Robot-assisted Laparoscopic Radical Nephrectomy Research Articles

The First Ever Robotic-Assisted Laparoscopic Radical Nephrectomy with Inferior Vena Cava Thrombectomy Performed in Thailand: A Case Report of Atypical Presentation of Urothelial Carcinoma with Tumor Thrombus

Background: Robotic-assisted surgery was proposed as an alternative to open surgery for management of inferior vena cava (IVC) thrombus together with radical nephrectomy in complex renal mass. Here, the authors reported the first case of this type to be managed via this surgical technique in Thailand. Case Report: A 76-year-old Thai female presented with right renal mass with tumor thrombus in the IVC extending 3 cm above the level of the renal vein. The presumed diagnosis was renal cell carcinoma of the right kidney with level 2 tumor thrombus in IVC, clinical staging T3bN0M0. The patient underwent robotic-assisted laparoscopic IVC thrombectomy together with right radical nephrectomy at Siriraj Hospital (Bangkok, Thailand) in May 2020. Results: The operation proceeded uneventfully without immediate complication. The postoperative reduction of IVC diameter was approximately 30%. Total IVC clamp time was 50 minutes, operative time was five hours, with docking time of 20 minutes and console time of 250 minutes, estimated intraoperative blood loss was 2,600 mL, and length of hospital stay was four days. At 30-days and 90-days postoperation, no thromboembolic event or compromising lower extremity venous return was detected. The pathological report revealed high-grade urothelial cell carcinoma with invasion into perinephric fat. Carcinoma involvement was observed in the tumor thrombus and IVC wall (T4N0M0). Conclusion: Robotic-assisted surgery of the IVC is a complex operation that requires robotic surgical proficiency and a highly experienced team. The observed success in the present case demonstrated the feasibly of this procedure in Thailand. Additional benefits include less postoperative pain, reduced blood loss, smaller surgical wound size, and shorter length of hospital stay. Keywords: Robotic-assisted laparoscopic radical nephrectomy; Inferior vena cava thrombectomy; Thailand

Sarcomatoid renal cell carcinoma with an inferior vena cava tumor thrombus that was completely resected by robot-assisted laparoscopic radical nephrectomy after neoadjuvant therapy nivolumab plus ipilimumab: a case report.

We here present a patient with a sarcomatoid renal cell carcinoma complicated by inferior vena cava tumor thrombus that we treated with nivolumab plus ipilimumab. This resulted in shrinkage of the tumor, enabling complete resection by robot-assisted laparoscopic radical nephrectomy. The patient is still alive with no evidence of recurrence.

Application of Improved Robot-assisted Laparoscopic Telesurgery with 5G Technology in Urology

The demand for telesurgery is rising rapidly, but robust evidence regarding the feasibility of its application in urology is still rare. From March to October 2021, a surgeon-controlled surgical robot in a tertiary hospital in Qingdao was used to remotely conduct robot-assisted laparoscopic radical nephrectomy (RN) in 29 patients located in eight primary hospitals. The median round-trip delay was 26 ms (interquartile range [IQR] 5) and the median distance between the primary hospital and the surgeon was 187 km (IQR 57). Both the master unit and the slave unit were guaranteed by network and mechanical engineers, and surgical assistants were well prepared on the patient side to prevent complications. The primary evaluation metric was the success rate, defined as the percentage of patients who underwent successful remote RN without conversion to other surgical procedures and no major intraoperative or postoperative complications. The results demonstrate that the combination of 5G technology and surgical robots is a novel potential telemedicine-based therapy choice for renal tumors. Patient summaryOur study shows that telesurgery using 5G technology is a safe and feasible treatment option for patients with kidney tumors. The total delay between the remote location and the operating rooms where surgery was being performed was just 200 ms. This approach could reduce health care costs and improve the quality of medical services accessed by patients.

