Robot-assisted Radical Nephrectomy Research Articles

Validation of a surgical workspace scale during robot-assisted surgery.

A sufficient surgical workspace is crucial to avoid complications. Within classic laparoscopy, many subjective surgical rating scales (SRSs) have previously been used to evaluate the surgical workspace. This study aimed to validate a modified version of the 5-point SRS during robot-assisted radical nephrectomy (RARN). Thirty-two intra-operative videos of intraperitoneal spaces were recorded from eight patients who underwent RARN. To attain the visualisation of different types of workspaces, we recorded 20 s panoramic videos of different pneumoperitoneum, namely 3, 5, 7 and 12 mmHg. The videos were randomised and presented two times to eight experienced robotic surgeons to evaluate the workspace using our modified 5-point SRS. Both inter-and intra-rater reliabilities were tested. The results of the validation study showed moderate inter-rater and good to excellent intra-rater reliability. This is a valid tool that can be confidently used by future researchers in the field of robot-assisted surgery.

Preliminary experience of oblique occlusion technique in robot-assisted infrahepatic inferior vena cava thrombectomy: step-by-step procedures and short term outcomes

BackgroundWe aimed to compare the oncological outcomes between the oblique occlusion technique and the traditional technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) thrombectomy, and to explore the safety and effectiveness of the oblique occlusion technique.MethodsOverall, 21 patients with renal cell carcinoma (RCC) and IVC tumor thrombus (TT) were admitted to our hospital from August 2019 to June 2020. All the patients underwent RARN with IVC thrombectomy, of which the IVC oblique occlusion technique was used in 11 patients and traditional occlusion technique was used in 10 patients. The oblique occlusion technique refers to oblique blocking from the upper corner of the right renal vein to the lower corner of the left renal vein using a vessel tourniquet or a vessel clamp (left RCC with IVCTT as an example).ResultsCompared with patients in the traditional group, those in the oblique group had lower serum creatinine at follow-up (3 month) (95 ± 21.1 vs. 131 ± 30.7 μmol/L, P = 0.03). There was no significant difference in operation time [149 (IQR 143–245) min vs. 148 (IQR 108–261) min, p = 0.86], IVC clamping time [18 (IQR 12–20) min vs. 20 (IQR 14–23) min, p = 0.41], and estimated intraoperative blood loss [300 (IQR 100–800) mL vs. 500 (IQR 175–738) mL, p = 0.51] between both groups. During a 16-month (range, 15–23 months) follow-up period, two cases progressed in the oblique group and three cases progressed in the traditional group.ConclusionsThe modified IVC oblique occlusion technique procedure is relatively safe and effective in RARN with IVC thrombectomy. The IVC oblique occlusion technique may play a role in the protection of renal function.

Does size matter? Comparing robotic versus open radical nephrectomy for very large renal masses.

We evaluated perioperative and mortality outcomes of robotic-assisted radical nephrectomy (RRN) vs. open radical nephrectomy (ORN) for very large renal cell carcinomas (RCC). Adult patients with non-metastatic RCC >10 cm in size (pT2b) were identified from the National Cancer Database (2010-2017). Mixed-effects multivariable logistic regression adjusting for patient, tumor, and facility characteristics were used to evaluate rates of positive margin, prolonged length of stay (LOS) (>75th percentile), 30-day readmission, and 30-day and 90-day mortality for RRN vs. ORN. Overall survival (OS) was evaluated using the Kaplan-Meier method and adjusted Cox proportional hazard modeling. Of the 2,977 patients who underwent radical nephrectomy, 492 (16.5%) underwent RRN. Factors associated with RRN included male gender, metro or urban locations, academic facilities, Charlson-Deyo score >2, private or Medicaid insurance, and surgery in a later year (all P < 0.05). Tumors ≥15.1cm in size were associated with a higher rate of conversion to open surgery (P < 0.001). ORN was associated with increased median postoperative LOS (4d [interquartile range; IQR 3-6] vs. 3d, [IQR 2-4]; P < 0.01). RRN demonstrated no significant difference in the risk of positive margin, 30-day readmission, 30-day mortality, or 90-day mortality. RRN was associated with a decreased risk of prolonged LOS (OR 0.38; 95%CI [0.28-0.53]). There was no difference in long-term OS observed in patients treated with ORN vs. RRN. Very large, non-metastatic RCC can be safely and effectively treated with RRN. Rates of conversion to open were higher for tumors ≥15.1 cm. RRN has comparable long-term OS and improved LOS compared to ORN.

