Robot-assisted Laparoscopic Approach Research Articles

Robotic assisted excision of a mesenteric cyst of Müllerian origin in a 29-year-old woman

Mesenteric cysts are rare, benign tumors of uncertain etiology that require management. The Müllerian subtype of one of the rarer types of mesenteric cysts. Diagnosis of a mesenteric cyst typically involves nonspecific symptoms or an asymptomatic presentation. Treatment involves resection to prevent life-threatening complications. Resection through laparotomy surgery is the most common approach. The laparoscopic approach is gaining traction. We present a case in which a large mesenteric cyst was resected using a robotic assisted laparoscopic approach.

Perioperative and functionnal outcomes of robot-assisted laparoscopic versus open ureterovesical reimplantation for benign lower ureteral pathologies: a single-center comparative study.

The robot-assisted laparoscopic(RALUVR) and open(OUVR) approaches have both been described for ureterovesical reimplantation to treat benign lower ureteral pathologies. Thus, we aimed to compare the perioperative and functional outcomes of RALUVR vs. OUVR. We performed a retrospective comparative study including all consecutive patients treated with RALUVR or OUVR for benign lower ureteral pathologies between January 2013 and December 2022 at our center. Logistic regression analyses were used to assess the predictors of complication ≥ Clavien-Dindo(CD)III within 90 days, prolonged length of stay(LOS), and 90-day overall success. The Kaplan-Meier method and Cox regression analyses were used to assess vesicoureteral reflux-free(VU-RFS) and stenosis-free(SFS) survivals. Overall, 44 patients underwent RALUVR(n = 19; 43%) and OUVR (n = 25; 57%). In univariable logistic regression analyses, the use of RALUVR vs. OUVR was not significantly associated with postoperative complications ≥ CDIII (OR = 0.98; 95% CI=[0.17-5.09]; p = 0.98), and 90-day overall success (OR = 1.43; 95% CI=[0.24-11.28]; p = 0.7). Despite a shorter median LOS after RALUVR vs. OUVR (4 vs. 10 days, respectively; p < 0.001), multivariable logistic regression analysis showed no impact of the surgical approach on prolonged LOS (OR = 0.51, 95% CI=[0.03-13.86]; p = 0.65). No significant difference was observed in 2-year VU-RFS (72.9% vs. 100%, respectively; p = 0.2) and 2-year SFS between the RALUVR and OUVR groups (85.7% vs. 87.7%, respectively; p = 0.8). In Cox regression analysis, the use of RALUVR vs. OUVR was not significantly associated with VU-RFS (HR = 4.26; 95% CI=[0.38-47.84]; p = 0.24) or SFS (HR = 1.32; 95% CI=[0.22-8.01]; p = 0.76). We observed that RALUVR provides similar perioperative and functional outcomes as compared to OUVR, except for potentially shorter LOS.

Ileal ureter replacement and ileocystoplasty for the treatment of bilateral ureteral strictures and bladder contracture: technique and outcomes.

The aim of this study was to explore the feasibility of ileal ureter replacement and ileocystoplasty for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture. A retrospective review of clinical data from seven patients who underwent bilateral Ileal Ureter Replacement and ileocystoplasty from April 2019 to February 2023 was conducted. The surgeries were performed using open, laparoscopic, and robot-assisted laparoscopic approaches. Baseline characteristics, perioperative, and mid-term results of the patients were collected. Follow-up period of 3-28 months. A detailed description of the technique was reported. The mean age of the patients was 52.86±6.06 years. The average duration of surgery was 365±28.54 minutes, and the estimated intraoperative blood loss was 357.14±184.06 mL. The mean length of harvested ileum was 37.86±8.40 cm. The preoperative serum creatinine level was 88.02±18.05 μmol/L, postoperative day 1 creatinine level was 90.7±12.93μmol/L, postoperative 3-month creatinine level was 93.77±33.34 μmol/L, and the mean creatinine level at the last follow-up was 94.89±27.89μmol/L. The postoperative bladder capacity was 249.43±32.50 mL on average. The average length of hospital stay was 26.57±15.46 days. No complications of Clavien-Dindo grade 3 or higher were observed. During the follow-up period, no patients experienced deterioration of renal function after surgery. Bilateral ileal ureter replacement and ileocystoplasty are effective surgical technique for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture caused by radiation therapy.

Robotic-assisted laparoscopic Malone appendicostomy: a 6-year perspective.

