Robotic Nephrectomy Research Articles

Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service

PurposeThe objective of this study was to perform a retrospective cohort analysis, in which we measured the association of an acute pain service (APS)-driven multimodal analgesia protocol that included preoperative intrathecal morphine (ITM) compared to historic controls (i.e., surgeon-driven analgesia protocol without ITM) with postoperative opioid use.MethodsThis was a retrospective cohort study in which the primary objective was to determine whether there was a decrease in median 24-h opioid consumption (intravenous morphine equivalents [MEQ]) among robotic nephrectomy patients whose pain was managed by the surgical team prior to the APS, versus pain managed by APS. Secondary outcomes included opioid consumption during the 24–48 h and 48–72 h period and hospital length of stay. To create matched cohorts, we performed 1:1 (APS:non-APS) propensity score matching. Due to the cohorts occurring at the different time periods, we performed a segmented regression analysis of an interrupted time series.ResultsThere were 76 patients in the propensity-matched cohorts, in which 38 (50.0%) were in the APS cohort. The median difference in 24-h opioid consumption in the pre-APS versus APS cohort was 23.0 mg [95% CI 15.0, 31.0] (p < 0.0001), in favor of APS. There were no differences in the secondary outcomes. On segmented regression, there was a statistically significant drop in 24-h opioid consumption in the APS cohort versus pre-APS cohort (p = 0.005).ConclusionsThe implementation of an APS-driven multimodal analgesia protocol with ITM demonstrated a beneficial association with postoperative 24-h opioid consumption following robot-assisted nephrectomy.

Bilateral robotic nephrectomy using a supine robotic approach without repositioning through 8-18 mm incisions in a young female with focal and segmental glomerulosclerosis: a video case report.

Bilateral robotic nephrectomy using a supine robotic approach without repositioning through 8-18 mm incisions in a young female with focal and segmental glomerulosclerosis: a video case report.

Surgical Trends and Complications in Partial and Radical Nephrectomy: Results from the GRAND Study.

We aimed to evaluate the current trends in renal cancer surgery, as well as to compare the perioperative outcomes of partial versus radical nephrectomy. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2021). We report the largest study in the field, with 317,843 patients and multiple patient-level analyses. Overall, 123,924 (39%) patients underwent partial and 193,919 (61%) underwent radical nephrectomy in Germany from 2005 to 2021. Of them, 57,308 (18%) were operated on in low-, 142,702 (45%) in intermediate-, and 117,833 (37%) in high-volume centers. A total of 249,333 (78%) patients underwent open, 44,994 (14%) laparoscopic, and 23,516 (8%) robotic nephrectomy. The number of patients undergoing renal surgery remained relatively stable from 2005 to 2021. Over the study period, the utilization of partial nephrectomy increased threefold, while radical nephrectomy decreased by about 40%. After adjusting for major risk factors in the multivariate regression analysis, radical nephrectomy was associated with 3.2-fold higher odds (95% CI: 3.2 to 3.9, p < 0.001) of 30-day mortality, longer hospitalization by 1.9 days (95% CI: 1.9 to 2, p < 0.001), and higher inpatient costs by EUR 1778 (95% CI: 1694 to 1862, p < 0.001) compared to partial nephrectomy. Furthermore, radical nephrectomy had a higher risk of in-hospital transfusion (p < 0.001), sepsis (p < 0.001), acute respiratory failure (p < 0.001), acute kidney disease (p < 0.001), acute thromboembolism (p < 0.001), surgical wound infection (p < 0.001), ileus (p < 0.001), intensive care unit admission (p < 0.001), and pancreatitis (p < 0.001). More patients are offered partial nephrectomy in Germany. Patients undergoing radical nephrectomy present with a higher rate of concomitant risk factors and have increased perioperative morbidity and mortality, prolonged hospitalization, and increased in-hospital costs.

