V13-01 SUPERIOR MESENTERIC ARTERY INJURY DURING ROBOTIC LEFT RADICAL NEPHRECTOMY: PREVENTION AND MANAGEMENT

Abstract

You have accessJournal of UrologyCME1 May 2022V13-01 SUPERIOR MESENTERIC ARTERY INJURY DURING ROBOTIC LEFT RADICAL NEPHRECTOMY: PREVENTION AND MANAGEMENT Aref S. Sayegh, Anibal La Riva, Laura C. Perez, Luis G. Medina, Edward Forsyth, Ryan Powers, Ben Challacombe, Michael Stifelman, Inderbir S. Gill, and Rene Sotelo Aref S. SayeghAref S. Sayegh More articles by this author , Anibal La RivaAnibal La Riva More articles by this author , Laura C. PerezLaura C. Perez More articles by this author , Luis G. MedinaLuis G. Medina More articles by this author , Edward ForsythEdward Forsyth More articles by this author , Ryan PowersRyan Powers More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , and Rene SoteloRene Sotelo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002646.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Injury to the Superior Mesenteric Artery (SMA) during renal surgery is a rare but potentially devastating complication. It can rarely occur in patients with large left renal tumors and bulky lymphadenopathy, or in the setting of re-do surgery with significant retroperitoneal and intraabdominal scarring, which may distort the vascular anatomy. In most cases, the inadvertent injury occurs due to misidentification of the SMA as the renal artery. Failure to recognize and repair an SMA injury may result in ischemic bowel and/or mortality. Herein, we present three different scenarios of injury to the SMA when misidentified as the left renal artery during left robotic radical nephrectomy. We also describe how to avoid and manage SMA injury. METHODS: A compilation of three video clips were collected anonymously from different surgeons to demonstrate how the SMA was misidentified, injured, recognized intraoperatively, and repaired either in a transperitoneal or retroperitoneal robotic approach to left nephrectomy. RESULTS: Left robotic radical nephrectomy was started as usual. Descending colon was reflected medially, gonadal vein and ureter were used as landmarks to trace the left renal hilum. An artery arising from the aorta was apparently coursing towards the kidney and was assumed to be the left renal artery in all cases. In the first case, the SMA misidentification was timely recognized, and the injury was avoided. The second case demonstrates the SMA being clipped. Suspicious was raised after a dilated left renal vein was seen; therefore, clip removal was performed. Lastly, the third case involved a complete transection of the SMA, and it was repair intraoperatively because of awareness of severe consequences. Increases in operative time of patients experiencing an intraoperative complication are expected. Increases in length of hospital stay may occur depending on the type of complication, and sequelae can occur. CONCLUSIONS: Proper anatomic identification and recognition of the SMA may prevent its injury. Intra-operative SMA injury should be promptly identified and repaired to avoid its severe consequences. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1031 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aref S. Sayegh More articles by this author Anibal La Riva More articles by this author Laura C. Perez More articles by this author Luis G. Medina More articles by this author Edward Forsyth More articles by this author Ryan Powers More articles by this author Ben Challacombe More articles by this author Michael Stifelman More articles by this author Inderbir S. Gill More articles by this author Rene Sotelo More articles by this author Expand All Advertisement PDF DownloadLoading ...