VE41 - Robot assisted radical nephrectomy with IVC thrombectomy - Level 2 IVC thrombus

VE41 - Robot assisted radical nephrectomy with IVC thrombectomy - Level 2 IVC thrombus

SC196 - Robot-assisted radical nephrectomy and inferior vena cava level i-iii thrombectomy: perioperative and mid-term oncologic outcomes

SC196 - Robot-assisted radical nephrectomy and inferior vena cava level i-iii thrombectomy: perioperative and mid-term oncologic outcomes

VE38 - Robot-assisted radical nephrectomy with the novel Hugo TM RAS System

VE38 - Robot-assisted radical nephrectomy with the novel Hugo TM RAS System

VE40 - Robot-assisted radical nephrectomy for Wilms’ tumour in children: A step-by-step surgical video

VE40 - Robot-assisted radical nephrectomy for Wilms’ tumour in children: A step-by-step surgical video

Video 14 - Robot-assisted right radical nephrectomy with en-block extended retro-peritoneal lymphadenectomy: operative technique with a dual-console Xi da Vinci surgical system

Video 14 - Robot-assisted right radical nephrectomy with en-block extended retro-peritoneal lymphadenectomy: operative technique with a dual-console Xi da Vinci surgical system

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.

A Decade of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy: A Systematic Review and Meta-Analysis of Perioperative Outcomes.

Open radical nephrectomy with inferior vena cava thrombectomy (O-CT) is standard management for renal cell carcinoma with inferior vena cava thrombus. First reported a decade ago, robotic-assisted radical nephrectomy with inferior vena cava thrombectomy (R-CT) is a minimally invasive option for this disease. We aimed to perform a systematic review to assess the safety and feasibility of R-CT in terms of perioperative outcomes and compare the outcomes between R-CT and O-CT. The PubMed®, Scopus®, Cochrane Central Register of Controlled Trials and Web of ScienceTM databases were searched using the free-text and MeSH terms "renal cell carcinoma," "inferior vena cava," "thrombosis" or "thrombus," "robot" and "thrombectomy." Studies reporting perioperative outcomes of R-CT and studies comparing R-CT with O-CT were included. The review was done in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search retrieved 28 articles describing R-CT, including 7 comparative studies. This systematic review included 1,375 patients, out of which 329 patients were in single-arm studies and 1,046 patients were in comparative studies. Of the 329 patients who underwent R-CT, 14.7% were level I, 60.9% level II, 20.4% level III and 2.5% level IV thrombus. Operative time ranged from 150 to 530 minutes; blood transfusion was administered in 38.2% (126). The overall complication rate was 30.3% (99). R-CT, in comparison to O-CT, was associated with a lower blood transfusion rate (18.4% vs 64.3%, p=0.002) and a lower complication rate (14.5% vs 36.7%, p=0.005). Major complication and 30-day mortality rates were similar in both groups. R-CT has acceptable perioperative outcomes in carefully selected patients. Compared with O-CT, R-CT is associated with a lower blood transfusion rate and fewer overall complications. In experienced hands with carefully selected patients, R-CT is feasible and safe, with acceptable outcomes; however, selection bias limits definitive inference of these results, and optimal patient selection criteria remain to be described.

Robotic surgery in comparison to the open and laparoscopic approaches in the field of urology: a systematic review.

