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VE24: Robotic Millin prostatectomy
U N M O D E R A T E D V I D E O P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60
ceeding on lateral aspect of right common iliac artery, then completing the right external iliac and the obturaror node dissection. Subsequently the presacral nodes were removed from the aortic bifurcation, toward the hypogastric nodes. The left common iliac dissection was perormed before deflecting medially the sigma and completing the left pelvic node dissection as done for the right side. Packages were marked with different size hem-o-locks and removed into two separate endocatch bags. Results: Intraoperative blood loss was 250 ml, operative time was 55 and 85 minutes for cystectomy and pelvic lymphadenectomy, respectively. Conclusions: The video demonstrates the feasibility of robot assisted radical cystectomy with a meticulous extended pelvic lymph node dissection. VE20 Robotic assisted re-do partial nephrectomy and partial adrenalectomy in a patient with von Hippel Lindau disease P. Sharma, K. Janosek-Albright, R. Barod, C. Rogers. Henry Ford Hospital, Dept. of Urology, Detroit, United States of America Introduction & Objectives: We present the case of a simultaneous robotic assisted redo partial nephrectomy and partial adrenalectomy in a patient with von Hippel Lindau disease. Material & Methods: A 32 year old female with von Hippel Lindau disease presented with a new onset 2.8 cm hypervascular right adrenal mass consistent with pheochromocytoma and an enlarging 2.8 cm right inferior pole renal mass. Her past medical history included cerebellar hemangioblastoma and a previous right partial nephrectomy for a G2pT1a clear cell RCC with negative margins. Her BMI was 44 and pre-operative eGFR was 110. Results: This video shows our technique of simultaneous robotic assisted redo right partial nephrectomy with partial adrenalectomy. Surgery was performed under alpha blockade with doxazosin. The patient had an uneventful postoperative course and was discharged on day 3. Pathology of the renal mass showed a G2pT1a clear cell RCC with negative margins. Pathology of the adrenal mass showed a pheochromocytoma with negative margins. Conclusions: To our knowledge, we demonstrate the first case of simultaneous robotic redo partial nephrectomy and adrenalectomy in a patient with von Hippel Lindau disease, showing the technique is both feasible and effective. VE21 Robotic fistulectomy and advancement flap for rectal-neobladder fistula R. Ballestero Diego 1 , M. Gómez 2 , D. Truán 1 , S. Zubillaga 1 , E. Mediavilla 2 , J. Fuentes 1 , C. Carrión 1 , G. Velilla 1 , J.I. Del Valle 1 , J.A. Portillo 1 , M. Correas 1 , E. Ramos 1 , M. Dominguez 1 , F. Campos 1 , J.L. Gutiérrez 1 . 1 Hospital Universitario Marqués de Valdecilla, Dept. of Urology, Santander, Spain; 2 Hospital Universitario Marqués de Valdecilla, Dept. of General Surgery, Santander, Spain Introduction & Objectives: Rectal injury is a severe complication after prostatectomy or bladder cancer surgery. Most of rectal injuries will behave as delayed fistulas. Although several techniques have been described, there is no consensus on how to solve them. Objective: We present the robotic transanal approach with excision of the fistula and an advancement full thickness flap to resolve it. Material & Methods: A 55 years old man with a cistectomy with Studer neobladder presents rectal-neobladder fistula after surgery 4 years ago. He had a good tolerance until his renal function worsened. Cistography and cistoscopy showed a small 5 mm fistula, 4 cm from the anal margin. We describe the patient position, Da Vinci robot and trocars position and tips-and-tricks in dissection and suture technique. All the surgery is performed through a robot transanal device. Conclusions: Transanal minimally invasive surgery (TAMIS) is a valid
55
alternative to treat vesicorectal fistulas. This technique is effective and reproductible and the robotic approach facilitates its performance. VE22 Robotic ileocistoplasty combined with supratrigonal cystectomy R. Ballestero Diego, S. Zubillaga, D. Truán, J. Del Valle, J. Portillo, M. Correas, E. Ramos, M. Dominguez, C. Aguilera, F. Campos, E. Mediavilla, J. Fuentes, C. Carrión, G. Velilla, J. Gutiérrez. Hospital Universitario Marqués de Valdecilla, Dept. of Urology, Santander, Spain Introduction & Objectives: Enteric bladder augmentation is the preferred option of treatment in cases of diminished bladder capacity causing renal function impairment. Material & Methods: We present a rare case of a 60-year-old male who was admitted in our hospital with history of