Robotic Nephrectomy Research Articles

Robotic Nephrectomy for Living Donation: Surgical Technique and Literature Systematic Review.

Background. As compared to traditional laparoscopy, robotic-assisted surgery provides better endowrist instruments and 3-D visualization of the operative field. Studies published so far indicate that living donor nephrectomy using the robot-assisted technique is safe, feasible, and provides remarkable advantages for the patients. Materials and Methods. From five papers reporting detailed descriptions of surgical technique for Robotic-Assisted-Nephrectomy (RAN) in Living-Donor-Kidney-Transplantation (LDKT), we have gathered information about the surgical techniques as well as about patients’ intra- and post-operative outcome. Data from these papers were analyzed together with the data from our own experience (33 cases) so that the total number of analyzed cases was 292. Results. In the analyzed populations, no case of donor death occurred, and no case developed complication above grade 2 of Clavien score. Peri-operative complications occurred in 37/292 patients (12.6%). Accidental acute hemorrhage occurred in 5/292 cases (1.7%). The average overall intra-operative blood loss was 67.8 ml (range: 10-1500 ml). The average warm ischemia time was 3.5 min (range: 0.58-7.6 min). Conversion to the open technique occurred in only four cases (1.3%). The average overall operative time was 192 minutes (range: 60-400 min). The average length of the hospital stay was 2.7 days (range: 1-10 days). Conclusion. Safety and feasibility of the RAN are pointed out in all the reviewed article, both as hand-assisted and as totally robotic technique. RAN appears to be significantly easier for the surgeons and the results are comparable to the ones obtained with the pure laparoscopic technique.

NEFRECTOMÍA ROBÓTICA DEL DONANTE VIVO PARA TRASPLANTE: PRIMER CASO EN LATINOAMÉRICA

Living robotic donor nephrectomy. The first case in Latin America Introduction: Living donor nephrectomy is the best alternative of treatment for patients with chronic renal disease. Even though open surgery remains the gold standard for donor nephrectomy, laparoscopic surgery has become a feasible alternative in referral centers. To minimize the long learning curve associated with this procedure, some centers have introduced robotic donor nephrectomy as a surgical option. Aim: To present the first robotic-assisted laparoscopic donor nephrectomy in Latin America. Clinical case: The donor is a 50 years old male, living-related to the recipient by affinity (husband/wife). The recipient is a 54 years old female with history of end-stage renal disease waiting to initiate dialysis program. A left transperitoneal robotic-assisted laparoscopic nephrectomy employing the da Vinci Si ® (Intuitive Surgical, Sunnyvale CA.) is performed. Mean operative time was 188 minutes with an estimated blood loss of 300 ml. Mean ischemia time was 6 minutes. The graft presented immediate function. Both patients were discharged at 72 h. Conclu- sion: Living donor robotic-assisted laparoscopic nephrectomy is a safe and viable procedure. Larger series are needed to establish its role.

Bias toward Internet advertisement of robotic nephrectomy.

e15559 Background: Despite unclear benefits over radical nephrectomy (RN), Robotic Assisted Nephrectomy (RaN) has become a more commonly chosen approach for kidney surgery. A reason for this could ...

Current trends in renal cell carcinoma

Kidney cancer is one of the most lethal urological malignancies and surgery was the only treatment of modality a decade ago. Open radical nephrectomy was the procedure of choice for long time for all malignant masses. The increase use of imaging modalities has led to diagnose small renal masses and most of the tumors are incidentally detected now a day[1]. Depending on tumor size, age and associated co-morbidities, various management options has evolved like AS, minimal invasive ablation, nephron sparing surgery, laparoscopic and robotic nephrectomy, open radical nephrectomy. Role of renal biopsy has become proven in many circumstances. Targeted systemic chemotherapy has shown improved progression free survival in metastatic RCC. Keywords: RCC-Renal cell carcinoma; Radical nephrectomy; Partial nephrectomy; Laparoscopic nephrectomy; Robotic surgery; Chemotherapy; Renal biopsy

Evolution of robotic nephrectomy for living donation: from hand-assisted to totally robotic technique