To establish the feasibility of robotic surgical procedures in urology in terms of the applications, merits, and demerits as well as the postoperative and oncological outcomes while comparing it with the conventional approaches. A systematic search of electronic databases was performed to identify Randomized Controlled Trials and Cohort studies on Robot-Assisted urological surgical procedures in comparison with the conventional methods. The quality assessment of included studies was performed using the Newcastle-Ottawa Scale and the revised Cochrane "Risk of Bias" tool. A qualitative narrative synthesis of the data extracted from the studies was performed and presented in tabulated form. After screening, 39 studies were included in our review (7 Randomized Controlled Trials and 32 Cohort studies). Robot-Assisted Prostatectomy appears to be associated with lower estimated blood loss and shorter length of hospital stay. For Robot-Assisted Cystectomy, the results suggest longer operative time and fewer complications. Robot-Assisted Radical Nephrectomy was found to be associated with fewer perioperative complications and longer mean operative time while Robot-Assisted Partial Nephrectomy was associated with less positive surgical margins and reduced need for postoperative analgesia. The mean operative time was longer while the length of stay was shorter for the robotic approach in inguinal lymphadenectomy and ureteral reimplantation. The feasibility of Robot-Assisted surgery varied for different outcome measures as well as for different procedures. Some common advantages were a shorter length of stay, lesser blood loss, and fewer complications while the drawbacks included longer operative time.Study protocol PROSPERO database (Registration Number: CRD42021256623).

V10-07 NEAR-INFRARED FLUORESCENCE IMAGING TECHNOLOGY APPLICATIONS IN UROLOGIC SURGERY

You have accessJournal of UrologyCME1 May 2022V10-07 NEAR-INFRARED FLUORESCENCE IMAGING TECHNOLOGY APPLICATIONS IN UROLOGIC SURGERY Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, and Giuseppe Simone Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical applications of near-infrared fluorescence (NIRF) with Indocyanine green (ICG) technology are rapidly growing. Potential improvements especially for functional outcomes have been described in different urologic procedures. In this video we highlights our experience with multiple clinical applications of NIRF-ICG technology in distinct urologic procedures. METHODS: In this video we collected multiple clinical applications of NIRF technology: ICG-marking of totally endophytic renal tumors selected for partial nephrectomy, assessment of thrombus extent during level III IVC tumor thrombectomy, identification of functioning adenomas during adrenal surgery, assessment of ureteral vascularization during robot assisted radical cystectomy and during ureteral reimplantation, identification of urethra and ejaculatory ducts during Madigan prostatectomy. RESULTS: First, NIRF-ICG technique was demonstrated useful to mark endophytic renal tumors in patients selected for purely off-clamp robotic partial nephrectomy. Lipiodol indocyanine green mixture was selectively delivered in the tertiary ordered arteries feeding the tumor. In this way, the use of NIRF imaging allow to easily recognize endophytic renal tumor. Therefore, parenchyma incision, margins scoring and deep part of enucleation were performed under NIRF imaging. Secondly, intravenous injection of ICG was used during robot-assisted radical nephrectomy with level III IVC tumor thrombectomy in order to better define thrombus boundaries, to control cranial IVC thrombus edge, to expect IVC lumen and to confirm proper restoration of IVC flow. Then, NIRF-ICG technology was used to easily identify hypervascularized adrenal mass during robotic partial adrenalectomy and to evaluate proper perfusion of distal ureters both during RARC and robot-assisted ureteral reimplantation. Finally, NIRF-ICG technology was reported as an essential tool during robot-assisted Madigan prostatectomy when ejaculation preservation is planned. A retrograde injection of ICG throw the urethral catheter placed on navicular fossa allowed to easily recognize proximal prostatic urethra, and therefore to preserve ejaculatory function avoiding unintended violation of the urinary tract. CONCLUSIONS: NIRF-ICG technology sounds a safe and feasible procedure. This technique allows to easy identify key anatomical landmarks, providing information about tissue vasculature and perfusion. NIRF-ICG technique demonstrated to potentially improve functional outcomes of robotic procedures even if larger series with longer follow-up are needed. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e850 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF DownloadLoading ...

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.