Solitary Brain Metastasis Detected 1 Year After Robot-Assisted Laparoscopic Radical Nephrectomy: A Case Report

Brain metastases are not rare in patients with renal cell carcinoma. However, there have been few reports of isolated brain metastases. In patients with localized renal masses, urologists tend to evaluate only the chest and abdomen region. We report the case of a 65-year-old patient who presented with sudden left-sided weakness. He underwent brain surgery after a mass was found on brain imaging. Histopathology analysis revealed a single brain metastasis that occurred 15 months after robot-assisted laparoscopic radical nephrectomy for renal cell carcinoma. Although the patient had been evaluated for localized kidney cancer in preoperative staging, he had not complained of any neurological symptoms before or after radical nephrectomy. Therefore, we had not perceived a need for brain evaluation at that time. This report is intended to draw attention to the need for further evaluation in patients with large renal masses, as well as patients with moderate to high recurrence risk scores.

Case reports of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy: A retrospective analysis.

Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery procedure. High rates of operative complications and mortality are usually associated with an open surgery procedure. The recently emerged robot-assisted laparoscopic radical nephrectomy (RAL-RN) and IVC tumor thrombectomy have shown to reduce operative related complications in patients with renal cell carcinoma.This case series study aimed to summarize technical utilization, perioperative outcomes, and efficacies of RAL-RN and IVC tumor thrombectomy in our hospital. A retrospective analysis was performed on clinical data from 20 patients who underwent RAL-RN and IVC tumor thrombectomy from January 2017 to December 2019 in our department.Patients had a median age of 59 years (interquartile range [IQR], 46–68). Four patients had renal neoplasm on left side and 16 on right side. Nineteen patients underwent RAL-RN (level 0: n = 2) or RAL-RN with IVC thrombectomy (n = 17) (level I: n = 3; level II: n = 12; and level III: n = 3) and 1 patient was converted into an open surgery. The median operative time was 328 minutes (IQR, 221–453). The estimated median blood loss was 500 mL (IQR, 200–1200). The median size of removed renal carcinoma was 67 cm2 (IQR, 40–91); the length of IVC tumor thrombus was 5 cm (IQR, 3–7). The postsurgery hospital length of stay was 6 days (IQR, 5–7). The complications included intestinal obstruction (n = 1), lymphatic fistula (n = 1), heart failure (n = 1), and low hemoglobin level (n = 1). The outcomes for patients after 16 months (IQR, 11–21) follow-up were tumor-free (n = 10), tumor progression (n = 4), loss of contact (n = 1), and death (n = 5).We concluded that RAL-RN and IVC thrombectomy renders good safety profiles including minimal invasiveness, low estimated median blood loss, short hospitalization, low morbidity, and quick renal function recovery. The long-term efficacy needs a further investigation.

Identifying tumor-related risk factors for simultaneous adrenalectomy in patients with cT1 - cT2 kidney cancer during robotic assisted laparoscopic radical nephrectomy.

Background In some cases, preservation of adrenal gland could be at risk in patients with cT1 and cT2 RCC. The aim of this study was to evaluate tumor-related factors that can potentially increase the risk of simultaneous adrenalectomy during robotic-assisted laparoscopic radical nephrectomy (RALRN) in patients with cT1-cT2 disease and the impact of performing such procedure on recurrence-free survival (RFS) and complication rates. Methods We used a multi-institutional kidney cancer database where we identified patients who underwent RALRN with or without adrenalectomy. We evaluated the tumor-related characteristics that could potentially increase the risk of adrenal gland resection of these patients. We also reported RFS at 12-24 months of follow-up, which was compared with an inverse probability of treatment weighted (IPTW) multivariable cox proportional hazards regression model and postoperative complications, which was compared with an IPTW multivariable logistic regression model. Results Tumor size, cT stage, pT stage, histologic subtype, sarcomatoid differentiation, BMI, lymph node involvement, metastatic disease, Fuhrman grade do not increase the risk of simultaneous adrenalectomy during RALRN. Moreover, RALRN with adrenalectomy had no significant benefit in RFS. No differences in post-operative complications were noted. Conclusions Our evaluated tumor-related characteristics did not show to impact the incidence of simultaneous adrenalectomy. Adrenal gland resection T does not provide significant benefit in recurrence-free survival. We consider that RALRN with adrenalectomy should be reserved only for patients with adrenal compromise as stated previously regardless that it has shown to be a safe procedure.