nephrolithiasis, bilateral hidronephrosis and a thick bladder wall. Repeated urine cultures including mycobacteriae where negatives, as well as urine cytology and bladder biopsy. He curses with acute renal insufficiency, bilateral grade 2 hidronephrosis, thickened bladder wall and high left ureteral stenosis. Bilateral nephrostomy was performed with subsequent normalization of renal function. Posteriorly, we decided to carry out a supratrigonal cystectomy with combined Camey II type substitution ileocystoplasty. We explain patient position, Da Vinci robot and trocars position and tips-and-tricks in dissection and suture technique. Conclusions: In the last years, robotic assisted surgery has emerged as an interesting option for urologists to perform different types of urinary diversion. Improvements in ergonomy, vision and suture technique provide extra help for complex cases as intracorporeal ileocystoplasty. VE23 Robotic inferior vena cava thrombectomy R. Papalia 1 , R. Mastroianni 2 , G. Simone 1 , S. Guaglianone 1 , M. Ferriero 1 , M. Gallucci 1 . 1 Regina Elena National Cancer Institute, Dept. of Urology, Rome, Italy; 2 Campus Bio-Medico University, Dept. of Urology, Rome, Italy Introduction & Objectives: The surgical approach of inferior vena cava (IVC) thrombus is usually open. At selected institutions, the robotic approach is being explored. We present here a case of robotic IVC thrombectomy. Material & Methods: The video shows the robotic approach of IVC thrombus in a 82 years old man with right kidney cancer extended to the vena cava. Results: Thrombectomy time was 160 min, IVC clamp time was 55 min and nephrectomy time was 110 min. Thrombus Size was 3 cm. Estimated blood loss was 800 cc. No intraoperative and postoperative transfusions were necessary. POD1 Haemoglobin was 12.7 and sCreatinine 1.88. Patient was discharged 3 days after surgery. Conclusions: At selected institutions robotic surgery for selected level I and II caval thrombi is feasible. Further, clinical experience is necessary to determine the appropriate place of robotic surgery in managing these complex patients with caval involvement. VE24 Robotic Millin prostatectomy G. Simone, M. Ferriero, R. Papalia, S. Guaglianone, M. Gallucci. Regina Elena National Cancer Institute, Dept. of Urology, Rome, Italy Introduction & Objectives: This video highlights surgical steps of a robotic Millin prostatectomy for benign prostatic hyperplasia. Material & Methods: With patient in steep Trendelemburg position a 5 trocar transperitoneal access was performed. Once prepared the Retzius space a transverse incision of the ventral prostate was performed and the dissection plane was developed anteriorly and pro-
56
U N M O D E R A T E D V I D E O P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60
gressively laterarly. Once transected the prostatic urethra the urethral catheter was clip ligated and a traction was applied to the catheter to expose the posterolateral aspect of the lobes. The bladder neck was finally transected and the posterior dissection was completed. Hemostasis was selectively performed in the prostatic fossa with monopolar coagulation. Bladder neck trigonization and anterior approximation of bladder neck with ventral prostate completed the procedure. Results: Operative time was 75 minutes and intraoperative blood loss was 200 mL. Patient was discharged on first postoperative day and the urethral catheter removed on third postoperative day. Conclusions: Robotic Millin prostatectomy is a feasible and effective procedure for large BPH. VE25 Robotic prostatectomy following neoadjuvant TAK-700 and leuprorelin acetate akin to salvage radical prostatectomy: Initial experience from the NEPTUNE study
pelvic junction (UPJ) obstruction with its renal pelvis and every calix full of small sized many soft stones that we did not identify preoperatively and which was a very surprising intraoperative finding. Material & Methods: A 35 year-old female patient was referred with the diagnosis of right UPJ obstruction. She had right flank pain for 6 months and urinary tract infection. She did not have history of urinary tract stone disease, abdominal or other surgery. Urine analysis revealed >50 leukocytes/HPF. Urine culture was sterile. Abdominal ultrasound (USG) revealed right hydronephrosis with extremely dilated calices and presence of 4 or 5 stones in 5 mm size in right renal pelvis. Intravenous urography (IVU) showed no renal opacity but right hydronephrosis, extremely dilated calices and a huge right kidney. Nuclear renal scan with diuretic washout demonstrated obstructive right kidney with T1/2 >20 minutes. Abdominal CT was not done preoperatively.