Factors Affecting Robotic Partial Nephrectomy Conversion to Radical Nephrectomy: A Retrospective Multi-Institutional Analysis in the Michigan Urologic Surgery Improvement Collaborative (MUSIC).

Objective: To identify factors related to the conversion of robot-assisted partial nephrectomy (RPN) to robot-assisted radical nephrectomy (RRN) based on data collected by a statewide database in Michigan.Methods: Using the Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) database we identified 574 patients for whom RPN was planned. Patient and tumor characteristics were obtained including body mass index (BMI), Charlson comorbidity index (CCI), RENAL nephrometry score, tumor size, and pathologic staging. Treating centers were subdivided by annualized case volume and academic status. Bivariate and multivariate analyses were performed to assess the impact of these factors on the risk of conversion to RRN from RPN.Results: The conversion rate of RPN to RN was 5.75% (33/574). The difference in RENAL nephrometry score, tumor stage, and size reached statistical significance on bivariate analysis (p<0.001). The tumor stage also reached statistical significance on multivariate analysis [odds ratio (OR); 95%CI (8.97; 3.93-20.48) p<0.001]. The conversion rate was lower among high-volume versus low-volume practices; however, statistical significance was not reached [5.2% (27/520) vs.11% (6/54); p=0.11].Conclusions: Patient factors such as tumor size and renal nephrometry score are likely related to the conversion of RPN to RRN decisions. The data shows that Michigan urologists appear to appropriately assess intra-operative findings and convert to RRN in cases of more advanced kidney tumors. Lower volume centers appear to trend towards a higher conversion rate. Continued quality improvement tracking analysis may further clarify this relationship.

VE23 - Robot assisted radical nephrectomy with vena caval thrombectomy

VE23 - Robot assisted radical nephrectomy with vena caval thrombectomy

SC302 - Robot-assisted radical nephrectomy and inferior vena cava level I - III thrombectomy: perioperative and long-term oncologic outcomes

SC302 - Robot-assisted radical nephrectomy and inferior vena cava level I - III thrombectomy: perioperative and long-term oncologic outcomes

Initial experience of robot-assisted radical nephrectomy in Japan: Single institutional study of 12 cases.

To evaluate the initial experience of robot-assisted radical nephrectomy (RARN) in a single institution in Japan. This study included a total of 12 patients with renal tumors who were not preoperatively regarded as optimal candidates for robot-assisted partial nephrectomy (RAPN) and subsequently treated with RARN between April 2019 and June 2021 at our institution. Comprehensive perioperative outcomes in these patients were retrospectively analyzed. Of the 12 included patients, 10 and two were male and female, respectively, and the median age was 66 years. The median tumor diameter was 44 mm, and four, four and four patients were classified into cT1a, cT1b and cT3a, respectively. There was no patient requiring open conversion, and the median operative and console times were 167 and 79 minutes, respectively. The median estimated blood loss was 42 cc, and no patient required blood transfusion. During the perioperative period, no major complication corresponding to Clavien-Dindo grade ≥3 occurred. Nine, two and one patient were pathologically diagnosed with clear cell carcinoma (CCC), non-CCC and benign cyst, respectively, and there was no patient who developed recurrent diseases. Considering complicated tumor characteristics not amenable to RAPN in this series, such as an intravenous tumor thrombus or previous history of open partial nephrectomy, perioperative outcomes of initial experience with RARN in Japan could be considered favorable. Collectively, these findings suggest that RARN may be a promising alternative to laparoscopic radical nephrectomy for patients with complicated renal tumors, contraindicated for RAPN.