Resection and Re-resection for a Clear Cell Renal Carcinoma with Sarcomatoid Features in a Patient with Birt-Hogg-Dubé Syndrome

Background: Birt-Hogg-Dubé syndrome (BHDS) is a rare monogenic autosomal dominant disorder which is, among other disease manifestations, associated with an increased life-time risk of developing renal cell carcinoma (RCC). Sarcomatoid RCC (sRCC) is a subtype of RCC associated with poor prognosis, high recurrence rates, and a significant resistance to a variety of systemic treatments. Case Report: Here, it is reported that the first case of a sRCC with local recurrence in a 62-year-old female patient with BHDS. This patient was successfully treated with a partial robotic nephrectomy and a re-resection of the tumor recurrence resulting in good short-term oncological outcomes. Conclusions: Robotic partial nephrectomy for sRCC, and robotic re-resection for locally recurrent sRCC in BHDS patients is a feasible treatment strategy associated with good short-term oncological outcomes. Due to the high risk of local and distant recurrences in sRCC cases, a lifelong follow-up with regular imaging is recommended.

Study of analgesic efficacy of ultrasound-guided Transversus Abdominis plane block for robotic nephrectomy

Study of analgesic efficacy of ultrasound-guided Transversus Abdominis plane block for robotic nephrectomy

Sarcopenia and body fat change as risk factors for radiologic incisional hernia following robotic nephrectomy

ObjectiveTo assess the effect of body muscle and fat metrics on the development of radiologic incisional hernia (IH) following robotic nephrectomy.Materials and MethodsWe retrospectively reviewed the records of patients who underwent robotic nephrectomy for kidney tumors between 2011 and 2017. All pre- and postoperative CTs were re-reviewed by experienced radiologists for detection of radiologic IH and calculation of the following metrics using Synapse 3D software: cross-sectional psoas muscle mass at the level of L3 and L4 as well as subcutaneous and visceral fat areas. Sarcopenia was defined as psoas muscle index below the lowest quartile. Cox proportional hazard model was constructed to examine the association between muscle and fat metrics and the risk of developing radiologic IH.ResultsA total of 236 patients with a median (IQR) age of 64 (54–70) years were included in this study. In a median (IQR) follow-up of 23 (14–38) months, 62 (26%) patients developed radiologic IH. On Cox proportional hazard model, we were unable to detect an association between sarcopenia and risk of IH development. In terms of subcutaneous fat change from pre-op, both lower and higher values were associated with IH development (HR (95% CI) 2.1 (1.2–3.4), p = 0.01 and 2.4 (1.4–4.1), p < 0.01 for < Q1 and ≥ Q3, respectively). Similar trend was found for visceral fat area changes from pre-op with a HR of 2.8 for < Q1 and 1.8 for ≥ Q3.ConclusionBoth excessive body fat gain and loss are associated with development of radiologic IH in patients undergoing robotic nephrectomy.

Bilateral Robotic Nephrectomy in a Pediatric Female Patient: A Case Report

Background: We present a report of a robotic bilateral native nephrectomy (BNN) performed on a pediatric patient awaiting kidney transplantation. We describe this rarely performed minimally invasive procedure, especially in the pediatric population. Case Summary: The procedure was performed on a six-year-old girl suffering from worsening kidney function secondary to focal segmental glomerulosclerosis (FSGS). The patient's disease was refractory to all medical management and incurred many complications throughout her course. Because of the complicated course and worsening proteinuria, it was decided to perform a robotic BNN while the patient awaited kidney transplantation. Conclusion: Heavy proteinuria carries a greater risk of severe complications in children with FSGS. Synchronized BNN has significantly reduced these risks, specifically thromboembolisms. In addition, these children could benefit from implementing robotic-assisted BNN with the techniques described. Minimally invasive robotic surgery provides a feasible approach to managing this problematic clinical condition.