A robotic-assisted laparoscopic approach to appendicostomy offers the benefits of a minimally invasive approach to patients who would typically necessitate an open procedure, those with a larger body habitus, and those requiring combined complex colorectal and urologic reconstructive procedures. We present our experience performing robotic-assisted appendicostomies with a focus on patient selection, perioperative factors, and functional outcomes. A retrospective review of patients who underwent a robotic-assisted appendicostomy/neoappendicostomy at our institution was performed. Twelve patients underwent robotic-assisted appendicostomy (n = 8) and neoappendicostomy (n = 4) at a range of 8.8-25.8years. Five patients had a weight percentile > 50% for their age. Seven patients underwent combined procedures. Median operative time for appendicostomy/neoappendicostomy only was 185.0min. Complications included surgical site infection (n = 3), stricture requiring minor operative revision (n = 2), conversion to an open procedure due to inadequate appendiceal length (prior to developing our technique for robotic neoappendicostomies; n = 1), and granuloma (n = 1). At a median follow-up of 10.8months (range 1.7-74.3months), 91.7% of patients were consistently clean with antegrade enemas. Robotic-assisted laparoscopic appendicostomy and neoappendicostomy with cecal flap is a safe and effective operative approach. A robotic approach can potentially overcome the technical difficulties encountered in obese patients and can aid in patients requiring both a Malone and a Mitrofanoff in a single, combined minimally invasive procedure.

Robotic Partial Nephrectomy for Treating Renal Masses: Outcomes and Complications.

Partial nephrectomy is the preferred treatment for renal tumors <7 cm. Robot-assisted laparoscopic approach is a minimally invasive method that offers advantages for resecting complex tumors. Here, we conducted a descriptive retrospective analysis of the first robotic partial nephrectomies (RPNs) performed at our center. A retrospective cohort of 94 patients who consecutively underwent RPN at our center between November 2012 and December 2022 was investigated. Baseline patient data, tumor characteristics, intraoperative variables, pathological tumor analysis, and postoperative complications at 30 days were analyzed. The patients were followed up for a median of 25.3 months. Baseline values included a median age of 63 years and a median body mass index (BMI) of 28.1. Intraoperative variables comprised a median surgical time of 150 min and a median warm ischemia time of 16 min. The mean postoperative creatinine level was 1 mg/dL. The median tumor size was 41.9 mm, with a median PADUA score of 8 and a median RENAL score of 8. Resected tumors were predominantly cT1a (58.5%) and cT1b (39.3%), while the positive margin rate was 21.3%. A total of 19.2% of the patients experienced Clavien-Dindo complications, of which 11% were Clavien-Dindo I; 66.7%, Clavien-Dindo II; And 22.2%, Clavien-Dindo IIIb. However, no Clavien-Dindo IIIa or IV complications were reported. RPN is an effective and safe technique for treating solid renal masses, demonstrating a low complication rate and adequate oncologic control locally and distally.

The robotic-assisted laparoscopic approach to biliary tract resection and reconstruction for benign indications: A single-center experience.

Benign biliary disease (BBD) is a prevalent condition involving patients who require extrahepatic bile duct resections and reconstructions due to nonmalignant causes. This study followed all patients who underwent biliary resections for BBD between 2015 and 2023. We excluded those with malignant conditions and patients who had an 'open' operation. Based on the patient's anatomy, the procedures employed were either robotic Roux-en-Y hepaticojejunostomy (RYHJ) or robotic choledochoduodenostomy (CDD). From the 33 patients studied, 23 were female, and 10 were male. Anesthesiology (ASA) class was 3±0.5; the MELD score was 9±4.1; the Child-Pugh score was 6±1.7. The primary indications for undergoing the operation included iatrogenic bile duct injuries, biliary strictures, and type 1 choledochal cysts. The average surgical duration was about 272min, and the average blood loss amounted to 79mL. Postoperatively, three patients experienced major complications, all attributed to anastomotic leaks. The average hospital stay was 4days, with a readmission rate of 15% within 30days. During an average follow-up period of 33months, one patient had to undergo a revision at 18months due to stricture. This necessitated further duct resection and reanastomosis. Notably, there were no reported hepatectomies, no conversion to the 'open' method, no intraoperative complications, and no mortalities. Robotic extrahepatic bile duct resection and reconstruction with Roux-en-Y hepaticojejunostomy or choledochoduodenostomy is safe with an acceptable postoperative morbidity, short hospital length of stay, and low postoperative stricture rate at intermediate duration follow-up.

