V03-09 MANAGEMENT OF INTRAOPERATIVE VASCULAR INJURIES IN UROLOGIC SINGLE-PORT OR MULTI-PORT ROBOTIC SURGERY

Abstract

You have accessJournal of UrologyCME1 Apr 2023V03-09 MANAGEMENT OF INTRAOPERATIVE VASCULAR INJURIES IN UROLOGIC SINGLE-PORT OR MULTI-PORT ROBOTIC SURGERY Anh Nguyen, David Ali, Benjamin Rudnick, Rogerio Huang, Mubashir Shabil Billah, and Mutahar Ahmed Anh NguyenAnh Nguyen More articles by this author , David AliDavid Ali More articles by this author , Benjamin RudnickBenjamin Rudnick More articles by this author , Rogerio HuangRogerio Huang More articles by this author , Mubashir Shabil BillahMubashir Shabil Billah More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are many challenges to managing vascular injuries during robotic urologic surgeries. These include limited exposure due to the small field, inability to quickly expand the surgical field with retractors and additional personnel, inability manually palpate or apply manual pressure over a broad area, and reliance on a limited array of robotic instruments. Other challenges include the limited field of vision of the robotic camera, as well as reliance on insufflation to maintain adequate visualization. Consultant surgeons may not have significant experience with using the robot. These all can translate into longer operative times for repair of vascular injuries with resultant blood loss. We sought to share insights on how a robotic surgeon may handle repairing a vascular injury. METHODS: Three robotic multi- and single-port operative cases with vascular injuries were examined. Operative strategy was analyzed and discussed. RESULTS: A single-port robotic nephroureterctomy was done on a 68 year-old female with past history of endometrial cancer, hysterectomy with lymph node dissection, and radiation to the pelvis. A common iliac vein injury was incurred during dissection of the distal ureter and was repaired using robotic 4th arm to clamp the injured vessel, strategic use of ROSI suction, and non-absorbable 4-0 suture. A multi-port robotic radical prostatectomy was done on a 63 year-old male with history of Gleason 4+3 prostate cancer with inadvertent injury of the external iliac artery. A combination of robotic bulldog clamps, assistant suction and non-absorbable 4-0 suture was used to successfully repair the injury. Lastly, a multi-port robotic adrenalectomy was done for a 48 year-old female with a 6.5 cm adrenal mass with invasion into the IVC. Repair of the IVC was done with a combination of 4th arm and bulldog clamps, vessel loop traction, and non-absorbable 4-0 suture. CONCLUSIONS: Strategies to robotically repair inadvertent vascular injuries during urologic surgery require strategic use of the 4th robotic arm, assistant- or robotically-applied clamps, and assistant instruments to free up working arms. Non-absorbable suture should be readily available. Closure of large blood vessels require releasing clamps momentarily before closure to avoid air embolus. Maximal visualization can be achieved using the zoom features of the robotic camera and its ability to discriminate fine detail. Maintaining composure with frequent and adequate communication with anesthesia and intensive care teams is vital in safely managing vascular injuries. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e248 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anh Nguyen More articles by this author David Ali More articles by this author Benjamin Rudnick More articles by this author Rogerio Huang More articles by this author Mubashir Shabil Billah More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...