Robotic-assisted Laparoscopic Repair Research Articles

Robotic-Assisted Laparoscopic Transection and Repair of an Obturator Nerve During Pelvic Lymphadenectomy for Endometrial Cancer

Obturator nerve injury may occur in gynecologic surgery, particularly in cases in which extensive pelvic sidewall retroperitoneal dissection is performed. The lack of tactile feedback from the robotic surgical system may contribute to obturator nerve injury. If surgical division occurs, microsurgical end-to-end anastomosis of the obturator nerve may be performed. A 76-year-old woman with stage IA endometrial adenocarcinoma sustained a left obturator nerve transection during pelvic lymphadenectomy that was recognized immediately. Robotic-assisted laparoscopic repair was performed successfully, with the patient experiencing no residual neuropathy 6 months postoperatively. Robotic-assisted laparoscopic repair is feasible for the treatment of obturator nerve injury.

381 FER IS PROLIFERATIVE REGULATOR OF RENAL CANCER CELLS AND ITS EXPRESSION WAS ASSOCIATED WITH PATHOLOGICAL FEATURES AND SURVIVAL IN PATIENTS WITH RENAL CELL CARCINOMA

INTRODUCTION AND OBJECTIVES: Repair of a vesicorectal fistula is a challenging surgery. This surgery becomes even more difficult after an initial repair is unsuccessful. In this video, we demonstrate a successful robotic-assisted repair of a vesicorectal fistula. METHODS: The patient is a 72-year-old obese gentleman who developed a vesicorectal fistula following a rectal injury during radical prostatectomy. He subsequently underwent sigmoid colostomy, then open transabdominal repair of his fistula with omental flap interposition. Unfortunately, the repair failed. The patient was referred to our medical center. We elected to perform his repair utilizing a robotic approach. The patient was placed supine on a split-leg operating table with a 15-degree Trendelenburg position. Both ureters were catheterized with 5F ureteral catheters through cystoscopy. A Foley catheter and a rectal tube were placed. A total of 4 ports were placed, including a 12-mm accessory port in the right upper quadrant close to the anterior axillary line, a 12-mm camera port and two 8-mm robotic arm ports. The left robotic arm port was placed below the colostomy to avoid injury. Extensive lysis of adhesions was required. The bladder was bivalved through the dome down to the trigone. The vesicorectal fistula area was debrided. The rectum defect was closed in two layers with 3-0 Monocryl sutures, an omental flap interpositioned, and the bladder was closed in two layers with 3-0 Monocryl sutures. RESULTS: The entire repair procedure was done robotically. Operative time was approximately 4 hours. Estimated blood loss was 50 ml. Postoperative course was uneventful and the length of hospital stay was 6 days. A cystogram done 4 weeks after surgery showed no leak and his Foley catheter was removed. At the 4-month followup, his cystogram and sigmoidoscopy showed no signs of vesicorectal fistula recurrence and he is scheduled for colostomy reversal. CONCLUSIONS: A robotic-assisted laparoscopic repair of vesicorectal fistula is a feasible alternative to open surgery in selected patients, even in the setting of a colostomy and failed initial open attempts at repair. The robotic surgical system provides us a platform to perform complex laparoscopic repair of the urinary tract in the deep pelvic area.

V380 ROBOTIC-ASSISTED LAPAROSCOPIC REPAIR OF A VESICORECTAL FISTULA FOLLOWING RADICAL PROSTATECTOMY AFTER INITIAL FAILED OPEN REPAIR