Retrospective analysis of robot-assisted laparoscopic transabdominal anterior approach for the treatment of lumbar paravertebral schwannoma.

The main objective of this study was to investigate the impact of robot-assisted laparoscopic resection on paravertebral tumours using the anterior peritoneal approach. A retrospective analysis to identify patients with paravertebral tumours. A total of 21 patients, who underwent robot-assisted laparoscopic transabdominal anterior approach surgery from March 2012 to August 2020. The median operation time was 66.2±14.5min, with a range of 0-100min. Intraoperative blood loss was minimal, with a median of 11.4±7.9mL and a range of 5-30mL. The median tumour length was 4.8±2.3cm, ranging from 2.1 to 11.3cm. Postoperative hospitalisation lasted for a median of 3.2±0.9days. During the 48-month follow-up period, no tumour recurrence or residual was observed in any patient. Robot-assisted laparoscopic resection of lumbar paravertebral schwannoma proved to be a safe and viable surgical approach. It offers a relatively new treatment option for paraspinal schwannoma.

Robotic-assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications.

The aim was to compare postoperative complications in patients undergoing the excision of a rectal endometriotic nodule over 3 cm by a robotic-assisted versus a conventional laparoscopic approach. We conducted a retrospective cohort study evaluating prospectively collected data. The main interventions included rectal shaving, disc excision or colorectal resection. All the surgeries were performed in one endometriosis reference institute. To evaluate factors significantly associated with the risk of anastomosis leakage or fistula and bladder atony, we conducted a multivariate logistic regression model. A total of 548 patients with rectal endometriotic nodule over 3 cm in diameter (#ENZIAN C3) were included in the final analysis. The demography and clinical characteristics of women managed by the robotic-assisted (n = 97) approach were similar to those of patients who underwent conventional laparoscopy (n = 451). The multivariate logistic regression demonstrated that the surgical approach (robotic-assisted vs. laparoscopic) was not associated with the rate of anastomosis leakage or fistula (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.3-4.0) and bladder dysfunction (aOR 0.5, 95% CI 0.1-1.8). A rectal nodule located lower than 6 cm from the anal verge was significantly associated with anastomosis leakage (aOR 4.1, 95% CI 1.4-10.8) and bladder atony (aOR 4.3, 95% CI 1.5-12.3). Anastomosis leakage was also associated with smoking (aOR 3.2, 95% CI 1.4-7.4), significant vaginal infiltration (aOR 2.7, 95% CI 1.2-6.7) and excision of nodules involving sacral roots (aOR 5.6, 95% CI 1.7-15.5). The robotic-assisted approach was not associated with increased risk of main postoperative complications compared to conventional laparoscopy for the treatment of large rectal endometriotic nodules.

Robot-assisted tubo-tubal reanastomosis after sterilization in 10 steps.

Five to 20% of women regret having a tubal ligation. These women are generally otherwise fertile and have a better chance of pregnancy than other patients experiencing infertility, whether by in vitro fertilization or after tubal surgery. Historically, tubal anastomosis surgery has long been performed by microsurgery through laparotomy, which provided very high precision but was associated with some degree of morbidity. The parallel development of in vitro fertilization and laparoscopy have contributed to reducing the indications for tubal surgery. The laparoscopic approach is challenging because of the number and precision of the sutures needed. The robot-assisted laparoscopic approach may reduce the surgical difficulty and improve the accessibility of this technique. We have described the technique of tubo-tubal reanastomosis after sterilization with robot-assisted laparoscopy in 10 steps. Robot-assisted laparoscopy provides favourable conditions for performing tubo-tubal reanastomosis after sterilization due to the camera stability, precision of movement, and amplitude of articulations.

Single-port robotic-assisted ureteral reconstruction for management of strictures after renal transplantation

Ureteral strictures are a common and often challenging complication of renal transplantation. The use of single-port (SP) robotic-assisted laparoscopic surgery is a novel approach in the management of these patients. Here we describe 3 patients with stricture of the transplant ureter causing hydronephrosis and allograft dysfunction, whose ureteral reconstructions were successfully performed using the SP robotic-assisted laparoscopic approach. Two patients underwent transplant-to-native ureteroureterostomy and 1 patient underwent ureteroneocystostomy. We demonstrate that the use of concurrent ureteroscopy and near-infrared fluorescence enables safe and rapid identification of native and transplant ureters. In addition, side-to-side anastomosis of transplant-to-native ureters allows for preservation of ureteral vasculature. In this limited series, the SP robotic platform demonstrates great promise in simplifying and streamlining our approach to ureteral strictures in this patient population.

