666 EVOLUTION TO HYBRID U-LESS ROBOT-ASSISTED NEPHROURETERECTOMY

Abstract

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2011666 EVOLUTION TO HYBRID U-LESS ROBOT-ASSISTED NEPHROURETERECTOMY Jae Won Lee, Francis Raymond Arkoncel, Jae Hung Jung, Ha Bum Jeoung, Hyung Ho Lee, Woong Kyu Han, and Koon Ho Rha Jae Won LeeJae Won Lee Seoul, Korea, Republic of More articles by this author , Francis Raymond ArkoncelFrancis Raymond Arkoncel Seoul, Korea, Republic of More articles by this author , Jae Hung JungJae Hung Jung Seoul, Korea, Republic of More articles by this author , Ha Bum JeoungHa Bum Jeoung Seoul, Korea, Republic of More articles by this author , Hyung Ho LeeHyung Ho Lee Seoul, Korea, Republic of More articles by this author , Woong Kyu HanWoong Kyu Han Seoul, Korea, Republic of More articles by this author , and Koon Ho RhaKoon Ho Rha Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1596AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single site nephroureterectomy is a challenging procedure to do since it involves dissection at opposite ends of the abdomen. We present the evolution of our technique in robot-assisted nephroureterectomy with bladder cuff excision using a home-made single-port. METHODS From May 2007 to April 2010, 27 robot-assisted nephroureterectomy with bladder cuff excision were conducted by a single surgeon for upper tract urothelial tumors. One was excluded since it involved simultaneous radical prostatectomy. The first 6 were conducted with conventional technique requiring change in patient position from flank to lithotomy and re-docking the robot. The next 10 were conducted via a hybrid port technique which maintained patient position but required repositioning of the robot arms. The last 10 cases were conducted via a hybrid umbilical laparoendoscopic single-site surgery (U-LESS) without patient re-positioning, robot re-docking or robot-arm re-positioning. Patient data and operative outcomes were gathered retrospectively. RESULTS Although there have been only 10 cases using the hybrid U-LESS technique, mean operative time appear to be less compared to the two previous techniques. Mean estimated blood loss was minimal in all techniques. There was one intraoperative complication of small bowel injury during adhesiolysis in the hybrid port technique. Surgical margins were all negative. After a median followup duration of 12 months (range: 3–35), bladder recurrence was seen in 6 patients. CONCLUSIONS Despite being at the initial stages of development, hybrid U-LESS robot-assisted nephroureterectomy outcomes are encouraging. As more cases will be conducted, its true benefits and utility may be confirmed. Table 1. Comparison of perioperative outcomes Standard port Hybrid port Single port p-value Mean operative time(min) 247(±37) 247(±40) 214(±40) 0.130 Mean EBL(ml) 115(±109) 150(±141) 158(±161) 0.838 Mean Hct change 5.7(±3.2) 4.6(±2.6) 4.0(±2.3) 0.493 Mean duration of drain(day) 2.5(±1.6) 1.6(±2.3) 2.0(±1.5) 0.656 Mean hospital stay(day) 7(±2.3) 6(±3.1) 5.4(±4.9) 0.719 Abbreviation: EBL, estimated blood loss; Hct, hematocrit © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e269-e270 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jae Won Lee Seoul, Korea, Republic of More articles by this author Francis Raymond Arkoncel Seoul, Korea, Republic of More articles by this author Jae Hung Jung Seoul, Korea, Republic of More articles by this author Ha Bum Jeoung Seoul, Korea, Republic of More articles by this author Hyung Ho Lee Seoul, Korea, Republic of More articles by this author Woong Kyu Han Seoul, Korea, Republic of More articles by this author Koon Ho Rha Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...