robot-assisted laparoscopic partial nephrectomy: initial experience introduction the ready...

Robot-assisted laparoscopic partial nephrectomy: initial experience Introduction The ready transition to robotic prostatectomy for surgeons with an established background in laparoscopic prostatectomy is well described. Similarly international series suggest a short learning curve for surgeons undertaking robotic partial nephrectomy, who are already proficient in laparoscopic partial nephrectomy. Conclusions In this series, initial oncological and peri-operative outcomes comparable to mature multi-institutional series were achieved. These outcomes suggest a smooth transition to robotic partial nephrectomy for surgeons who have an established background in advanced, complex laparoscopy. Results 9 cases , median age 70 years (57 – 74). 5 males and 4 females, 6 left and 3 right sided lesions. Median lesion size was 2.5 cm (1.3 – 5). This included a 5 cm heminephrectomy as the third case of the series (Fig 1). There were 8 exophytic and 1 endophytic lesions. Median operating time was 180 mins (180 – 260). Median warm ischaemia time was 13 mins (8 – 13). There were no intensive care admissions, no transfusions and no open conversions. One patient had a transient, self-limiting neuralgia (Clavien Dindo grade 1). Postoperative renal function was within normal limits at 6 months follow up. Methods Prospective database - robot-assisted partial nephrectomy Placement of an ipsilateral ureteric catheter Transperitoneal - 4 arm approach - da Vinci S Renal hilum was dissected, kidney defatted, colonic mobilisation. Intra-operative ultrasound used to assist tumour margin Renal artery and vein seperately clamped – Scanlan robotic bulldog clamps Tumour excised - cold scissor dissection Collecting system defects repaired - integrity assessed with retrograde instillation of methylene blue Renorrhaphy - 2/0 V-loc suture Vascular clamps released - bleeding vessels suture ligated Cortical reconstruction - single, running horizontal mattress 12 inch 0/0 V-LOC suture. Floseal applied. Acknowledgements Aim To report the initial robot-assisted partial nephrectomy experience of 2 fellowship-trained surgeons established in laparoscopic partial nephrectomy in an Australian context. References Rogers et al. (2008). Robotic partial nephrectomy: a multi-institutional analysis. J Robotic Surg 2(3):141-143. Kevin Lah 1 , Devang Desai 1 , Charles Chabert 2 , Troy Gianduzzo 1,2 1 Royal Brisbane and Women’s Hospital, Queensland, Australia 2 Wesley Private Hospital, Brisbane, Queensland, Australia No. 191 Posters Proudly Supported by: Parameters Rogers, Bhayani et al Our study Study population 148 (6 centres) 9 (1 centre) Study period 5 years 12 months Surgeons 9 2 Demographics USA Brisbane, Australia Type Retrospective Prospective Age 25-83 yrs 57-74 yrs Tumour size 0.8 – 7.5 cms 1.3 – 5 cms Cancer : Benign 109 : 39 8 : 1 pT1a : 1b : 2 : 3a 87 : 15 : 3 : 4 7 : 1 : 0 : 0 Mean Operative time 197 mins 190 mins Mean Warm ischaemic time 27.8 mins 15.7 mins Blood loss 15-1000 mls 50-1000 mls +ve margin rates 6 0 Fig 1. 5 cm renal mass

Upload: taya-wilton

Post on 31-Mar-2015

219 views

Category:

Documents

0 download

Report

Download

Embed Size (px):

TRANSCRIPT

Robot-assisted laparoscopic partial nephrectomy: initial experience

IntroductionThe ready transition to robotic prostatectomy for surgeons with an established background in laparoscopic prostatectomy is well described. Similarly international series suggest a short learning curve for surgeons undertaking robotic partial nephrectomy, who are already proficient in laparoscopic partial nephrectomy.

ConclusionsIn this series, initial oncological and peri-operative outcomes comparable to mature multi-institutional series were achieved.

These outcomes suggest a smooth transition to robotic partial nephrectomy for surgeons who have an established background in advanced, complex laparoscopy.

Results9 cases , median age 70 years (57 – 74).

5 males and 4 females, 6 left and 3 right sided lesions.

Median lesion size was 2.5 cm (1.3 – 5). This included a 5 cm heminephrectomy as the third case of the series (Fig 1).

There were 8 exophytic and 1 endophytic lesions.

Median operating time was 180 mins (180 – 260).

Median warm ischaemia time was 13 mins (8 – 13).

There were no intensive care admissions, no transfusions and no open conversions. One patient had a transient, self-limiting neuralgia (Clavien Dindo grade 1).

Postoperative renal function was within normal limits at 6 months follow up.

MethodsProspective database - robot-assisted partial nephrectomy

Placement of an ipsilateral ureteric catheter Transperitoneal - 4 arm approach - da Vinci S Renal hilum was dissected, kidney defatted, colonic

mobilisation. Intra-operative ultrasound used to assist tumour margin Renal artery and vein seperately clamped – Scanlan robotic

bulldog clamps Tumour excised - cold scissor dissection Collecting system defects repaired - integrity assessed with

retrograde instillation of methylene blue Renorrhaphy - 2/0 V-loc suture Vascular clamps released - bleeding vessels suture ligated Cortical reconstruction - single, running horizontal mattress

12 inch 0/0 V-LOC suture. Floseal applied.

Acknowledgements

AimTo report the initial robot-assisted partial nephrectomy experience of 2 fellowship-trained surgeons established in laparoscopic partial nephrectomy in an Australian context.

ReferencesRogers et al. (2008). Robotic partial nephrectomy: a multi-institutional analysis. J Robotic Surg 2(3):141-143.

Kevin Lah1, Devang Desai1, Charles Chabert2, Troy Gianduzzo1,2

1 Royal Brisbane and Women’s Hospital, Queensland, Australia2 Wesley Private Hospital, Brisbane, Queensland, Australia

No. 191

Posters Proudly Supported by:

Parameters Rogers, Bhayani et al Our study

Study population 148 (6 centres) 9 (1 centre)

Study period 5 years 12 months

Surgeons 9 2

Demographics USA Brisbane, Australia

Type Retrospective Prospective

Age 25-83 yrs 57-74 yrs