The Combined Robotic-assisted Laparoscopic and Thoracic Approach in the Management of Diaphragmatic, Pleural, and Pericardial Endometriosis

To demonstrate the advantages of a combined robotic-assisted laparoscopic and thoracic approach in the management of extensive diaphragmatic, pleural, and pericardial endometriosis. A video article demonstrating excision of endometriosis from pericardium, diaphragm, and pleura. Thoracic endometriosis is the most common site of extrapelvic endometriosis [1]. Surgical treatment aims to excise all visible disease to relief symptoms and prevent recurrence [2-4]. A 41-year-old lady with cyclical shoulder tip and chest pain and known extensive diaphragmatic endometriosis was referred to our center. The procedure was done jointly by a gynecologist and a thoracic surgeon experienced in robotic-assisted endometriosis excision (Supplemental Video 1). Robotic-assisted laparoscopy revealed extensive full-thickness diaphragmatic endometriosis and a full-thickness pericardial nodule. Pericardial endometriosis excision was performed and a 1 cm defect was left open in the pericardium. Multiple diaphragmatic endometriotic nodules were excised and pleural cavity was entered (Image 2). On robotic-assisted thoracic surgery, further deep endometriotic lesions were detected and excised from the posterior aspect of the diaphragm. These lesions were not identified abdominally despite complete division of falciform ligament, full mobilization of the liver, and the use of a 30-degree scope. Superficial endometriotic lesions on parietal pleura were also detected (Image 3) and excised. The defects on the diaphragm were closed (Image 4). Chest and abdominal drains were left in situ. The patient was discharged on day 4. The combined robotic-assisted laparoscopic and thoracic approach is indicated in selected cases and allows full exploration of the thoracic cavity and both sides of the diaphragm, thus preventing incomplete excision of the disease. Robotic surgery also allows smooth dual-surgeon teamwork.

Recent Advances in the Management of Localized and Locally Advanced Renal Cell Carcinoma: A Narrative Review.

To review the current status of surgical and procedural treatments for renal cell carcinoma (RCC), focusing on oncological and functional outcomes, and the use of techniques for advanced disease over the last 10 years. Partial nephrectomy (PN) has become the reference standard for most T1 and T2 masses. In cT2 RCC, PN exhibits oncological equivalence and improved functional outcomes compared to radical nephrectomy (RN). Additionally, emerging data suggest that PN may be used to treat cT3a RCC. The robot-assisted platform is increasingly used to treat locally advanced RCC. Studies suggest safety and feasibility of robotic RN and robotic inferior vena cava tumor thrombectomy. Additionally, single-port robot-assisted laparoscopic approaches are comparable to multiport approaches in select patients. Long-term data show that cryoablation, radiofrequency ablation, and microwave ablation are equipotent in management of small renal masses. Emerging data suggest that microwave may effectively treat cT1b masses.

Robotic-assisted approach for complex cholecystectomies

Robotic approaches have facilitated the minimally invasive completion of increasingly complex surgical procedures. In the management of the difficult gallbladder, we have found that the wristed instruments, three-dimensional camera, the ability to use indocyanine green (ICG) with integrated fluorescent imaging, and ease of intracorporeal suturing to be useful in tackling the challenges associated with complex benign gallbladder disease. We describe the rationale and technical lessons learned during four cases of complex cholecystectomies that highlight the management principles and technical advantages afforded by the use of the robotic-assisted laparoscopic (RAL) approach. The cases include a subtotal fundus-first reconstituting cholecystectomy, subtotal fenestrating cholecystectomy, a cholecystocolonic fistula managed by a RAL subtotal fenestrating cholecystectomy, and an iatrogenic cholecystoduodenal fistula managed by RAL cholecystectomy. In each case, the operation was performed safely without intraoperative injury or conversion to open, and three of the four patients were discharged from the recovery room. In our view, these favorable outcomes were greatly facilitated by the robotic platform. It is our intent to share adaptations and innovations that we found helpful to encourage other surgeons with sufficient robotic experience to tackle complex gallbladder cases minimally invasively.