A. Sridhar, M. Goldstraw, G. Basnett, J. Hines, S. Nathan, T. Briggs, J. Kelly, P. Cathcart. UCLH NHS Foundation Trust, Dept. of Urology, London, United Kingdom Introduction & Objectives: The NEPTUNE study is a National Cancer Research Institute (NCRI) and Cancer Research UK endorsed randomized phase II study of neoadjuvant TAK-700 and Leuprorelin acetate versus surgery alone for intermediate and high risk prostate cancer. In this abstract we report the technical nuances of robotic prostatectomy in this clinical trial setting. Material & Methods: A significant proportion of men undergoing radical prostatectomy for high risk prostate cancer experience biochemical failure requiring subsequent adjuvant therapy in the form of radiation therapy or endocrine therapy. The development of more effective testosterone targeted therapy such as TAK-700 has prompted a re-evaluation of use of these agents in the neoadjuvant setting prior to radical prostatectomy in an attempt to reduce the need for adjuvant therapy. Within the the NEPTUNE study, patients opting to undergo surgery for intermediate and high risk prostate cancer are randomised to undergo either immediate robotic radical prostatectomy or alternatively 24 weeks of therapy with TAK-700 (300 mg twice daily) and leuprorelin acatate (3.75 mg every 28 days) following by robotic radical prostatectomy. Results: Following TAK-700 and leuprorelin acatate therapy, tissue plans around the prostate are very similar to those experienced when performing a “salvage radical prostatectomy”. The endopelvic fascia is densely adherent to the prostate. In addition, dissection of the seminal vesicles demonstrates marked fibrosis while the layers of the denonvilliers fascia are fused to both the prostate and the rectum making dissection difficult. Despite these changes, full bilateral nerve sparing remains feasible. Pathological findings following administration of TAK-700 demonstrate marked therapy affect with downstaging of tumour volume. Conclusions: Robotic radical prostatectomy with bilateral nerve sparing is possible following neoadjuvant administration TAK-700 – an example of a new era testosterone suppression therapy. However, treatment effect results in a markedly more difficult dissection akin to that of “salvage prostatectomy”.
