopic magnification and suturing techniques due to the flexibility of the robotic wristed Renal perfusion was excellent with immediate diuresis.

CONCLUSIONS: This initial experience demonstrates that robotic assisted kidney transplantation is feasible. Currently technical and financial barriers limit the widespread use of robots. However, with advancea in miniaturization, computer technology and high-speed data transmission the routine use of telerobotics will likely be added to the surgical armamentarium within the next decades.

laparoscopic

results.

Open pyeloplasty

has been performed

using an extraperitoneal

junction

we have

performing

approach.

The second case illustrates

due to a crossing

pyeloplasty

techmque,

approach,

5 trocars

a right-sided

vessel. Both cases were

with associated

the aberrant artery in the second case. Our laparoscopic extraperitoneal

with excellent been

This tilm presents two cases. The first patlent

obstruction

treated with dismembered

junction

into the field of urology

the last few years

TECHNIQUE:

has been considered

of ureteropelvic

of laparoscopy

had a severe left sided hydronephrosis. ureteropelvic

treatment

pyeloplasty

During

pyeloplasty

OPERATIVE

purely RESULTS: anastomosis ultra-precise instruments.

& OBJECTIVES:

for a long time as the gold standard

laparoscopic MATERIAL & METHODS: A right cadaveric kidney was transplanted into a 26-year-old male patient who has been on haemodialysis for 11years. Surgery was done with the help of the Da Vinci robot (Intuitive Surgical, Inc., Mountain View, California) by a remote surgeon, who completely performed vascular dissection and anastomosis as well as ureterovesical anastomosis. The role of the assistant by the side of the patient was limited to access creation, exposure, hemostasis and maintaining traction on the running sutures performed by the robot.

CrCteil, France

uncrossing

technique

arc used. (Two in the posterior

axlllary line for the primary surgeon, one in the median axillary lint just above the iliac crest for the camera, and two trocars In the anterior axillary line for the assistant).

CONCLUSIONS:

We find that the retroperitoneal

approach to the proximal of various

anatomic

laparoscopic

route

offers

ureter and the renal pedicle allowing

malformations.

pyeloplasty

It is currently

a direct

the management

our routmc

approach

NEW

Schiin G.

V36 HAND-ASSISTED

RETROPERlTONEOSCOPlC

Ghent University

MATERIAL & METHODS: With the patient in the lateral position, an incision is made below the 12th rib and a retroperitoneal space is created with a finger. This makes it unnecessary to fit an inflatable balloon. Two working trocars (12 mm, S mm) are placed and confirmed by palpation. A pncumoperitoneum with a CO2 pressure of approx. 10 mmHg is induced. Due to its exposed location, the artery can be sealed immediately with an endoclip. In contradiction to statements made up to now in the literature, the vein w be ligated with clips during all nephrectomies saving the costs of a vascular stapler. RESULTS: 35 consecutive nephrectomies and tumour nephrectomies were performed successfully without needing to convert to open surgery or needing to use the vascular stapler. Fast access to the renal vessels saves considerable time. The average operating time was I I4 minutes, the blood loss was 120 ml.

tiospitdl, Urology. Ghent, Belgium

INTRODUCTION extraperitoneal

& OBJECTIVES:

radical nephrectomy,

drawback.

Therefore,

IlandPort

device

CONCLUSIONS: Retroperitoneal endoscopic nephrectomy is an established procedure for removal of non-functioning kidneys and kidney tumours. By replacing the vascular stapler with economical endoclips to ligate the renal vein, this operation does not cost more than the open operation and by simplifying access and technique, the operating time is not significantly longer compared with the open technique. Supplements

2 (2003) No. 1, pp. 212

When

performing

a laparoscopic

the hmited working space is a considerable

we developed

facilitates

a new technique

the procedure

and

where

reduces

the use of the operating

time

significantly. MATERIAL. operations. aspects.

& METHODS:

The procedure

We describe

The video

is demonstrated

insertion

shows

a selection

step-by-step,

control is established, Finally

the kidney

of recorded

highlighting

important

of the hand into the extraperitoneal

providing a better exposure of the renal vessels during dissection. the hand is used for blunt dissection is easily extracted

through

space,

Once vascular-

of the perirenal fat.

the incision

of‘the

HandPort,

without need for morcelation. CONCLUSIONS: kidney

tumour,

morcelation

When performing extraction

or elongation

apply tissue morcelation,

Urology

W

Klinik, Urology. WiirTburg, Germany

INTRODUCTION & OBJECTIVES: Retroperitoneal endoscopic nephrectomy has become the standard therapy for nephrectomy and tumour nephrectomy at several centres. Some of the reticence towards the laparoscopic technique is certainly due to the high costs of materials and the longer operating time. In this video, we demonstrate a simple procedure for establishing the port and cost-effective management of the arteries and veins.

European

RADICAL

NEPHRECTOMY Dekuvoer P., Oosterlinck

Missionsirztliche

to

as well as other renal procedures.

v35 RETROPERITONEAL ENDOSCOPIC NEPHRECTOMY: TECHNIQUE FOR ACCESS AND MANAGEMENT OF VESSELS

of

is based on a

procedure. tactile possible

feedback

of one of the incisions. the complete

nephrectomy.

of maintaining

possible

after

for a tissue

If the surgeon prefers not to

extraperitoneal

This technique

with those of a laparoscopic

applying a muscle-split

radical nephrectomy

is only

the incision might as well be made at the start of the

We demonstrate

device for radical

a laparoscopic

of the specimen

the advantages

combines procedure.

use of a hand assist the advantages Furthermore

of leaving the peritoneum

of is it

intact and

incision even reduces surgical trauma even further.