Robotic-assisted laparoscopic and thoracoscopic approach: a challenging multidisciplinary minimally invasive surgery of intravascular leiomyomatosis with intracardiac extension

To show a case of severe intravascular leiomyomatosis with intracardiac extension treated by a multidisciplinary minimally invasive surgery. Stepwise demonstration of the technique with a video. General Hospital. A 40-year-old woman with palpitation and dyspnea. The patient was diagnosed with intravascular leiomyomatosis by computed tomography scan. She underwent a successful single-stage minimally invasive surgery with complete excision. The feasibility and safety of using this technique for intravascular leiomyomatosis with intracardiac extension. A combined thoracoabdominal surgery was successfully performed. During the procedure, cardiopulmonary bypass was maintained for 72 minutes. The patient soon recovered and was discharged. Minimally invasive surgery is a possible choice for intravascular leiomyomatosis with intracardiac extension.

Laparoscopic Management of a Juvenile Cystic Adenomyoma

<h3>Study Objective</h3> To demonstrate how to diagnose and surgically manage an adenomyotic cyst by a robotic assisted laparoscopic approach. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> Operating theatre. <h3>Patients or Participants</h3> A 17-year-old patient with acute pelvic pain in the setting of chronic dysmenorrhea associated with a 4 cm cystic lesion in the endometrium on MRI consistent with a juvenile cystic adenomyoma. After no improvement with hormonal management, the patient opted for laparoscopic exploration and removal. <h3>Interventions</h3> MRI imaging was used to identify the adenomyotic cyst. Upon laparoscopy, the surgical site was injected with vasopressin for hemostasis. Sharp and blunt dissection was used to minimize trauma and thermal injury to the surrounding myometrium. Chromopertubation was used verify no cavity entry after removal. Lastly, the myometrium was closed in multiple layers to prevent hematoma formation. <h3>Measurements and Main Results</h3> Successful outpatient procedure with improved pain post-operatively. <h3>Conclusion</h3> This video shows techniques to identify and perform a minimally invasive fertility preserving resection of a juvenile cystic adenomyoma.

“H-Incision” Technique for Robotic-Assisted Laparoscopic Adenomyosis Resection

<h3>Study Objective</h3> The purpose of this video is to present a case of a robotic-assisted laparoscopic adenomyomectomy using an "H-Incision" technique. This minimally invasive approach is a novel application of a uterine-sparing adenomyosis resection previously reported only in open cases. <h3>Design</h3> N/A. <h3>Setting</h3> The patient was placed in dorsal lithotomy with Allen stirrups. <h3>Patients or Participants</h3> This video presents a single surgical case. <h3>Interventions</h3> The patient received a robotic-assisted laparoscopic adenomyomectomy. <h3>Measurements and Main Results</h3> The patient received a robotic-assisted laparoscopic adenomyomectomy using an H-incision technique. <h3>Conclusion</h3> This surgical video demonstrates the steps of the "H-incision" technique for adenomyomectomy using a robotic-assisted laparoscopic approach. Since the H-incision technique was originally proposed for use in open surgery, widespread use has been limited in traditional laparoscopy. However, with advances in robotic-assisted surgery, the H-Incision technique offers an alternative approach to traditional resection methods that may enhance outcomes for patients pursuing future pregnancy. This video presents one of the first cases in the literature of robotic-assisted laparoscopic adenomyomectomy using the H-Incision technique.

Robotic-Assisted vs Conventional Laparoscopic Transabdominal Cerclage Placement

<h3>Study Objective</h3> To compare and contrast robotic-assisted versus laparoscopic transabdominal cerclage placement. <h3>Design</h3> Video. <h3>Setting</h3> Tertiary academic medical center with two minimally-invasive gynecologists. <h3>Patients or Participants</h3> Two patients at approximately 13 weeks gestation with cervical insufficiency. <h3>Interventions</h3> Transabdominal cerclage. <h3>Measurements and Main Results</h3> It is important to know useful tools in placement of minimally invasive transabdominal cerclage. These include the 30-degree laparoscope, sacrocolpopexy cup, uterine manipulators, and laparoscopic paddle retractor. Consider use of a suprapubic port for laparoscopic cerclage placement for more ideal angle for dissection of the avascular tunnel and passage of the Mersilene tape. Tying the Mersilene tape anteriorly laparoscopically can be helpful so that no additional port is used for manipulation of the uterus. <h3>Conclusion</h3> Transabdominal cerclage may be placed safely in a minimally invasive fashion both with robotic-assisted and conventional laparoscopic approach.