Results: We performed right transperitoneal robotic pyeloplasty. When we excised the obstructed UPJ and opened the renal pelvis, we were very surprised to see that almost the whole renal pelvis and all of the renal calices were full of 5 mm sized many soft kidney stones. By using the advantage of the robotic wristed hand movements, we cleared all the stones in the renal pelvis and easily entered every calix and removed all of the small sized stones that we think is almost impossible to achieve with standard laparoscopy. Dilated renal pelvis was excised, a JJ stent was inserted and anastomosis with the spatulated ureter was completed successfully without any complication. Operation time was 1.5 hours. Blood loss was 50 cc. Postoperative follow-up was uneventful. Patient was discharged on postoperative day-2. 3rd-month nuclear scan showed non-obstructive right kidney. CT urography showed stone-free state. Conclusions: Robotic pyleloplasty is a safe minimally invasive procedure that has excellent surgical and functional outcomes. Preoperative USG and IVU can miss most of the small non-opaque and soft stones as happened in our case that might be a surprising intraoperative situation to handle for the surgeon. Therefore, we think that preoperative CT is also essential in all patients for detecting particularly non-opaque and small stones. Surgical robot allows precise, gentle and quick tissue handling with 3D magnified image capability, higher grades of wristed hand movements and decreased hand tremor that gives the opportunity of easily entering every distal calix and removal of all small sized stones leading to a stone-free state. In addition, robotic approach has the advantages of enabling quicker tissue dissection, reconstruction, intracorporeal suturing, antegrade double-J stenting and excellent ergonomics for the console surgeon.
VE26 Robotic pyeloplasty and synchronous removal of many kidney stones: A piece of cake with robotic surgery
VE27 Saphenous vein sparing robot assisted video endoscopic inguinal lymphadenectomy (R-VEIL): Steps as video demonstration
A.E. Canda 1 , O.U. Cakici 2 , A.F. Atmaca 1 , M.E. Arslan 2 , D. Kamaci 2 . Beyazit University, School of Medicine, Ankara Ataturk Training and Research Hospital, Dept. of Urology, Ankara, Turkey; 2 Ankara Ataturk Training and Research Hospital, Dept. of Urology, Ankara, Turkey
Y. Thyavihally, A. Pednekar, N. Gulavani, H. Pokharkar, H. Rao, N. Dharmadhikari, A. Patil. Kokilaben Dhirubhai Ambani Hospital, Dept. of Uro-oncology, Mumbai, India
1 Yildirim
Introduction & Objectives: We present a challenging case of uretero-
Introduction & Objectives: Groin lymph node dissection (GND) in carcinoma of penis is associated with high incidence of wound related complications like flap necrosis, infection etc. R-VEIL is a surgi-
ceeding on lateral aspect of right common iliac artery, then completing the right external iliac and the obturaror node dissection. Subsequently the presacral nodes were removed from the aortic bifurcation, toward the hypogastric nodes. The left common iliac dissection was perormed before deflecting medially the sigma and completing the left pelvic node dissection as done for the right side. Packages were marked with different size hem-o-locks and removed into two separate endocatch bags. Results: Intraoperative blood loss was 250 ml, operative time was 55 and 85 minutes for cystectomy and pelvic lymphadenectomy, respectively. Conclusions: The video demonstrates the feasibility of robot assisted radical cystectomy with a meticulous extended pelvic lymph node dissection. VE20 Robotic assisted re-do partial nephrectomy and partial adrenalectomy in a patient with von Hippel Lindau disease P. Sharma, K. Janosek-Albright, R. Barod, C. Rogers. Henry Ford Hospital, Dept. of Urology, Detroit, United States of America Introduction & Objectives: We present the case of a simultaneous robotic assisted redo partial nephrectomy and partial adrenalectomy in a patient with von Hippel