P069 - Robotic Assisted Laparoscopic Radical Nephrectomy (RALN) for T3a tumours with renal vein involvement

P069 - Robotic Assisted Laparoscopic Radical Nephrectomy (RALN) for T3a tumours with renal vein involvement

PD02-11 COMPARISON OF PERIOPERATIVE OUTCOMES BASED ON SURGICAL APPROACH FOR RENAL MASSES > 10CM

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I (PD02)1 Apr 2020PD02-11 COMPARISON OF PERIOPERATIVE OUTCOMES BASED ON SURGICAL APPROACH FOR RENAL MASSES > 10CM Felix Chen*, Jenny Chang, Argyrios Ziogas, John Sfakianos, Ketan Badani, Edward Uchio, Hoda Anton-Culver, and Greg Gin Felix Chen*Felix Chen* More articles by this author , Jenny ChangJenny Chang More articles by this author , Argyrios ZiogasArgyrios Ziogas More articles by this author , John SfakianosJohn Sfakianos More articles by this author , Ketan BadaniKetan Badani More articles by this author , Edward UchioEdward Uchio More articles by this author , Hoda Anton-CulverHoda Anton-Culver More articles by this author , and Greg GinGreg Gin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000822.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive approaches for radical nephrectomy have surpassed open surgery. Robotic-assisted laparoscopic radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN) but there are concerns over costs and measurable benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, we compare perioperative outcomes for robotic-assisted, laparoscopic, and open radical nephrectomy for very large renal masses. METHODS: Using the National Cancer Database, we identified patients who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010-2015. We excluded patients with cT3b-4 disease. Patients were analyzed according to surgical approach: RRN versus LRN versus ORN. Using multivariate logistic and linear regression, perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30 and 90-day mortality were compared among cohorts. 1:1 Propensity matching was also performed to compare cohorts. We also analyzed utilization trends of each approach over the study period. RESULTS: A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). On multivariate analysis, LRN had a higher rate of conversion to open compared to RRN (OR 1.48; 95% CI 1.10-1.98; p=0.0087). Compared to ORN, recipients of either RRN or LRN had similar rates of 30-day readmission, 30-day mortality, and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ± 0.19; p<0.0001) and LRN (-1.40 days ± 0.12; p<0.0001) compared to ORN. Conversion to open from RRN or LRN added 1.3 additional days of inpatient stay. RRN and LRN were less likely to have positive surgical margin than ORN (RRN: OR 0.75; 95% CI 0.56-0.99; p=0.044, LRN: OR 0.64; 95% CI 0.52-0.78; p<0.0001). Over the study period, RRN use increased from 4.1% to 14.8%, LRN from 20.9% to 25.6%, while ORN use decreased from 75% to 59.6%. CONCLUSIONS: Minimally invasive approaches are increasingly utilized in very large renal masses. After adjusting for covariates, RRN has lower rates of conversion to open but produces comparable perioperative outcomes to pure laparoscopy. Minimally invasive approaches have shorter length of inpatient stay but otherwise report similar readmission and mortality rates compared to open radical nephrectomy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e70-e71 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felix Chen* More articles by this author Jenny Chang More articles by this author Argyrios Ziogas More articles by this author John Sfakianos More articles by this author Ketan Badani More articles by this author Edward Uchio More articles by this author Hoda Anton-Culver More articles by this author Greg Gin More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-assisted laparoscopic radical nephrectomy and inferior vena cava thrombectomy: A multicentre Indian experience

ABSTRACT Objective To assess feasibility of robot-assisted laparoscopic radical nephrectomy (RALRN) and inferior vena cava thrombectomy (IVCT) in treating renal tumours with level I–III IVC thrombi and to assess their outcomes. Patients and methods We conducted a retrospective analysis of RALRN-IVCTs, involving four centres across India, from September 2015 to June 2019. We analysed patients who underwent RALRN-IVCT for level I–III thrombi according to the Mayo classification. The total operative duration with console time, length of hospital stay, preoperative and postoperative creatinine, IVC clamp time and intraoperative blood loss were recorded. Results Of the 13 patients that underwent RALRN-IVCT, five had a level I thrombus, seven had level II, and one had a level III thrombus. In all, 11 of the patients had right-sided tumours and the remaining two had left-sided tumours. The mean (SD) age of the patients was 56.5 (12.3) years, the mean (SD) operative time was 329.5 (97.22) min, the mean (SD) console time was 222.5 (70) min, the mean (SD) blood loss was 395 (170) mL, and the mean (SD) IVC clamp time was 19.14 (9.5) min. The mean (SD) length of hospital stay was 7.8 (3.27) days. Of the 13 patients, 12 had clear cell renal cell carcinoma (RCC) and one had papillary RCC. The mean (range) follow-up was 19 (4–50) months. One patient had upfront metastasis and two patients developed metastasis, while 10 patients remained disease-free during the follow-up. Conclusion With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level I–III IVCT is feasible and can be performed efficiently. Larger experiences, with longer follow-ups and comparisons with open surgery are needed to confirm these initial outcomes. Abbreviations ECOG: Eastern Cooperative Oncology Group; IVC: inferior vena cava; IVCT: inferior vena cava thrombectomy; (RAL)RN: (robot-assisted laparoscopic) radical nephrectomy

