Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy

Cabello, José M.; Benway, Brian M.; Bhayani, Sam B.

doi:10.1590/s1677-55382009000200010

Cited by 29 publications

(22 citation statements)

References 7 publications

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“…Our surgical approach is similar to that reported previously [12]. All cases were performed using the da Vinci S model, with 4 robot arms utilized during surgery.…”

Section: Methodsmentioning

confidence: 99%

Robotic partial nephrectomy outcomes at a single institution and experience with R.E.N.A.L. nephrometry score

2011

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Partial nephrectomy is the current gold-standard treatment of small renal masses. The articulated instruments of the surgical robot have made the laparoscopic approach more feasible. We present our experience with 50 robot-assisted laparoscopic partial nephrectomy (RALPN) surgeries and attempt to validate a recently reported nephrometry score. From July 2008 to July 2010, 50 (53 planned) elective RALPNs were performed utilizing the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). All patients had an enhancing renal mass on CT scan pre-operatively. Clinicopathologic, surgical, and renal functional (Cockcroft-Gault formula) outcomes were recorded prospectively and analyzed. Mean tumor size, length of surgery (LS), warm ischemia time (WIT), and nephrometry scores were 3.6 cm (1-8), 303 min (133-610), 29.1 min (11-42), and 6.8 (4-11) respectively. Renal cell carcinoma was found in 39 (78%) patients. When evaluating the nephrometry score, comparison of low, medium, and high complexity tumors for length of surgery, WIT, and estimated blood loss (EBL) showed no difference (p > 0.05). Nearness to the collecting system (N score 1 vs. N score 3) showed increased EBL (195 ml vs. 510 mL, p = 0.005), and location relative to polar lines (L score 1 and L score 2) increased mean LS (265 vs. 359 min, p = 0.02). RALPN is safe and effective. Nephrometry scores are a method of standardizing tumor complexity and can be utilized in comparing tumor cohorts but may not be predictive of intra-operative outcomes.

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“…Our surgical approach is similar to that reported previously [12]. All cases were performed using the da Vinci S model, with 4 robot arms utilized during surgery.…”

Section: Methodsmentioning

confidence: 99%

Robotic partial nephrectomy outcomes at a single institution and experience with R.E.N.A.L. nephrometry score

2011

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“…7,13,[17][18][19] For the renorrhaphy, three different methods for renal reconstruction were evaluated: (1) The ends of the suture were left long enough to protrude from the trocar. To this free end of the suture material, a digital force gauge (Chatillon, Largo, FL) was utilized to measure the maximum allowable tension on the closure before the suture ripped through the renal capsule, thus indicating the relative maximum strength of each closure.…”

Section: Methodsmentioning

confidence: 99%

“…Though a detailed description of the technique for slidingclip renorrhaphy can be found elsewhere, 15,17,19 we briefly summarize the technique here. A 0 or no.…”

Section: Methodsmentioning

confidence: 99%

Sliding-Clip Renorrhaphy Provides Superior Closing Tension During Robot-Assisted Partial Nephrectomy

Benway

Cabello²,

Figenshau³

et al. 2010

Journal of Endourology

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Benway, Brian M.; Cabello, Jose M.; Figenshau, Robert S.; and Bhayani, Sam B., ,"Sliding-clip renorrhaphy provides superior closing tension during robot-assisted partial nephrectomy." Journal of Endourology.24,4. 605-608. (2010 AbstractObjective: Recently, our institution refined a technique for robot-assisted renorrhaphy utilizing sliding Weck Hem-O-Lock clips, which are tightened by the surgeon seated at the console and locked into place with a LapraTy clip. In addition to the relative ease of implementation, we believe that our technique also provides a superior strength of closure over other commonly used techniques. Methods: An in vivo porcine model was used to compare a sliding-clip technique against an assistant-placed LapraTy-only closure, and a surgeon-placed simple suture closure. A force gauge was used to record the maximum tension that could be applied during each closure method before the suture ripped through the renal parenchyma, thus illustrating the relative strength of each closure. Results: The simple suture closure performed relatively poorly, ripping through parenchyma at a mean force of 11.3 N. The LapraTy-only method allowed a maximum applicable mean force of 16.7 N. The sliding Weck clip with a LapraTy bolster provided the tightest closure, allowing for a mean force of 32.7 N before ripping through parenchyma. Statistical analysis reveals that a sliding-clip technique provides a significantly tighter closure than both of the other tested methods. Conclusion: A sliding-clip technique allows for more tension to be safely applied to the closure of a partial nephrectomy defect than other commonly used methods. We believe that this is primarily attributable to the larger footprint of the Hem-O-Lock clip, which allows for the tension to be distributed over a greater surface area. The LapraTy then ensures the security of the closure by holding the Weck clip in place. Further studies are necessary to determine if this increased tension translates into appreciably better hemostasis.

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“…To shorten the time taken for renorrhaphy and overall ischemia time, the sliding-clip technique for renorrhaphy had been described [27,28]. Using Weck (Teleflex, Research Triangle Park, NC) Hem-o-lok clips placed at both ends of the suture, the console surgeon slid the clips to tighten the tension of the renorrhaphy to achieve a secure, haemostatic apposition of the cortical defect.…”

Section: Techniques To Lessen Ischaemic Damage or Ischemia Timementioning

confidence: 99%

Current Status of Robot-Assisted Laparoscopic Partial Nephrectomy

Png

Sundaram

2011

Indian J Surg Oncol

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With increased incidence of diagnosis of small renal masses, partial nephrectomy has been preferred over radical nephrectomy as the surgical treatment of choice. The transition from open to laparoscopic partial nephrectomy had been challenging for many urologists. Robotic-assisted laparoscopic partial nephrectomy(RLPN) is increasingly used to facilitate this transition . In this review, we examine the recent technical advances and clinical outcomes in RLPN. Many series had successfully reported the feasibility of using the da Vinci Surgical (Intuitive Surgical Inc, Sunnyvale, CA) System in laparoscopic partial nephrectomy. Recent advances had focused on reducing risk of renal damage by shortening the warm ischaemia time. These techniques included unclamped excision, selective arterial clamping and improved renorrhaphy methods. Operative times and warm ischaemia times have also improved once the learning curve are overcome, which is less steep than conventional laparoscopy. With longer follow-up and more widespread experience, the outcome of RLPN could be favourable compared to conventional laparoscopy. Improving techniques had made this surgery a safe and efficacious treatment option for small renal masses.

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Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy

Cited by 29 publications

References 7 publications

Robotic partial nephrectomy outcomes at a single institution and experience with R.E.N.A.L. nephrometry score

Robotic partial nephrectomy outcomes at a single institution and experience with R.E.N.A.L. nephrometry score

Sliding-Clip Renorrhaphy Provides Superior Closing Tension During Robot-Assisted Partial Nephrectomy

Current Status of Robot-Assisted Laparoscopic Partial Nephrectomy

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