Lindau disease. Material & Methods: A 32 year old female with von Hippel Lindau disease presented with a new onset 2.8 cm hypervascular right adrenal mass consistent with pheochromocytoma and an enlarging 2.8 cm right inferior pole renal mass. Her past medical history included cerebellar hemangioblastoma and a previous right partial nephrectomy for a G2pT1a clear cell RCC with negative margins. Her BMI was 44 and pre-operative eGFR was 110. Results: This video shows our technique of simultaneous robotic assisted redo right partial nephrectomy with partial adrenalectomy. Surgery was performed under alpha blockade with doxazosin. The patient had an uneventful postoperative course and was discharged on day 3. Pathology of the renal mass showed a G2pT1a clear cell RCC with negative margins. Pathology of the adrenal mass showed a pheochromocytoma with negative margins. Conclusions: To our knowledge, we demonstrate the first case of simultaneous robotic redo partial nephrectomy and adrenalectomy in a patient with von Hippel Lindau disease, showing the technique is both feasible and effective. VE21 Robotic fistulectomy and advancement flap for rectal-neobladder fistula R. Ballestero Diego 1 , M. Gómez 2 , D. Truán 1 , S. Zubillaga 1 , E. Mediavilla 2 , J. Fuentes 1 , C. Carrión 1 , G. Velilla 1 , J.I. Del Valle 1 , J.A. Portillo 1 , M. Correas 1 , E. Ramos 1 , M. Dominguez 1 , F. Campos 1 , J.L. Gutiérrez 1 . 1 Hospital Universitario Marqués de Valdecilla, Dept. of Urology, Santander, Spain; 2 Hospital Universitario Marqués de Valdecilla, Dept. of General Surgery, Santander, Spain Introduction & Objectives: Rectal injury is a severe complication after prostatectomy or bladder cancer surgery. Most of rectal injuries will behave as delayed fistulas. Although several techniques have been described, there is no consensus on how to solve them. Objective: We present the robotic transanal approach with excision of the fistula and an advancement full thickness flap to resolve it. Material & Methods: A 55 years old man with a cistectomy with Studer neobladder presents rectal-neobladder fistula after surgery 4 years ago. He had a good tolerance until his renal function worsened. Cistography and cistoscopy showed a small 5 mm fistula, 4 cm from the anal margin. We describe the patient position, Da Vinci robot and trocars position and tips-and-tricks in dissection and suture technique. All the surgery is performed through a robot transanal device. Conclusions: Transanal minimally invasive surgery (TAMIS) is a valid
55
alternative to treat vesicorectal fistulas. This technique is effective and reproductible and the robotic approach facilitates its performance. VE22 Robotic ileocistoplasty combined with supratrigonal cystectomy R. Ballestero Diego, S. Zubillaga, D. Truán, J. Del Valle, J. Portillo, M. Correas, E. Ramos, M. Dominguez, C. Aguilera, F. Campos, E. Mediavilla, J. Fuentes, C. Carrión, G. Velilla, J. Gutiérrez. Hospital Universitario Marqués de Valdecilla, Dept. of Urology, Santander, Spain Introduction & Objectives: Enteric bladder augmentation is the preferred option of treatment in cases of diminished bladder capacity causing renal function impairment. Material & Methods: We present a rare case of a 60-year-old male who was admitted in our hospital with history of nephrolithiasis, bilateral hidronephrosis and a thick bladder wall. Repeated urine cultures including mycobacteriae where negatives, as well as urine cytology and bladder biopsy. He curses with acute renal insufficiency, bilateral grade 2 hidronephrosis, thickened bladder wall and high left ureteral stenosis. Bilateral nephrostomy was performed with subsequent normalization of renal function. Posteriorly, we decided to carry out a supratrigonal cystectomy with combined Camey II type substitution ileocystoplasty. We explain patient position, Da Vinci robot and trocars position and tips-and-tricks in dissection and suture technique. Conclusions: In the last years, robotic assisted surgery has emerged as an interesting option for urologists to perform different types of urinary diversion. Improvements in ergonomy, vision and suture technique provide extra help for complex cases as intracorporeal ileocystoplasty. VE23 Robotic inferior vena cava thrombectomy R. Papalia 1 , R. Mastroianni 2 , G. Simone 1 , S. Guaglianone 1 , M. Ferriero 1 , M. Gallucci 1 . 