V03-01 SINGLE-PORT KIDNEY AUTO-TRANSPLANTATION (SP-KAT) WITH BOARI FLAP URETERAL REIMPLANT: DESCRIPTION OF OUR NOVEL APPROACH

You have accessJournal of UrologyCME1 Apr 2023V03-01 SINGLE-PORT KIDNEY AUTO-TRANSPLANTATION (SP-KAT) WITH BOARI FLAP URETERAL REIMPLANT: DESCRIPTION OF OUR NOVEL APPROACH Jaya Sai Chavali, Jihad Kaouk, Ethan Ferguson, Roxana Ramos, Albert Geskin, Alvin Wee, and Mohamed Eltemamy Jaya Sai ChavaliJaya Sai Chavali More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Albert GeskinAlbert Geskin More articles by this author , Alvin WeeAlvin Wee More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to demonstrate the feasibility and safety of the novel minimally invasive technique for efficient, multiquadrant robotic kidney transplantation using da Vinci single-port robot platform (SP-KAT). The study patient had a good split renal function and complete ureter avulsion. METHODS: Eight consecutive patients underwent SP KAT using the DaVinci SP platform. Overall patient clinicopathologic variables were recorded in Table 1. We demonstrate our technique in 58 year old male that presented after complete avulsion of the ureter during ureteroscopy. He had good split renal function on imaging. Technical steps of the surgery included (1). Robotic nephrectomy; (2) Kidney benching; (3) Dissection of Iliac vessels and Kidney placement; (4) Vascular anastomosis; (5) Ureteral reimplant. Extra corporeal kidney benching performed at the same time while the iliac vessels are being exposed robotically for subsequent transplant. This patient in addition required Boari flap ureteroneocystostomy due to insufficient length of ureter. RESULTS: All SP KAT cases were successfully performed without repositioning or conversion to open. Total operative time was 701 minutes. Estimated blood loss was 500cc. The Foley and stent removed at 2 and 6 weeks postoperatively. Patient had complete preservation of renal function. No documented postoperative complications up to latest follow up at 1 year. CONCLUSIONS: We demonstrate our single-port efficient, multiquadrant robotic kidney transplantation technique performed though a single incision further reducing surgical morbidity. All the cases were completed successfully without conversion or loss of graft function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e246 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jaya Sai Chavali More articles by this author Jihad Kaouk More articles by this author Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Albert Geskin More articles by this author Alvin Wee More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF downloadLoading ...

V05-07 ROBOTIC-ASSISTED LEFT RADICAL NEPHRECTOMY AND IVC THROMBECTOMY IN CROSS-FUSED RENAL ECTOPIA

You have accessJournal of UrologyCME1 Apr 2023V05-07 ROBOTIC-ASSISTED LEFT RADICAL NEPHRECTOMY AND IVC THROMBECTOMY IN CROSS-FUSED RENAL ECTOPIA Hannah Pham, Raj Satkunasivam, Brian Miles, Wesley Ekeruo, Mark Sultenfuss, Michael Brooks, and Monty Aghazadeh Hannah PhamHannah Pham More articles by this author , Raj SatkunasivamRaj Satkunasivam More articles by this author , Brian MilesBrian Miles More articles by this author , Wesley EkeruoWesley Ekeruo More articles by this author , Mark SultenfussMark Sultenfuss More articles by this author , Michael BrooksMichael Brooks More articles by this author , and Monty AghazadehMonty Aghazadeh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Crossed fused renal ectopia is a relatively rare entity with an estimated prevalence of 1 in 2000 births (Tsuboi et al). Renal cell carcinoma (RCC) in this setting is even more rare and there are no previous reports of associated inferior vena cava (IVC) tumor thrombi. Renal malignancy involving crossed fused ectopia presents a unique, complex surgical challenge and, therefore, there a few reports of minimally invasive surgical management. Herein, we describe a successful robotic resection of a large left renal mass with IVC thrombus involving a crossed fused ectopic right kidney. METHODS: We performed a transperitoneal robotic nephrectomy and caval thrombectomy on a 68-year-old male with an 11cm left renal mass and level 1 IVC thrombus, in the setting of a crossed fused ectopic right kidney. A two-position approach - modified left flank, followed by modified right flank - was employed to safely complete the procedure. Critical procedure steps included: 1) Pre-operative left renal artery embolization, 2) IVC control, cavotomy, and thrombectomy, 3) Left radical nephrectomy, and 4) Partial nephrectomy of the ectopic right kidney. The use of intraoperative ultrasound, Firefly technology, and indocyanine green were also fundamental adjuncts to the procedure. Perioperative outcomes are reported along with associated contemporary comparisons. RESULTS: The total operative time was five hours and thirty-one minutes, which included re-positioning and re-docking time. Estimated blood loss was 300cc without the need for perioperative transfusion. The postoperative course was uncomplicated, and the patient was discharged on postoperative day 4. There were no major perioperative complications. Pre- and postoperative estimated glomerular filtration rate was 86 and 52, respectively. Final pathology showed pT3b, N1, and clear cell RCC. Margins were negative. CONCLUSIONS: We demonstrate robotic resection of RCC with IVC thrombus in the setting of crossed fused renal ectopia, which is, to our knowledge, the first reported description of this entity and this approach. Success was predicated on strict adherence to standard oncologic and operative principles for minimally invasive IVC thrombectomy, radical nephrectomy, and partial nephrectomy. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e426 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Pham More articles by this author Raj Satkunasivam More articles by this author Brian Miles More articles by this author Wesley Ekeruo More articles by this author Mark Sultenfuss More articles by this author Michael Brooks More articles by this author Monty Aghazadeh More articles by this author Expand All Advertisement PDF downloadLoading ...