The application of robotic-assisted surgery offers EndoWrist instruments and 3-D visualization of the operative field, which are improvements over traditional laparoscopy. The results of the few studies published so far have shown that living donor nephrectomy using the robot-assisted technique is safe, feasible, and offers advantages to patients. Since November 2009, 16 patients have undergone robotic-assisted living donor nephrectomy at our Institute. Patients were divided into two groups according to the surgical technique adopted for the procedure: Group A, hand-assisted robotic nephrectomy (eight patients); Group B, totally robotic nephrectomy (eight patients). Intra-operative bleeding was similar in the two groups (90 vs 100 mL for Group A and B, respectively). Median warm ischemia time was significantly shorter in Group A (2.3 vs 5.1 min for Group A and B, respectively, P-value = 0.05). Switching to the open procedure was never required. Median operative time was not significantly longer in Group A than Group B (275 min vs 250 min, respectively). Robotic assisted living kidney recovery is a safe and effective procedure. Considering the overall technical, clinical, and feasibility aspects of living kidney donation, we believe that the robotic assisted technique is the method of choice for surgeon's comfort and donors' safety.

Technical considerations in robotic nephrectomy with vena caval tumor thrombectomy.

Robotic surgery has been applied to increasingly complex urologic procedures since its initial widespread adoption for prostatectomy. While laparoscopic nephrectomy was initially reported over 2 decades ago, renal tumors involving the inferior vena cava (IVC) appeared to be a limitation to the application of laparoscopy. Laparoscopic management had only been reported in a limited fashion for short tumor thrombi not requiring cross-clamping of the IVC. The first robotic nephrectomy for renal cancer with IVC tumor thrombus was performed in 2008 with the first series reported in 2011, including for larger tumor thrombi requiring IVC cross-clamping for thrombus extraction. Since then, several surgeons at various institutions have adopted robotic surgery for these complex procedures. With experience and meticulous surgical technique, the procedure can be reproduced in properly selected cases. Further adoption and reports of multi-institutional experiences are necessary to validate this still relatively new procedure, and such work is already underway.

Robotic nephrectomy for angiomyolipoma

Robotic nephrectomy for angiomyolipoma

Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database

ObjectivesWe sought to examine the trends in perioperative outcomes of kidney cancer surgery stratified by type (radical nephrectomy [RN] vs. partial nephrectomy [PN]) and approach (open vs. minimally invasive). MethodsWe queried the National Surgical Quality Improvement Program database to identify kidney cancer operations performed from 2005 to 2011. We examined 30-day perioperative outcomes including operative time, transfusion rate, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious), and mortality. ResultsA total of 2,902 PN and 5,459 RN cases were identified. The use of PN increased over time, accounting for 39% of all nephrectomies in 2011. Minimally invasive approaches also increased over time for both RN and PN. Open surgery was associated with increased length of stay, receipt of transfusion, major complications, and perioperative mortality. Resident involvement and open approach were independent predictors of major complications for both PN and RN. Additionally, the presence of a medical comorbidity was also a risk factor for complications after RN. The overall complication rates decreased for all approaches over the study period. ConclusionsMinimally invasive approaches to kidney cancer renal surgery have increased with favorable outcomes. The safety of open and minimally invasive PN improved significantly over the study period. Although pathologic features cannot be determined from this data set, these data show that complications from renal surgical procedures are decreasing in an era of increasing use.

Completely Intracorporeal Robotic Renal Autotransplantation

Abstract Introduction and Objectives: Totally intracorporeal robotic donor nephrectomy with autotransplantation has not been previously described. We present a video demonstration of this novel pro...

Initial Experience with Robot-Assisted Nephrectomy for Living-Donor Kidney Transplantation: Feasibility and Technical Notes

BackgroundRobot-assisted surgery provide endowrist instruments and 3-dimensional visualization of the operative field that are improvements over traditional laparoscopy. The few research studies published so far have demonstrated that living-donor nephrectomy using the robot-assisted technique is safe and feasible, providing advantages for patients. MethodsSince November 2009, we performed 20 robot-assisted living-donor nephrectomies. Eight patients underwent hand-assisted robotic nephrectomy, whereas 20, totally robotic nephrectomy. ResultsMedian intraoperative bleeding was 174 mL (range, 10–750) but no patient needed intraoperative transfusion with blood cells. The median warm ischemia time was 3.16 minutes (range, 0.30–6.5). there was no case of conversion to an open procedure. The median operative time was 311 minutes (range, 85–530); the median console time was 160 minutes (range, 135–220). ConclusionRobot-assisted living-donor kidney recovery was a safe and effective procedure. The totally robotic recovery is an evolving technique. The prospect of robotic staplers, endowrist ligature, and robotic single port may further increase these advantages.