7458 Approach to the Fertility-Preserving Surgical Management of a Unicornuate Uterus with a Noncommunicating, Functional Rudimentary Horn

<h3>Study Objective</h3> To demonstrate how a unicornuate uterus with a functional non-communicating rudimentary horn in a patient desiring fertility can be safely managed with a robotic approach <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> A tertiary academic hospital <h3>Patients or Participants</h3> A healthy 22-year-old presenting with complaints of cyclic dysmenorrhea and desire for future fertility. <h3>Interventions</h3> A robotic-assisted laparoscopic approach to the resection of a functional non-communicating rudimentary horn with several key strategies to minimize blood loss, damage of normal tissue, and prevention of adhesion formation. 1. Placing a stay suture through the tissue of the rudimentary horn to aid with traction and counter traction necessary for enucleation of the horn in the correct tissue cleavage plane. 2. Minimizing blood loss by dilute vasopressin injection at planned incision site along with care to stay within the fibrotic tissue layer connecting the rudimentary horn to the unicornuate uterus. 3. Removing canalized fallopian tube attached to rudimentary horn to prevent rudimentary horn pregnancy. 4. Combination cold dissection with careful and deliberate use of electrosurgery following principles to minimize thermal injury to surrounding normal myometrium. 5. Two-layer non-locking suture to restore tissue integrity, ensure hemostasis, and prevent adhesion formation. 6. Surgical treatment (excision preferred) of all endometriosis at the time of surgery. <h3>Measurements and Main Results</h3> Final pathology confirmed a rudimentary horn with functioning endometrial tissue, endometriosis implants, and endometriosis of the appendix. <h3>Conclusion</h3> This technique allows for the surgical removal of a non-communicating rudimentary horn with: Restoration of anatomy, prevention of rudimentary horn pregnancy, removal of endometriosis, and optimization of future fertility.

Robot-Assisted Versus Laparoscopic Approach for Splenectomy in Children: Systematic Review and Meta-Analysis.

Aim: To compare the outcomes of pediatric splenectomies for hematologic diseases performed by robot-assisted laparoscopic surgery (RALS) and laparoscopic approach. Materials and Methods: Web of Science, Scopus, and PubMed databases were systematically searched for publications in English language from January 2000 to March 2020. All the studies dealing with pediatric elective splenectomies performed by RALS were included. The primary outcomes were the rate of postoperative complications and conversion. The secondary outcomes were the length of hospital stay and the operative time. Results: The search yielded 969 articles. Ten articles were included in the systematic review. Eighty patients underwent RALS splenectomy. Thirteen postoperative complications (16%) were reported and RALS was converted to open surgery in five cases (6.3%). Five of the included articles, three retrospective studies and two case series, were considered relevant for the meta-analysis and dealt with 130 patients. Of them, 71 children (55%) underwent RALS. No difference in the rate of complications was found between the two approaches (P = .235). RALS presented a similar rate of conversion to open surgery (P = .301). The mean operative times and length of hospital stays for RALS, reported in three different studies, were 107.5, 159.6, 140.5 minutes and 4.2, 3.93, 2.1 days, respectively. Conclusion: Even if few studies were included in the review, this meta-analysis reported similar rates of complication and conversion for RALS when compared with laparoscopy. Further studies are required to prove that this innovative technique was as safe and feasible as the current gold standard technique.

Robotic-assisted laparoscopy living donor nephrectomy: Technique and results of a monocentric retrospective series

Robot-assisted nephrectomy for living kidney donation (LKD) has been described in the literature as a safe and reproducible technique in high volume centers with extensive robotic surgery experience. Any surgical procedure in a healthy individual ought to be safe in regards to complications. The objective of this study was to evaluate the Robotic-assisted Living Donor Nephrectomy (RLDN) experience in a robotic surgery expert center. This is a retrospective study from 11/2011 and 12/2019. In total, 118 consecutive Living Donor (LD) kidney transplants were performed at our institution. All the procedures were performed by robotic-assisted laparoscopic approach. Extraction was performed by iliac (IE), vaginal (VE) or umbilical extraction (UE). The left kidney was preferred even if the vascular anatomy was not modal. For donors: the median operative time was 120min with 50mL of blood loss. The median warm ischemia time was 4min, with a non-significant shorter duration with the UE (4min) in comparison with IE or VE (5min). Nine patients had postoperative complications including 1 grade II (blood transfusion) and 1 grade IIIb (vaginal bleeding after VE). None of our procedures were converted to open surgeries and no deaths were reported. For the recipients: 1.7% presented delayed graft function; their median GFR at 1 year was 61mL/min/1.73m2. RLDN in an expert center appears to be a safe technique. The advantages of the robot device in terms of ergonomy don't hamper the surgical outcomes. Donor, recipient and graft survivals seem comparable to the reported laparoscopic outcomes in the literature.