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence), Oncology & Prostate Cancer1 Apr 2011V380 ROBOTIC-ASSISTED LAPAROSCOPIC REPAIR OF A VESICORECTAL FISTULA FOLLOWING RADICAL PROSTATECTOMY AFTER INITIAL FAILED OPEN REPAIR Guan Wu, Christine Mastrodenato, Jonah Marshall, and Hani Rashid Guan WuGuan Wu Rochester, NY More articles by this author , Christine MastrodenatoChristine Mastrodenato Rochester, NY More articles by this author , Jonah MarshallJonah Marshall Rochester, NY More articles by this author , and Hani RashidHani Rashid Rochester, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.467AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repair of a vesicorectal fistula is a challenging surgery. This surgery becomes even more difficult after an initial repair is unsuccessful. In this video, we demonstrate a successful robotic-assisted repair of a vesicorectal fistula. METHODS The patient is a 72-year-old obese gentleman who developed a vesicorectal fistula following a rectal injury during radical prostatectomy. He subsequently underwent sigmoid colostomy, then open transabdominal repair of his fistula with omental flap interposition. Unfortunately, the repair failed. The patient was referred to our medical center. We elected to perform his repair utilizing a robotic approach. The patient was placed supine on a split-leg operating table with a 15-degree Trendelenburg position. Both ureters were catheterized with 5F ureteral catheters through cystoscopy. A Foley catheter and a rectal tube were placed. A total of 4 ports were placed, including a 12-mm accessory port in the right upper quadrant close to the anterior axillary line, a 12-mm camera port and two 8-mm robotic arm ports. The left robotic arm port was placed below the colostomy to avoid injury. Extensive lysis of adhesions was required. The bladder was bivalved through the dome down to the trigone. The vesicorectal fistula area was debrided. The rectum defect was closed in two layers with 3-0 Monocryl sutures, an omental flap interpositioned, and the bladder was closed in two layers with 3-0 Monocryl sutures. RESULTS The entire repair procedure was done robotically. Operative time was approximately 4 hours. Estimated blood loss was 50 ml. Postoperative course was uneventful and the length of hospital stay was 6 days. A cystogram done 4 weeks after surgery showed no leak and his Foley catheter was removed. At the 4-month followup, his cystogram and sigmoidoscopy showed no signs of vesicorectal fistula recurrence and he is scheduled for colostomy reversal. CONCLUSIONS A robotic-assisted laparoscopic repair of vesicorectal fistula is a feasible alternative to open surgery in selected patients, even in the setting of a colostomy and failed initial open attempts at repair. The robotic surgical system provides us a platform to perform complex laparoscopic repair of the urinary tract in the deep pelvic area. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e154 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Guan Wu Rochester, NY More articles by this author Christine Mastrodenato Rochester, NY More articles by this author Jonah Marshall Rochester, NY More articles by this author Hani Rashid Rochester, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robotic-Assisted Laparoscopic Repair of a Vesicouterine Fistula

As cesarean sections become a more common mode of delivery, they have become the most likely cause of vesicouterine fistula formation. The associated pathology with repeat cesarean deliveries may make repair of these fistulas difficult. Computer-enhanced telesurgery, also known as robotic-assisted surgery, offers a 3-dimensional view of the operative field and allows for intricate movements necessary for complex suturing and dissection. These qualities are advantageous in vesicouterine fistula repair. A healthy 34-year-old woman who underwent 4 cesarean deliveries presented with a persistent vesicouterine fistula. Conservative management with bladder decompression and amenorrhea-inducing agents failed. Robotic-assisted laparoscopic repair was successfully performed with the patient maintaining continence after surgery. Robotic-assisted laparoscopic repair of vesicouterine fistulas offers a minimally invasive approach to treatment of a complex disease process.

Robotic-assisted Laparoscopic Reconstruction of the Upper Urinary Tract: Tips and Tricks

To examine whether simple tips and tricks provided in this manuscript and video make robotic reconstruction of the urinary tract possible from the renal calyx to the bladder. The da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) has been widely accepted by urologists for complex reconstructive maneuvers such as radical prostatectomy and pyeloplasty. The manuscript and accompanying video outline tips and tricks for patient selection, patient evaluation, port placement, dissection techniques, robotic docking, ureteral repair, and stent management for complex urinary tract reconstruction of the upper urinary tract from the level of the renal calyx to the bladder. Modifications such as port placement, robotic docking techniques, and ureter reconstruction have simplified the technique of complex robotic-assisted laparoscopic reconstruction of the urinary tract. Numerous scenarios can be encountered during robotic-assisted laparoscopic repair of the upper urinary tract. Simple tips and tricks provided in this manuscript and video make robotic reconstruction of the urinary tract possible from the renal calyx to the bladder.

Robotic Assisted Laparoscopic Repair of Post-Cesarean Uterine Scar Defect

Study Objective: Robotic assisted laparoscopic repair of post-cesarean uterine scar defect. Our patient is a 34 year G2P1 who was found to have a scar dehiscence on ultrasound during stimulation in an IVF/ET cycle.This was further confirmed by MRI which showed a 2 mm long and 2 cm wide defect at the uterocervical junction.She had undergone a low transverse cesarean section a term in 2007. Due to the potential morbid complications of extrauterine pregnancy and rupture uterus she was considered for a robotic assisted repair of this defect.

Laparoscopic vesicovaginal fistula repair with robotic reconstruction

To describe, to our knowledge, the first case report of robotic-assisted laparoscopic repair of a vesicovaginal fistula. A 44-year-old woman presented with a vesicovaginal fistula after vaginal hysterectomy. She had been noted to have a bladder injury that was repaired at that time. A vesicovaginal fistula developed several weeks later, and she was referred for repair. The location of the fistula was deemed amenable to repair using a robot-assisted laparoscopic approach. The total operative time was 280 minutes, including placement of ureteral catheters and repositioning. The estimated blood loss was 50 mL. The fistula was repaired using robot-assisted laparoscopic techniques without complications, and the patient went home on the second postoperative day. The Foley catheter was removed 2 weeks postoperatively. The patient continued to void normally without recurrence at 16 weeks of follow-up. Laparoscopic repair of vesicovaginal fistulas has not gained widespread acceptance owing to its technical difficulty. We describe a minimally invasive laparoscopic approach using the DaVinci robotic system to repair a vesicovaginal fistula.