Retroperitoneal robotic renal surgery: technique and early results

Patel, Manish; Kaul, Sanjeev; Laungani, Rajesh; Eun, Daniel; Bhandari, Mahendra; Menon, Mani; Rogers, Craig G.

doi:10.1007/s11701-009-0123-0

Cited by 12 publications

(10 citation statements)

References 19 publications

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“…Consequently, the results may not be applicable to the urologic community at large. Our study focused on a transperitoneal approach for RPN, although we did include a subset analysis of patients who underwent a retroperitoneal RPN and we have previously described our experience with a retroperitoneal approach for robotic kidney surgery [37]. Patients who underwent a retroperitoneal approach had similar perioperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

Robotic partial nephrectomy in the setting of prior abdominal surgery

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate our experience with robotic partial nephrectomy in patients with previous abdominal surgery and evaluate the effect of previous abdominal surgery on perioperative outcomes. We also describe a technique for intraperitoneal access for patients with prior abdominal surgery utilizing the 8 mm robotic camera for direct‐vision trocar placement. PATIENTS AND METHODS From a prospective cohort of 197 consecutive patients who underwent robotic renal surgery at a single academic institution, a total of 95 patients underwent transperitoneal robotic partial nephrectomy (RPN). Patients with and without previous abdominal surgery were compared. Patients with prior abdominal surgery were subcategorized into two groups: upper midline or ipsilateral upper quadrant scar or lower abdominal, contralateral, or minimally‐invasive scar. Demographic and perioperative variables were compared between the surgery and no surgery groups. Access was obtained using a Veress needle or Hassan technique. We utilized a technique of direct vision placement of the initial trocar on our 10 most recent cases, using an 8 mm robotic camera placed through the obturator of 12 mm clear‐tipped trocar. Lysis of adhesions was performed as needed to allow for placement of additional robotic ports. RESULTS A total of 95 patients underwent transperitoneal RPN, of which 41 (43%) had a history of prior abdominal surgery and six had upper midline or ipsilateral upper quadrant scars. There were no statistically significant differences between patients with previous abdominal surgery and patients with no previous abdominal surgery in BMI (30.4 vs 29.4 kg/m2), median tumor size (2.5 cm vs 2.3), median total operative time (246 vs 250 min), median warm ischemia time (21 vs 16 min), median EBL (150 vs100 ml), clinical stage, transfusion rate, or complications. A total of six patients underwent 7 previous upper midline or ipsilateral upper quadrant surgeries, including open cholecystectomy‐2 patients (33%), open partial gastrectomy‐2 patients (33%) and exploratory laparotomy‐1 patient (17%). Complications in this group were an enterotomy during lysis of adhesions that was repaired robotically without sequelae and a mesenteric hematoma during Veress needle placement. A total of 35 patients underwent 16 other prior abdominal surgeries, including abdominal hysterectomy‐10 patients (29%), umbilical/inguinal hernia repair‐9 patients (26%) and appendectomy‐7 patients (20%). There were no access related injuries in the 10 cases in which the robotic 8 mm camera was used for initial trocar placement. CONCLUSIONS Transperitoneal robotic partial nephrectomy is feasible in the setting of prior abdominal surgery. The majority of these patients can have their procedure performed safely without an increase in complications. Direct‐vision intraperitoneal placement of initial trocar may be achieved by using an 8 mm robotic camera, without the need to switch between conventional and robotic cameras.

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Section: Discussionmentioning

confidence: 99%

Robotic partial nephrectomy in the setting of prior abdominal surgery

et al. 2010

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“…Patel et al [4] reported a series of 10 patients who underwent robotic retroperitoneal renal surgery (three partial nephrectomies, three radical nephrectomies, two simple nephrectomies, one pyeloplasty and one cryoablation). Patel et al [4] reported a series of 10 patients who underwent robotic retroperitoneal renal surgery (three partial nephrectomies, three radical nephrectomies, two simple nephrectomies, one pyeloplasty and one cryoablation).…”

Section: Discussionmentioning

confidence: 99%

Robotic retroperitoneal surgery

Patel

Porter²

2013

Current Opinion in Urology

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“…We use the transperitoneal route, as do most of the RPN series reported. A retroperitoneal approach has also been described [19] .…”

Section: Methodsmentioning

confidence: 99%

Robotic partial nephrectomy: The new horizon

Laydner

Kaouk

2012

Arab Journal of Urology

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BackgroundThere has been an exponential growth in the reporting of series of robotic partial nephrectomy (RPN). We review the technique of RPN and the outcomes from large single-centre series of RPN.MethodsWe searched databases to identify original articles related to RPN. For the technical aspects, we describe our technique and provide a general review of previous work. For outcomes, we reviewed previous reports using more rigid criteria, including only single-institution studies with at least 50 patients undergoing RPN.ResultsWe found seven retrospective studies that met our criteria, with a total of 701 patients. Mean tumour size was 2.8 cm, with an average R.E.N.A.L. score (Radius, tumour size as maximum diameter; Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior, a/posterior, p, descriptor, and the Location relative to the polar line) of 6.8. The mean warm ischaemia time was 21 min and mean operative duration was 196 min. The mean estimated blood loss was 182 mL, with a 7.4% transfusion rate. The conversion rate was 1.7% and the postoperative complication rate was 14%. The mean length of stay was 3.6 days. There were positive surgical margins in 1.7% of patients. The mean decrease in renal function was 5.4% and the mean follow-up was 8.4 months.ConclusionsRPN is feasible and safe for different levels of complexity of renal tumours. Perioperative outcomes are comparable to those found with more established techniques. Future studies should compare different approaches and prioritise prospective and randomised designs.

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Retroperitoneal robotic renal surgery: technique and early results

Cited by 12 publications

References 19 publications

Robotic partial nephrectomy in the setting of prior abdominal surgery

Robotic partial nephrectomy in the setting of prior abdominal surgery

Robotic retroperitoneal surgery

Robotic partial nephrectomy: The new horizon

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