Robotic Right Nephrectomy and Inferior Vena Cava Tumor Thrombectomy with Caval Patch Graft Reconstruction

Abstract Introduction: Despite the increasing popularity of laparoscopic and robotic approaches for renal tumors, open surgery is the standard approach for the surgical management of renal tumors with extension into the inferior vena cava (IVC).1 Abaza reported the first robot-assisted radical nephrectomy with IVC tumor thrombectomy in a series of five patients with good outcomes. Two patients necessitated cross-clamping of the IVC, and in all cases, the IVC cavotomy was closed using a two layer suture.2 We present our technique and perioperative results of the first robot-assisted radical nephrectomy and IVC tumor thrombectomy and reconstruction using a synthetic patch graft. Materials and Methods: A 61-year-old woman presented with an 8-cm right renal mass, bilateral pulmonary embolism, and IVC tumor thrombus extending into the subhepatic IVC. After counseling and discussion of all available treatment options, the patient opted for robotic-assisted surgical management. The procedure was performed by a s...

Surgical aspects of living donor nephrectomy

ContextLiving donor renal transplant surgery has evolved from the classical nephrectomy by lumbotomy to less invasive surgery, the laparoscopic and robotic nephrectomy currently being the most important. It is important to know the available evidence on whether nephrectomy in patients with multiple arteries, right kidney and in obese patients can be performed safely when there is a correct indication. ObjectiveTo perform a review of the different surgical techniques in living donor nephrectomy, adapted to the current surgical evidence and other aspects related to the indication. Evidence acquisitionA systematic review was made in PubMed (1997–2011). This included previous reviews randomized controlled clinical studies, cohort studies, and meta-analyses of these surgical aspects of living donor nephrectomy. ConclusionsCurrently, there is sufficient evidence to consider living donor laparoscopic nephrectomy (LDLN) as the technique of choice, although the role of hand-assisted retroperitoneoscopic technique is still not totally clear. Open surgery techniques using mini-incision are an acceptable alternative for the sites that have not yet implemented laparoscopic surgery. Right kidney nephrectomy, of those cases that present multiple pedicles and in obese donors, is justified in selected cases.

V3 First clinical application: Transvaginal hybrid NOTES robotic donor nephrectomy

V3 First clinical application: Transvaginal hybrid NOTES robotic donor nephrectomy

V2 Robotic transrectal hybrid NOTES nephrectomy: Initial experience in a cadaver model

V2 Robotic transrectal hybrid NOTES nephrectomy: Initial experience in a cadaver model

Aspectos quirúrgicos actuales de la nefrectomía de donante vivo

ContextLiving donor renal transplant surgery has evolved from the classical nephrectomy by lumbotomy to less invasive surgery, the laparoscopic and robotic nephrectomy currently being the most important. It is important to know the available evidence on whether nephrectomy in patients with multiple arteries, right kidney and in obese patients can be performed safely when there is a correct indication. ObjectiveTo perform a review of the different surgical techniques in living donor nephrectomy, adapted to the current surgical evidence and other aspects related to the indication. Evidence acquisitionA systematic review was made in PubMed (1997-2011). This included previous reviews randomized controlled clinical studies, cohort studies, and meta-analyses of this surgical aspects of living donor nephrectomy. ConclusionsCurrently, there is sufficient evidence to consider living donor laparoscopic nephrectomy as the technique of choice, although the role of hand-assisted retroperitoneoscopic technique is still not totally clear. Open surgery techniques using mini-incision are an acceptable alternative for the sites that have not yet implemented laparoscopic surgery. Right kidney nephrectomy, of those cases that present multiple pedicles and in obese donors, is justified in selected cases.

Renal Artery Aneurysm in Robotic Donor Nephrectomy: A Case Report

With the current disparity between donor organ availability and recipient need, creative techniques help optimize the use of available organs. We present a case of a woman, who was worked-up as a kidney donor, who was incidentally found to have a saccular aneurysm on her renal artery. The patient was asymptomatic, normotensive, and had normal renal function. We performed a laparoscopic robotic donor nephrectomy, repaired the aneurysm on the back table, and transplanted the organ into the recipient. The donor underwent a successful robotic nephrectomy, successfully eradicating any risk of aneurysmal complications; the recipient received an anatomically normal organ with excellent function. An altruistic act by the donor identified a potentially fatal lesion, which was not only remedied, but the intended donation proceeded when a creative approach was used.

