V11-09 ROBOTIC MODIFIED BALLOON-LESS RETROPERITONEAL APPROACH FOR POSTERIOR RENAL MASSES

Abstract

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-09 ROBOTIC MODIFIED BALLOON-LESS RETROPERITONEAL APPROACH FOR POSTERIOR RENAL MASSES Thomas Lowrey, Jacob Allen, Daniel Parker, Andrew McIntosh, and Sanjay Patel Thomas LowreyThomas Lowrey More articles by this author , Jacob AllenJacob Allen More articles by this author , Daniel ParkerDaniel Parker More articles by this author , Andrew McIntoshAndrew McIntosh More articles by this author , and Sanjay PatelSanjay Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This video demonstration will describe an efficient modified robotic retroperitoneal approach for posterior renal masses, avoiding the need for balloon dilation and extensive defatting in the traditional approach. METHODS: The patient is placed in the 90 degree flank position. A 5 mm laparoscope is placed 4 cm superior to the umbilicus at the midclavicular line, which will aid in visualizing placement of the working robotic ports. The reflection of the peritoneum at the white line of Toldt is identified in order to mark the robotic camera port site 2 fingerbreadths above the iliac crest. Two medial 8-mm robotic ports are placed 2 fingerbreadths above the iliac crest and 8 cm apart using the robotic camera port as reference. Next, with laparoscopic scissors and Kittner Dissector, the lateral side wall attachments to the colon are taken down creating space to safely place the camera port and lateral most trocar. Using a 30 degree upward scope, the peritoneum along white line of Toldt and lateral kidney attachments are incised up to the splenic flexure or hepatic flexure. Complete incision of the peritoneum allows the kidney to naturally flop medially thereby doubling the working space as compared to the traditional approach. Once the white line of Toldt is mobilized, the 4th arm lifts the kidney to place the hilum on traction. After Gerota’s fascia is incised and the hilum identified, standard partial nephrectomy is performed. RESULTS: A total of 15 patients underwent this new technique without any Clavien 1-4 complications. The technique allows for efficient port placement without the need for: blind finger entry, balloon dilation, tedious dissection and sweeping of the peritoneum required for port placement, and extensive defatting of the pararenal fat to create the retroperitoneal space. The port location in this technique is the same as the traditional retroperitoneal approach, thus affording the same view with increased working space and improved visualization of landmarks. Insufflation is also more consistent given less air leaks from inadvertent peritoneal tears and from the balloon dilating port site. CONCLUSIONS: This modified retroperitoneal approach allows for quick, efficient, and safe port placement resulting in larger working space and excellent visualization of anatomical landmarks without the need for complicated retroperitoneal balloon dilation, sweeping of peritoneum for port placement, and defatting of the pararenal fat. Since the development of this technique, we have abandoned the traditional robotic retroperitoneal approach with balloon dilation at our institution. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e860-e860 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Lowrey More articles by this author Jacob Allen More articles by this author Daniel Parker More articles by this author Andrew McIntosh More articles by this author Sanjay Patel More articles by this author Expand All Advertisement Loading ...