MP14-03 ROBOT-ASSISTED RADICAL NEPHRECTOMY AND INFERIOR VENA CAVA LEVEL I-III THROMBECTOMY: PERIOPERATIVE AND LONG-TERM ONCOLOGIC OUTCOMES

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP14)1 Sep 2021MP14-03 ROBOT-ASSISTED RADICAL NEPHRECTOMY AND INFERIOR VENA CAVA LEVEL I-III THROMBECTOMY: PERIOPERATIVE AND LONG-TERM ONCOLOGIC OUTCOMES Umberto Anceschi, Aldo Brassetti, Maria Consiglia Ferriero, Gabriele Tuderti, Leonardo Misuraca, Alfredo Maria Bove, Riccardo Mastroianni, Alfredo Maria Bove, Salvatore Guaglianone, Monish Aron, Mihir Desai, Inderbir Gill, Michele Gallucci, and Giuseppe Simone Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Maria Consiglia FerrieroMaria Consiglia Ferriero More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Monish AronMonish Aron More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001995.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study is to describe long-term oncologic outcomes of robot-assisted radical nephrectomy (RARN) with inferior vena cava tumor thrombectomy (IVCT) performed at a single-institution. METHODS: Between January 2014 and October 2018, 30 consecutive patients underwent RARN-IVCT for RCC and VTT for either curative (n=19) or cytoreductive intent (n=11) at a single tertiary-care center. Baseline, demographic and perioperative data were collected. A descriptive statistical analysis was performed. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. Overall survival (OS), cancer-specific survival (CSS), local recurrence-free survival (LRFS) and metastasis-free (MFS) were computed by Kaplan-Meier curves for the entire cohort and compared by surgical indication with the log-rank test. RESULTS: All cases were succesfully completed without any conversion to open surgery. Median operative time was 360 minutes (IQR 240-390). Median estimated blood loss was 550 ml (IQR 225-1500). Fifteen patients (50%) required blood transfusions. Median hospital stay was 7 days (IQR 4-12.2). Overall, nineteen patients (63.3%) had perioperative complications, 15 Clavien grade 1-2 (50%) and 4 grade 3-5 (13.3%) complications, respectively. At a median follow-up of 31.1 months (IQR 18-52.9), LRFS, MFS, CSS and OS were 93.3%, 40%, 46.7% and 40%, respectively. No significant survival differences were noted according to surgical indication (each p>0.1). The small cohort, high rate of adjuvant targeted-therapies (46.7%) and extreme surgical complexity may affect reproducibility of outcomes. CONCLUSIONS: RARN-IVCT represents a feasible and safe surgical option in tertiary referral centers; long-term oncologic results seem to be comparable to those reported in open surgery literature. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e252-e253 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Maria Consiglia Ferriero More articles by this author Gabriele Tuderti More articles by this author Leonardo Misuraca More articles by this author Alfredo Maria Bove More articles by this author Riccardo Mastroianni More articles by this author Alfredo Maria Bove More articles by this author Salvatore Guaglianone More articles by this author Monish Aron More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement Loading ...

Robot-assisted versus open surgery for radical nephrectomy with level 1-2 vena cava tumor thrombectomy: a French monocenter experience (UroCCR study #73).

The aim of this paper was to assess the feasibility of robot-assisted radical nephrectomy (RN) with inferior vena cava thrombectomy (RRVCT) and compare perioperative and oncological outcomes of this approach to open surgery for renal tumors with level 1-2 inferior vena cava (IVC) thrombus. We performed a retrospective analysis of patients surgically treated for renal cancer with IVC level 1-2 thrombus in the Urology department of Bordeaux University Hospital between December 2015 and December 2019. Patients were stratified by surgical approach in two groups: open vs. robotic procedures. Pre-, per- and postoperative data were collected within the framework of the UroCCR project (NCT03293563). Univariate and multivariate analysis using regression models were performed. A total of 40 patients underwent RN with IVC tumor thrombus. Open and robotic surgery represented respectively 30 and 10 cases. The two groups were comparable regarding pre-operative tumor and patient characteristics. Robotic procedures were associated with lower estimated blood loss (EBL) (500 vs. 1250 mL, P=0.02), shorter Intensive Care Unit stay (2 vs. 4 days, P=0.03) and decrease of global length of stay (LOS) (7 vs. 10 days, P<0.01). Operative Time (OT) was significantly longer in the robotic group (350.5 vs. 208 min, P<0.01). No difference were observed between the two approaches regarding complications and oncological outcomes. Robotic approach induced lower bleeding and shorter LOS but required longer OT. This technique is feasible and safe for selected cases and experimented surgical teams. Complications rate and oncological outcomes are not different compared to standard open procedures.