Nefrectomía simple por puerto único (LESS) asistida por robot (da Vinci)

Single-site port robotic-assisted simple nephrectomy (LESS) Introduction: Minimally invasive surgery in urology is rapidly advancing and Laparo-endoscopic single-site surgery (LESS) is not the exception. Such laparoscopic procedures are technically challenging and require an experienced laparoscopic surgeon due to the lack of port placement triangulation and instrument clashing. The benefi t of the da Vinci surgical system has recently introduced to LESS. We present two cases of robotic LESS nephrectomy. Matherials and Methods: Two patients, a female of 23 years old, diagnosed with right renal atrophy secondary to chronic pyelonephritis and one male patient with diagnosis of left staghorn calculi and renal atrophy. Both underwent to a total nephrectomy assisted by the da Vinci S surgical system through a single port incision using the GelPoint® access system. Results: The fi rst surgery was performed without incidents or conversion. The second patient required the installation of an additional robotic port for triangulation. The dock time and the mean operative time was 18 and 110 min. The mean estimated blood loss was 100 cc and the hospital stay was 27 hours. There were no complications. Conclusions: LESS robotic surgery is feasible using current robotic systems. However, there are several limitations. The design of specifi c technology for the use of the robot through single incision can solve this problem.

Techniques for Robotic Nephrectomy with Vena Caval Tumor Thrombectomy

Objectives: Laparoscopy has become the standard of care for most renal tumors but not yet for renal cell carcinoma involving the vena cava (IVC). Robotic technology may facilitate such complex procedures. Methods: Two techniques for totally intracorporeal robotic nephrectomy for renal tumors with IVC tumor thrombus are described with video illustration.1,2 The first technique for smaller tumor thrombi involves tangential clamping of the IVC for preserved flow, whereas larger tumor thrombi are managed with IVC cross-clamping using modified Rummel tourniquets. In all cases, the IVC is circumferentially mobilized with all lumbar veins controlled. Laparoscopic ultrasonography is used selectively to evaluate extent of larger thrombi and to confirm lack of caval invasion. These techniques have been performed in five patients with one patient having two renal veins each with an IVC thrombus. Results: Robotic surgery has been applied safely for renal cell carcinoma with IVC tumor thrombus with the two described techniques in five patients with tumor sizes of 6 to 15.5 cm and thrombi protruding 1 to 5 cm into the IVC. Mean estimated blood loss was 170 mL (range, 50–400 mL). Mean operative time from incision to dressing including robotic full retroperitoneal lymphadenectomy in four patients was 327 minutes (range, 240–411 minutes). The largest incision used for extraction was 6 cm and as small as 4 cm. Four patients were discharged on postoperative day 1 and the other patient on day 2. There were no complications, transfusions, or readmissions. Conclusions: Further experience is necessary to validate this promising application of robotic surgery and to determine whether more extensive thrombi can treated in minimally-invasive fashion. The author has no disclosures to report relevant to this publication. No competing financial interests exist. Runtime of video: 6 mins 54 secs

Robotic surgery and minimally invasive management of renal tumors with vena caval extension

Although laparoscopic nephrectomy for renal cell carcinoma (RCC) has become a widely accepted option for most renal tumors, open surgery remains the standard in managing tumors with extension into the inferior vena cava (IVC). Robotic technology has been applied to increasingly complex laparoscopic procedures and may facilitate minimally invasive procedures previously felt unfeasible with standard laparoscopy. The evolution to completely intracorporeal techniques for IVC tumor thrombectomy from incremental advancements in laparoscopic and hybrid techniques is reviewed. Laparoscopic management of IVC tumor thrombi has been demonstrated in animal models and more recently in the form of individual case reports. Hybrid laparoscopic techniques have been developed to allow hand-assisted thrombus retraction out of the IVC or open incisions for IVC management after laparoscopic dissection. Robotic surgery only recently has been described to allow a completely minimally invasive technique for tumor thrombectomy even when cross-clamping of the cava is required. Such techniques have yet to gain popular acceptance but have been reproduced to a limited degree by other investigators. Robotic technology applied to complex laparoscopic procedures may extend the limits of what can be performed successfully in minimally invasive fashion. The early reported experiences of robotic nephrectomy with IVC tumor thrombectomy, thus far, demonstrate feasibility but require further investigation. Discrimination of ideal candidates and reproducibility by other surgeons will be necessary before widespread adoption and acceptance.

Initial Series of Robotic Radical Nephrectomy with Vena Caval Tumor Thrombectomy

Initial Series of Robotic Radical Nephrectomy with Vena Caval Tumor Thrombectomy