Application of hidden incision in specimen extraction of robot-assisted laparoscopic pediatric radical nephrectomy

To investigate the value of hidden incision applied to specimen extraction in children's robot-assisted laparoscopic radical nephrectomy. The clinical data of robotic-assisted laparoscopic radical nephrectomy in our hospital were retrospectively analyzed. The patients were treated with 60° lateral position and the eyepiece Trocar was located at the umbilical contralateral margin. The operation hole 1 is located 6-7 cm above the anterior median line (depending on the abdominal wall space of the child), and the operation hole 2 is located at the intersection of the anterior median line and the lower transverse Pfannenstiel, Trocar sneaked under the skin, and then inserted into the abdominal cavity (1.5cm above the operation hole 2) , if the auxiliary hole is needed, the auxiliary hole Trocar is placed on the affected side of the lower abdominal transverse line. All the operations are performed with radical resection. The specimen was placed in the specimen bag, then extend the lower abdominal transverse incision (the length of the incision is the smallest diameter of the kidney), the specimen bag is taken through the incision (Pfannenstiel incision), and the wound is partially injected with ropivacaine mesylate. Postoperative routine cefuroxime to prevent infection, no analgesic pump. A total of 7 patients with robot-assisted laparoscopic radical nephrectomy were enrolled in our hospital from August 2015 to February 2019, including 4 boys, 3 girls, 5 left side, 2 right side. The average length of the incision is 6.5cm (5.5-7.0cm). All the specimens were completely removed. The average postoperative hospital stay was 4.5 days (4-7 days). There was no active bleeding, splitting, infection in the postoperative wound, the average follow-up time is 25m (4-46m), no scar hyperplasia was observed. The hidden incision (Pfannenstiel incision) can be safely and effectively applied to specimen extraction in children's robot-assisted laparoscopic radical nephrectomy.

Identifying tumor-related risk factors for simultaneous adrenalectomy in patients with cT1-cT2 kidney cancer during robotic assisted laparoscopic radical nephrectomy.

In some cases, preservation of adrenal gland could be at risk in patients with cT1 and cT2 RCC. The aim of this study was to evaluate tumor-related factors that can potentially increase the risk of simultaneous adrenalectomy during robotic-assisted laparoscopic radical nephrectomy (RALRN) in patients with cT1-cT2 disease and the impact of performing such procedure on recurrence-free survival (RFS) and complication rates. We used a multi-institutional kidney cancer database where we identified patients who underwent RALRN with or without adrenalectomy. We evaluated the tumor-related characteristics that could potentially increase the risk of adrenal gland resection of these patients. We also reported RFS at 12-24 months of follow-up, which was compared with an inverse probability of treatment weighted (IPTW) multivariable cox proportional hazards regression model and postoperative complications, which was compared with an IPTW multivariable logistic regression model. Tumor size, cT stage, pT stage, histologic subtype, sarcomatoid differentiation, BMI, lymph node involvement, metastatic disease, Fuhrman grade do not increase the risk of simultaneous adrenalectomy during RALRN. Moreover, RALRN with adrenalectomy had no significant benefit in RFS. No differences in post-operative complications were noted. Our evaluated tumor-related characteristics did not show to impact the incidence of simultaneous adrenalectomy. Adrenal gland resection T does not provide significant benefit in recurrence-free survival. We consider that RALRN with adrenalectomy should be reserved only for patients with adrenal compromise as stated previously regardless that it has shown to be a safe procedure.

