Robot-assisted single port radical nephrectomy and cholecystectomy: description and technical aspects

ABSTRACT

Introduction

Robot-Assisted Single Site Radical Nephrectomy (RASS-RN) has been reported by surgeons in Europe and United States (¹–³). To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America.

Case

A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected.

Results

Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3 cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using an 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis.

Discussion

Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (²). Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision.

Conclusion

RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20160560-Mota_et_al

Int Braz J Urol. 2018; 44 (Video #3): 202-3

• Published as Ahead of Print: June 21, 2017

REFERENCES

• ¹
  Won Lee J, Arkoncel FR, Rha KH, Choi KH, Yu HS, Chae Y, Han WK. Urologic robot-assisted laparoendoscopic single-site surgery using a homemade single-port device: a single-center experience of 68 cases. J Endourol. 2011;25:1481-5.
• ²
  Khanna R, Stein RJ, White MA, Isac W, Laydner H, Autorino R, Hillyer S, Spana G, Shah G, Haber GP, Kaouk J. Single institution experience with robot-assisted laparoendoscopic single-site renal procedures. J Endourol. 2012;26:230-4.
• ³
  Mathieu R, Verhoest G, Vincendeau S, Manunta A, Bensalah K. Robotic-assisted laparoendoscopic single-site radical nephrectomy: first experience with the novel Da Vinci single-site platform. World J Urol. 2014;32:273-6.

Publication Dates

• Publication in this collection
  Jan-Feb 2018

History

• Received
  09 Dec 2016
• Accepted
  27 Apr 2017