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Transperitoneal robot assisted partial nephrectomy with modified port configuration (Retrorenal approach to the renal hilum)
VE16 Transperitoneal robot assisted partial nephrectomy with modified port configuration (Retrorenal approach to the renal hilum) Argun O.B.1, Tufek I.1, Tuna M.B.2, Doganca T.3, Mourmouris P.1, Obek C.3, Keskin S.1, Kural A.R.1 1
Acibadem University, Dept. of Urology, Istanbul, Turkey, 2Acibadem Aile Hospital, Dept. of Urology, Istanbul, Turkey, Acibadem Taksim Hospital, Dept. of Urology, Istanbul, Turkey
3
INTRODUCTION & OBJECTIVES: In this video; a modified port configuration for robot assisted transperitoneal partial nephrectomy (Retrorenal approach to the renal hilum ) approach is presented. MATERIAL & METHODS: The patient was a 30 year old woman with left kidney tumor 45 mm in diameter. It was located at the posterior superior medial part of the kidney. The daVinci Xi system was used during the case. The patient was placed in modified right lateral decubitus position. Robotic ports were placed as seen in image 1. First, the robot was docked in standard fashion for anterior dissection. After the incision of Toldt’s line the colon was mobilized medially. When it was difficult to see and reach the tumor from this angle of view, the robotic crane was repositioned perpendicular to the patient and redocked. The camera was moved to the most inferior robotic port which enabled us to see the posterior aspect of the kidney. With this modified technique, the visualization of the tumor was better and renal artery identification was easier compared to the standard port configuration. Laparoscopic ultrasonography probe was used for demarcation of the tumor. After complete enucleation of the tumor clip renorraphy technique was used for parenchymal repair. Renal perfusion was controlled with indocyanine green.
RESULTS: Console time was 72 minutes, warm ischemia time was 17 minutes and estimated blood loss was 50 ml. Final histopathology revealed RCC, clear cell type, Fuhrman grade II. Tumor diameter was 3.5 cm. and surgical margins were negative. CONCLUSIONS: Transperitoneal robot assisted partial nephrectomy with modified port configuration seems to be feasible. Using this technique may provide better access to the posteriorly located tumors and easy identification of renal artery.
Eur Urol Suppl 2016; 15(7):319
Acibadem University, Dept. of Urology, Istanbul, Turkey, 2Acibadem Aile Hospital, Dept. of Urology, Istanbul, Turkey, Acibadem Taksim Hospital, Dept. of Urology, Istanbul, Turkey
3
INTRODUCTION & OBJECTIVES: In this video; a modified port configuration for robot assisted transperitoneal partial nephrectomy (Retrorenal approach to the renal hilum ) approach is presented. MATERIAL & METHODS: The patient was a 30 year old woman with left kidney tumor 45 mm in diameter. It was located at the posterior superior medial part of the kidney. The daVinci Xi system was used during the case. The patient was placed in modified right lateral decubitus position. Robotic ports were placed as seen in image 1. First, the robot was docked in standard fashion for anterior dissection. After the incision of Toldt’s line the colon was mobilized medially. When it was difficult to see and reach the tumor from this angle of view, the robotic crane was repositioned perpendicular to the patient and redocked. The camera was moved to the most inferior robotic port which enabled us to see the posterior aspect of the kidney. With this modified technique, the visualization of the tumor was better and renal artery identification was easier compared to the standard port configuration. Laparoscopic ultrasonography probe was used for demarcation of the tumor. After complete enucleation of the tumor clip renorraphy technique was used for parenchymal repair. Renal perfusion was controlled with indocyanine green.
RESULTS: Console time was 72 minutes, warm ischemia time was 17 minutes and estimated blood loss was 50 ml. Final histopathology revealed RCC, clear cell type, Fuhrman grade II. Tumor diameter was 3.5 cm. and surgical margins were negative. CONCLUSIONS: Transperitoneal robot assisted partial nephrectomy with modified port configuration seems to be feasible. Using this technique may provide better access to the posteriorly located tumors and easy identification of renal artery.
Eur Urol Suppl 2016; 15(7):319