Robotic Partial Nephrectomy with the Da Vinci Xi.

George J S Kallingal,Dipen J Parekh,Mark L Gonzalgo,Sanjaya Swain,Fadi Darwiche,Murugesan Manoharan,Sanoj Punnen

doi:10.1155/2016/9675095

Abstract

Purpose. The surgical expertise to perform robotic partial nephrectomy is heavily dependent on technology. The Da Vinci Xi (XI) is the latest robotic surgical platform with significant advancements compared to its predecessor. We describe our operative technique and experience with the XI system for robotic partial nephrectomy (RPN). Materials and Methods. Patients with clinical T1 renal masses were offered RPN with the XI. We used laser targeting, autopositioning, and a novel “in-line” port placement to perform RPN. Results. 15 patients underwent RPN with the XI. There were no intraoperative complications and no operative conversions. Mean console time was 101.3 minutes (range 44–176 minutes). Mean ischemia time was 17.5 minutes and estimated blood loss was 120 mLs. 12 of 15 patients had renal cell carcinoma. Two patients had oncocytoma and one had benign cystic disease. All patients had negative surgical margins and pathologic T1 disease. Two postoperative complications were encountered, including one patient who developed a pseudoaneurysm and one readmitted for presumed urinary tract infection. Conclusions. RPN with the XI system can be safely performed. Combining our surgical technique with the technological advancements on the XI offers patients acceptable pathologic and perioperative outcomes.

Highlights

Robotic surgery has been increasingly utilized for a variety of procedures including robotic partial nephrectomy (RPN)
In this paper we detail our first experiences and lessons learned with the Da Vinci Xi system for RPN
Patients with T2 masses or highly complex renal masses where partial nephrectomy was not deemed feasible were not included in this study

Summary

Introduction

Robotic surgery has been increasingly utilized for a variety of procedures including robotic partial nephrectomy (RPN). Compared to laparoscopic partial nephrectomy, RPN is technically less difficult and is associated with less chance of conversion to radical nephrectomy [1], less blood loss [2,3,4], shorter ischemia times [2, 5], and shorter hospital stay [2, 3]. The robotic platform allows better articulation of the wrists and improved vision in 3 dimensions, which has facilitated a shorter learning curve for surgeons adopting minimally invasive surgery. Since the year 2000, when the Da Vinci robot was first utilized, the robot has undergone several iterations, each with tremendous technological advancement over the prior version.

Methods

Results

Conclusion