V11-05 MONOCENTRIC EXPERIENCE OF ROBOT-ASSISTED RADICAL NEPHRECTOMY WITH VENA CAVA THROMBECTOMY: TECHNIQUE AND RESULTS

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-05 MONOCENTRIC EXPERIENCE OF ROBOT-ASSISTED RADICAL NEPHRECTOMY WITH VENA CAVA THROMBECTOMY: TECHNIQUE AND RESULTS Louis Gobinet, Lorenzo Tesi, Nam Son Vuong, Melanie Percot, Laure Dupitout, Helene Simeon, Eric Alezra, Franck Bladou, Gregoire Robert, Marine Gross Goupil, and Jean Christophe Bernhard Louis GobinetLouis Gobinet More articles by this author , Lorenzo TesiLorenzo Tesi More articles by this author , Nam Son VuongNam Son Vuong More articles by this author , Melanie PercotMelanie Percot More articles by this author , Laure DupitoutLaure Dupitout More articles by this author , Helene SimeonHelene Simeon More articles by this author , Eric AlezraEric Alezra More articles by this author , Franck BladouFranck Bladou More articles by this author , Gregoire RobertGregoire Robert More articles by this author , Marine Gross GoupilMarine Gross Goupil More articles by this author , and Jean Christophe BernhardJean Christophe Bernhard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Open surgery remains the gold standard treatment for renal tumours with thrombus extension of the inferior vena cava (IVC), whereas the robotic approach has been developed by some expert teams. Two comparative studies are available in the literature. This video’s objective was to present the technique and results of robot-assisted radical nephrectomy with IVC thrombectomy. METHODS: We described the surgical technique of the robotic approach, carried out with the Da-Vinci SI (Intuitive Surgical) surgical robot and intra-operative ultrasound (Hitachi). We present the results of the comparative monocentric retrospective study, which included patients undergoing a radical nephrectomy with IVC thrombus from level 1 to 3 (Mayo clinic classification), between December 2015 and December 2019. Clinical data, collected after consent, come from the prospective French kidney cancer data base UroCCR (CNIL DR 2013-206, NCT03293563). Patients were divided into 2 groups, according to the surgical approach, open or robotic. We present univariate and multivariate analysis of perioperative morbidity and oncological findings. RESULTS: The patient, an 81-year-old man, presented an 8cm tumour of the upper and mid-pole of the right kidney, associated with a thrombus of the IVC. The CT-scan for extension work-up was negative. Operative time (OT) was 320 minutes, including 24 minutes of IVC clamping, with 300cc of blood loss. The length of hospital stay (LOS) was 4 days. Pathology report showed a Clear cell renal carcinoma, Fuhrman grade 4, pT3cN0M0.The open-approach group included 30 patients and the robotic group 10 patients. OT was significantly longer in the robotic group (350 vs 208 min (p<0.01) while blood loss (500 vs 1250 mL (p=0.02)) and LOS (7 Vs 10 days (p<0.01) were reduced. There was no significant difference in terms of postoperative complications or oncological results. CONCLUSIONS: The robotic approach for radical nephrectomy with IVC thrombectomy appears to be feasible and safe, for selected patients in expert centers. It leads to longer operative times, but reduced blood loss and shorter length of stay. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e859-e859 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Louis Gobinet More articles by this author Lorenzo Tesi More articles by this author Nam Son Vuong More articles by this author Melanie Percot More articles by this author Laure Dupitout More articles by this author Helene Simeon More articles by this author Eric Alezra More articles by this author Franck Bladou More articles by this author Gregoire Robert More articles by this author Marine Gross Goupil More articles by this author Jean Christophe Bernhard More articles by this author Expand All Advertisement Loading ...