The Association of Robot-assisted Versus Pure Laparoscopic Radical Nephrectomy with Perioperative Outcomes and Hospital Costs

BackgroundAlthough robot assistance can facilitate the advantages of minimally invasive surgery, it is unclear whether it offers benefits in settings in which laparoscopic surgery has been established as the standard of care. ObjectiveTo examine the comparative effectiveness of robot-assisted laparoscopic radical nephrectomy (RALRN) and laparoscopic radical nephrectomy (LRN) using a nationwide data set. Design, setting, and participants8316 adults who underwent RALRN or LRN for non-urothelial renal cancer from the Nationwide Inpatient Sample from 2010 to 2013. InterventionRALRN and LRN. Outcome measurements and statistical analysisThe associations of surgical approach with perioperative outcomes and total hospital costs were evaluated using multivariable logistic regression. Results and limitationsOver the study period, utilization of RALRN increased from 46% to 69%. Compared to LRN, RALRN was associated with lower rates of intraoperative (0.9% vs 1.8%; p<0.001) and postoperative complications (20.4% vs 27.2%; p<0.001), but there were no differences in perioperative blood transfusion (5.6% vs 6.2%; p=0.27) and prolonged hospitalization (7.2% vs 7.1%; p=0.81). RALRN was also significantly associated with higher total hospital costs (median $16 207 vs $15 037; p<0.001). In multivariable analyses, RALRN remained independently associated with a lower risk of intraoperative (odds ratio [OR] 0.50; p=0.001) and postoperative complications (OR 0.72; p<0.001) but not perioperative blood transfusion (OR 1.10; p=0.34), and with a higher risk of prolonged hospitalization (OR 1.29; p=0.007) and higher mean total hospital costs (+$1468; p<0.001). There was no effect modification by hospital volume. ConclusionsAlthough RALRN was independently associated with a reduction in perioperative complications compared to LRN, it was associated with prolonged hospitalization and higher total hospital costs. These relationships must be interpreted in light of potential differences in case mix. Patient summaryAlthough robot-assisted laparoscopic radical nephrectomy was independently associated with a reduction in perioperative complications compared to laparoscopic radical nephrectomy, it was associated with prolonged hospitalization and higher total hospital costs.

International multi-center study on clinical efficiency of robot-assisted laparoscopic partial nephrectomy in the treatment of clinical T2 renal tumors

Objective To analyze the safety and effectiveness of robot-assisted laparoscopic partial nephrectomy(RLPN) for cT2 renal tumors in international multi-centers. Methods This study was conducted to collect information on surgical procedures performed by RLPN and robot assisted laparoscopic radical nephrectomy(RRN) in nineteen international urological centers from January 2012 to December 2017. RLPN were performed in 159 patients (118 males and 41 females), with the average age of (59.3±13.2) years, body mass index(BMI) of (28.7±5.4 )kg/m2, preoperative GFR of (77.3±22.1) ml/min. RRN were performed in 219 patients, with the average age of (62.0±12.9) years, BMI of (28.7±6.1)kg/m2, preoperative GFR of (71.4±20.3) ml/min. There was no statistical difference between the two groups in gender and BMI. The age of the patients in RLPN group was younger than that in RRN group, and the preoperative GFR was better. The patient′s baseline demographics, perioperative data, tumor pathology, oncologic outcomes, and renal function(GFR) were recorded. Results All 378 cases underwent successful surgery. The operation time of RLPN was 150 min(65-353 min), which was shorter than that of RRN [180 min(85-361 min), P<0.001]. The intra-operative blood loss of RLPN was more than that of RRN [150 ml(40-3 000 ml) vs. 100 ml (10-1 100 ml), P<0.001]. The incidence of intra-operative complications were not statistically different between the two groups [5.7%(9/159) vs. 3.2%(7/219), P=0.240]. The incidence of postoperative complications was higher in the RLPN group than that in RRN group [19.5%(31/159) vs. 10.5%(23/219), P=0.014], but there was no significant difference in the incidence of complications of grade 3 or above [4.4%(7/159) vs. 2.3%(5/219), P=0.246] . The recurrence-free survival rate of RLPN group was higher than that of RRN group [91.4%(117/128) vs. 81.9%(167/204), P=0.013], and RLPN group was more conducive to renal function protection (P<0.001). Conclusions RLPN for cT2 tumors can obtain effective tumor control rate and better renal function preservation. It could be an acceptable alternative for surgical management of cT2 tumors. Key words: Kidney neoplasms; Locally advanced; Partial nephrectomy; Renal function; Radical nephrectomy

Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.

Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8mm robotic, one 8mm robotic, bariatric length (arm 3), 15mm for the assistant and 12mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300cc, console time 140min, operating room time 200min, anesthesia time 180min, hospital stay 2.5days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.

Cost Aspects of Radical Nephrectomy for the Treatment of Renal Cell Carcinoma in Korea: Open, Laparoscopic, Robot-Assisted Laparoscopic, and Video-Assisted Minilaparotomy Surgeries

PurposeThis study aimed to comparatively evaluate the cost-effectiveness of four different types of radical nephrectomy (RN) techniques: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgery (VAMS).Materials and MethodsAmong patients who were diagnosed with renal cell carcinoma and underwent RN, 20 patients were selected who received open, laparoscopic, robot-assisted laparoscopic, or VAMS RN between January 2008 and December 2010. Their medical fees were divided into four categories: procedure and operation, anesthesia, laboratory test, and medical supply fees. The medical costs of the patients were also divided into insured and uninsured costs.ResultsThe total direct cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN were 2,023,791±240,757, 2,024,246±674,859 (p=0.998), 3,603,557±870,333 (p<0.01), and 8,021,902±330,157 (p<0.01) Korean Won (KRW, the currency of South Koea), respectively. The total insured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 1,904,627±231,957, 1,798,127±645,602 (p=0.634), 3,039,769±711,792 (p<0.01), and 899,668±323,508 (p<0.01) KRW, respectively. The total uninsured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 119,163±24,581, 226,119±215,009, 563,788±487,798 (p<0.01), and 7,122,234±56,117 (p<0.01) KRW, respectively. Medical supply fees accounted for the largest portion of the costs and amounted to 33.43% of the VAMS cost.ConclusionsVAMS RN is as cost-effective as open surgery. Furthermore, it is comparatively more cost-effective than laparoscopic and robot-assisted laparoscopic RN.

Near Infrared Fluorescence Imaging With Robotic Assisted Laparoscopic Partial Nephrectomy: Initial Clinical Experience for Renal Cortical Tumors

We evaluated the utility of near infrared fluorescence of intravenously injected indocyanine green in performing robotic assisted laparoscopic partial nephrectomy. In addition, we evaluated the initial performance of a novel near infrared fluorescence imaging system integrated into the da Vinci® Si Surgical System during robotic assisted laparoscopic nephrectomy. Fluorescence imaging for the da Vinci Si Surgical System was used for all cases. Indocyanine green was injected before near infrared imaging. Immediate imaging assessed the renal vasculature while delayed imaging differentiated renal cortical tumors from normal parenchyma. The intraoperative performance of near infrared fluorescence of intravenous indocyanine green was evaluated for tumor appearance relative to surrounding renal parenchyma as well as identification of the renal vasculature. A total of 11 patients underwent robotic assisted laparoscopic nephrectomy with 2 converted to robotic assisted laparoscopic radical nephrectomy. Indocyanine green injections were repeated up to a total of 5 times depending on the goal of visualization. Of the 11 patients 10 demonstrated malignancy on final pathology. Of the malignant tumors 7 were hypofluorescent and 3 were isofluorescent compared to the surrounding renal parenchyma. Near infrared fluorescence imaging delineated the vascular anatomy in all cases. All surgical margins were negative on final pathology. Intraoperative imaging of indocyanine green with near infrared fluorescence is a safe and effective method to accurately identify the renal vasculature and to differentiate renal tumors from surrounding normal parenchyma. The capacity for multimodal imaging within the surgical console further facilitates this imaging. Further study is needed to determine if this technique will help improve outcomes of robotic assisted laparoscopic nephrectomy.

