Robotic assisted retroperitoneoscopic nephroureterectomy - first experience and the hybrid port technique

Abstract

Robot-assisted renal surgery is usually performed transperitoneally due to more available space for excursion of the robotic arms. To our knowledge, we report the first experience with robotic retroperitoneoscopic nephroureterectomy using the Da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) and a hybrid port technique. Robotic retroperitoneal nephroureterectomy was performed on two male patients. One 37-year-old patient had a painful non-functioning hydronephrotic left kidney and megaureter; the other aged 76 had a muscle invasive lower left ureteric tumour. Both the procedures were successfully completed with the robot without conversion. Mean operative time was 182.5 min and estimated blood loss 75 ml. Histological examination confirmed the preoperative diagnoses; margins were clear in the patient with tumour. Postoperative recovery was uneventful. We report the technical feasibility of robotic retroperitoneoscopic nephroureterectomy. However, as with all new technology, the benefits need to be further evaluated and proven before this technique can be widely accepted.

Retroperitoneal robotic renal surgery: technique and early results

“…Although a few cases of a robotic retroperitoneal approach have been described for nephroureterectomy [13] and pediatric pyeloplasty [14], there is a paucity of reports with a detailed description of technique for a retroperitoneal approach for other robotic kidney surgeries, such as partial nephrectomy and radical nephrectomy. Rose et al presented their experience of robotic retroperitoneal nephroureterectomy in two patients using a hybrid four-port technique [13]. They advocated that the four robotic ports should be placed at a minimum distance of 6 cm from the camera.…”

“…Robotic renal surgery has been described by several groups [7][8][9][10][11][12][13]18], primarily utilizing a transperitoneal approach. Although a few cases of a robotic retroperitoneal approach have been described for nephroureterectomy [13] and pediatric pyeloplasty [14], there is a paucity of reports with a detailed description of technique for a retroperitoneal approach for other robotic kidney surgeries, such as partial nephrectomy and radical nephrectomy.…”

“…Most reports on robotic renal surgery have utilized a transperitoneal approach [7][8][9][10][11][12]. A robotic retroperitoneal approach has been described for nephroureterectomy [13] and pediatric pyeloplasty [14], but there is a paucity of literature describing detailed technique for a retroperitoneal approach for robotic radical nephrectomy and partial nephrectomy. We describe the optimization of a robotic retroperitoneal approach applicable to a variety of renal surgeries and our early results.…”

Laparoscopic radical nephroureterectomy for transitional cell carcinoma: where are we in 2007?

“…Robot-assisted LNU has recently been described using a retroperitoneoscopic approach. Rose et al [18] reported use of a four-port approach to perform the robotic laparoscopic portion of the operation followed by open excision of the bladder cuff. The utility of this approach remains to be determined.…”

Robotic renal surgery: The future or a passing curiosity?

“…Numerous feasibility case series have been reported highlighting the safety and efficacy of robotic assistance. [43][44][45][46][47][48] No major patient or equipment complications were reported. Although a standard laparoscopic approach is usually employed for nephrectomy at most centres today, robot-assisted techniques are attractive to surgeons who have minimal laparoscopic experience.…”