1 Regina Elena National Cancer Institute, Dept. of Urology, Rome, Italy; 2 Campus Bio-Medico University, Dept. of Urology, Rome, Italy Introduction & Objectives: The surgical approach of inferior vena cava (IVC) thrombus is usually open. At selected institutions, the robotic approach is being explored. We present here a case of robotic IVC thrombectomy. Material & Methods: The video shows the robotic approach of IVC thrombus in a 82 years old man with right kidney cancer extended to the vena cava. Results: Thrombectomy time was 160 min, IVC clamp time was 55 min and nephrectomy time was 110 min. Thrombus Size was 3 cm. Estimated blood loss was 800 cc. No intraoperative and postoperative transfusions were necessary. POD1 Haemoglobin was 12.7 and sCreatinine 1.88. Patient was discharged 3 days after surgery. Conclusions: At selected institutions robotic surgery for selected level I and II caval thrombi is feasible. Further, clinical experience is necessary to determine the appropriate place of robotic surgery in managing these complex patients with caval involvement. VE24 Robotic Millin prostatectomy G. Simone, M. Ferriero, R. Papalia, S. Guaglianone, M. Gallucci. Regina Elena National Cancer Institute, Dept. of Urology, Rome, Italy Introduction & Objectives: This video highlights surgical steps of a robotic Millin prostatectomy for benign prostatic hyperplasia. Material & Methods: With patient in steep Trendelemburg position a 5 trocar transperitoneal access was performed. Once prepared the Retzius space a transverse incision of the ventral prostate was performed and the dissection plane was developed anteriorly and pro-
56
U N M O D E R A T E D V I D E O P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60
gressively laterarly. Once transected the prostatic urethra the urethral catheter was clip ligated and a traction was applied to the catheter to expose the posterolateral aspect of the lobes. The bladder neck was finally transected and the posterior dissection was completed. Hemostasis was selectively performed in the prostatic fossa with monopolar coagulation. Bladder neck trigonization and anterior approximation of bladder neck with ventral prostate completed the procedure. Results: Operative time was 75 minutes and intraoperative blood loss was 200 mL. Patient was discharged on first postoperative day and the urethral catheter removed on third postoperative day. Conclusions: Robotic Millin prostatectomy is a feasible and effective procedure for large BPH. VE25 Robotic prostatectomy following neoadjuvant TAK-700 and leuprorelin acetate akin to salvage radical prostatectomy: Initial experience from the NEPTUNE study
pelvic junction (UPJ) obstruction with its renal pelvis and every calix full of small sized many soft stones that we did not identify preoperatively and which was a very surprising intraoperative finding. Material & Methods: A 35 year-old female patient was referred with the diagnosis of right UPJ obstruction. She had right flank pain for 6 months and urinary tract infection. She did not have history of urinary tract stone disease, abdominal or other surgery. Urine analysis revealed >50 leukocytes/HPF. Urine culture was sterile. Abdominal ultrasound (USG) revealed right hydronephrosis with extremely dilated calices and presence of 4 or 5 stones in 5 mm size in right renal pelvis. Intravenous urography (IVU) showed no renal opacity but right hydronephrosis, extremely dilated calices and a huge right kidney. Nuclear renal scan with diuretic washout demonstrated obstructive right kidney with T1/2 >20 minutes. Abdominal CT was not done preoperatively.