1210 NEAR INFRARED FLUORESCENCE IMAGING FOR THE DA VINCI SI SURGICAL SYSTEM: INITIAL CLINICAL EXPERIENCE WITH ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR RENAL CORTICAL TUMORS

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 20111210 NEAR INFRARED FLUORESCENCE IMAGING FOR THE DA VINCI SI SURGICAL SYSTEM: INITIAL CLINICAL EXPERIENCE WITH ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR RENAL CORTICAL TUMORS Scott Tobis, Joy Knopf, Christopher Silvers, Jorge Yao, Hani Rashid, Guan Wu, and Dragan Golijanin Scott TobisScott Tobis Rochester, NY More articles by this author , Joy KnopfJoy Knopf Rochester, NY More articles by this author , Christopher SilversChristopher Silvers Rochester, NY More articles by this author , Jorge YaoJorge Yao Rochester, NY More articles by this author , Hani RashidHani Rashid Rochester, NY More articles by this author , Guan WuGuan Wu Rochester, NY More articles by this author , and Dragan GolijaninDragan Golijanin Rochester, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.866AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the utility of near infrared fluorescence (NIRF) of intravenously injected indocyanine green (ICG) in performing robot-assisted laparoscopic partial nephrectomy (RALPN). In addition, we evaluated the initial performance of a novel NIRF imaging system integrated into the da Vinci® Si Surgical System during RALPN. METHODS A Fluorescence imaging for the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) was utilized for all cases. ICG was injected prior to near infrared imaging. Immediate imaging assessed the renal vasculature, while delayed imaging differentiated renal cortical tumors from normal parenchyma. The intraoperative performance of NIRF of intravenous ICG was evaluated for tumor appearance relative to surrounding renal parenchyma as well as identification of the renal vasculature. RESULTS Eleven patients underwent RALPN, with two converted to robot-assisted laparoscopic radical nephrectomy. ICG injections were repeated up to a total of 5 times depending on the goal of visualization. Ten of the 11 patients demonstrated a malignancy on final pathology. Of the malignant tumors, 7 were hypofluorescent and 3 isofluorescent compared to the surrounding renal parenchyma. NIRF imaging delineated the vascular anatomy in all cases. All surgical margins were negative on final pathology. CONCLUSIONS Intraoperative imaging of ICG with NIRF is a safe and effective method to accurately identify the renal vasculature and to differentiate renal tumors from surrounding normal parenchyma. The capacity for multimodal imaging within the surgical console further facilitates this imaging. Further study is needed to determine if this technique will help improve outcomes from RALPN. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e485-e486 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Scott Tobis Rochester, NY More articles by this author Joy Knopf Rochester, NY More articles by this author Christopher Silvers Rochester, NY More articles by this author Jorge Yao Rochester, NY More articles by this author Hani Rashid Rochester, NY More articles by this author Guan Wu Rochester, NY More articles by this author Dragan Golijanin Rochester, NY More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Renal Artery Injury During Robot-Assisted Renal Surgery

Laparoscopic partial nephrectomy (LPN) is becoming the standard of care for incidentally diagnosed, small renal tumors. With its seven degrees of freedom and three-dimensional vision, the DaVinci robotic surgical system has been used to assist in LPNs. The main disadvantage of robot-assisted surgery, however, is the lack of tactile feedback. We present a case of renal artery injury during robot-assisted renal surgery. Robot-assisted partial nephrectomy (RPN) was planned for 47-year-old man with a 3.5-cm right renal mass. After standard bowel mobilization, renal hilar dissection was performed. In the attempt to complete the dissection posteriorly, however, there was sudden profuse bleeding. The intraperitoneal pressure immediately increased to 20 mm Hg, and an additional suction device was inserted through the 5-mm liver retractor port. On inspection, there was an injury at the takeoff of the posterior segmental artery. A decision was made to convert to robot-assisted laparoscopic radical nephrectomy. The main renal artery and renal vein were controlled with Hem-o-Lok clips. The estimated blood loss was 2,000 mL. Four units of packed red blood cells were transfused intraoperatively. The post-transfusion hemoglobin level was 12.6 g/dL. There were no other perioperative complications. The surgeon should keep in mind that the robotic arms are very powerful and can easily injure major vessels because of lack of tactile feedback. A competent and experienced tableside surgeon is very important in robot-assisted surgery because the unsterile console surgeon cannot immediately react to intraoperative complications.