A. Sridhar, M. Goldstraw, G. Basnett, J. Hines, S. Nathan, T. Briggs, J. Kelly, P. Cathcart. UCLH NHS Foundation Trust, Dept. of Urology, London, United Kingdom Introduction & Objectives: The NEPTUNE study is a National Cancer Research Institute (NCRI) and Cancer Research UK endorsed randomized phase II study of neoadjuvant TAK-700 and Leuprorelin acetate versus surgery alone for intermediate and high risk prostate cancer. In this abstract we report the technical nuances of robotic prostatectomy in this clinical trial setting. Material & Methods: A significant proportion of men undergoing radical prostatectomy for high risk prostate cancer experience biochemical failure requiring subsequent adjuvant therapy in the form of radiation therapy or endocrine therapy. The development of more effective testosterone targeted therapy such as TAK-700 has prompted a re-evaluation of use of these agents in the neoadjuvant setting prior to radical prostatectomy in an attempt to reduce the need for adjuvant therapy. Within the the NEPTUNE study, patients opting to undergo surgery for intermediate and high risk prostate cancer are randomised to undergo either immediate robotic radical prostatectomy or alternatively 24 weeks of therapy with TAK-700 (300 mg twice daily) and leuprorelin acatate (3.75 mg every 28 days) following by robotic radical prostatectomy. Results: Following TAK-700 and leuprorelin acatate therapy, tissue plans around the prostate are very similar to those experienced when performing a “salvage radical prostatectomy”. The endopelvic fascia is densely adherent to the prostate. In addition, dissection of the seminal vesicles demonstrates marked fibrosis while the layers of the denonvilliers fascia are fused to both the prostate and the rectum making dissection difficult. Despite these changes, full bilateral nerve sparing remains feasible. Pathological findings following administration of TAK-700 demonstrate marked therapy affect with downstaging of tumour volume. Conclusions: Robotic radical prostatectomy with bilateral nerve sparing is possible following neoadjuvant administration TAK-700 – an example of a new era testosterone suppression therapy. However, treatment effect results in a markedly more difficult dissection akin to that of “salvage prostatectomy”.
Results: We performed right transperitoneal robotic pyeloplasty. When we excised the obstructed UPJ and opened the renal pelvis, we were very surprised to see that almost the whole renal pelvis and all of the renal calices were full of 5 mm sized many soft kidney stones. By using the advantage of the robotic wristed hand movements, we cleared all the stones in the renal pelvis and easily entered every calix and removed all of the small sized stones that we think is almost impossible to achieve with standard laparoscopy. Dilated renal pelvis was excised, a JJ stent was inserted and anastomosis with the spatulated ureter was completed successfully without any complication. Operation time was 1.5 hours. Blood loss was 50 cc. Postoperative follow-up was uneventful. Patient was discharged on postoperative day-2. 3rd-month nuclear scan showed non-obstructive right kidney. CT urography showed stone-free state. Conclusions: Robotic pyleloplasty is a safe minimally invasive procedure that has excellent surgical and functional outcomes. Preoperative USG and IVU can miss most of the small non-opaque and soft stones as happened in our case that might be a surprising intraoperative situation to handle for the surgeon. Therefore, we think that preoperative CT is also essential in all patients for detecting particularly non-opaque and small stones. Surgical robot allows precise, gentle and quick tissue handling with 3D magnified image capability, higher grades of wristed hand movements and decreased hand tremor that gives the opportunity of easily entering every distal calix and removal of all small sized stones leading to a stone-free state. In addition, robotic approach has the advantages of enabling quicker tissue dissection, reconstruction, intracorporeal suturing, antegrade double-J stenting and excellent ergonomics for the console surgeon.
VE26 Robotic pyeloplasty and synchronous removal of many kidney stones: A piece of cake with robotic surgery
VE27 Saphenous vein sparing robot assisted video endoscopic inguinal lymphadenectomy (R-VEIL): Steps as video demonstration
A.E. Canda 1 , O.U. Cakici 2 , A.F. Atmaca 1 , M.E. Arslan 2 , D. Kamaci 2 . Beyazit University, School of Medicine, Ankara Ataturk Training and Research Hospital, Dept. of Urology, Ankara, Turkey; 2 Ankara Ataturk Training and Research Hospital, Dept. of Urology, Ankara, Turkey
Y. Thyavihally, A. Pednekar, N. Gulavani, H. Pokharkar, H. Rao, N. Dharmadhikari, A. Patil. Kokilaben Dhirubhai Ambani Hospital, Dept. of Uro-oncology, Mumbai, India
1 Yildirim
Introduction & Objectives: We present a challenging case of uretero-
Introduction & Objectives: Groin lymph node dissection (GND) in carcinoma of penis is associated with high incidence of wound related complications like flap necrosis, infection etc. R-VEIL is a surgi-