PD40-01 TRENDS IN OPEN, LAPAROSCOPIC, AND ROBOTIC APPROACH FOR PARTIAL AND RADICAL NEPHRECTOMY FOR RENAL CANCER: A REAL-WORLD STUDY USING THE NATIONAL INPATIENT SAMPLE DATABASE

You have accessJournal of UrologyCME1 Apr 2023PD40-01 TRENDS IN OPEN, LAPAROSCOPIC, AND ROBOTIC APPROACH FOR PARTIAL AND RADICAL NEPHRECTOMY FOR RENAL CANCER: A REAL-WORLD STUDY USING THE NATIONAL INPATIENT SAMPLE DATABASE Sanjana Ranganathan, Carlos Riveros, Jiaqiong Xu, Courtney Chang, Michael Geng, and Raj Satkunasivam Sanjana RanganathanSanjana Ranganathan More articles by this author , Carlos RiverosCarlos Riveros More articles by this author , Jiaqiong XuJiaqiong Xu More articles by this author , Courtney ChangCourtney Chang More articles by this author , Michael GengMichael Geng More articles by this author , and Raj SatkunasivamRaj Satkunasivam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is a preferred option for management of small renal masses due to benefits in postoperative renal function offered by preservation of normal parenchyma when compared to radical nephrectomy (RN). PN is a technically challenging procedure, requiring a high level of expertise to achieve negative margins and minimize blood loss and ischemia times. Considering increased interest in minimally invasive surgery (MIS) and the rapid adoption of robotic surgery within the field of urology, our study aims to elucidate contemporary trends in surgical approach for PN and RN and analyze patient and facility characteristics associated with treatment choice. METHODS: We used the National Inpatient Sample to identify patients diagnosed with malignant neoplasm of the kidney treated with PN or RN from 2014 to 2019. We examined trends in surgical approach (open, laparoscopic, and robotic) over the study period using a Wilcoxon-type test for trend and performed multivariable logistic regression modeling to determine relevant covariates. RESULTS: In the PN group, 4,543 (28.5%) were treated with open PN (OPN), 1,515 (9.52%) with laparoscopic PN (LPN), and 9,857 (61.9%) with robotic PN (RPN). In the RN group, 11,588 (48.1%) were treated with open RN (ORN), 6,533 (27.1%) with laparoscopic RN (LRN), and 5,947 (24.7%) with robotic RN (RRN). There was an increase in robotic and laparoscopic surgery and decrease in open surgery over the study period for both PN and RN (p<0.001). For PN, multivariable analysis (Table 1) showed higher income quartile, private insurance coverage, and treatment at urban teaching facilities to be associated with higher likelihood of receiving MIS compared to OPN. For RN, high income quartile and treatment at urban teaching facilities were associated with higher likelihood of receiving MIS compared to ORN. Self pay/uninsured patients are less likely to receive both RPN and RRN. CONCLUSIONS: There was increased MIS utilization for nephrectomy with a concurrent decrease in open surgery over the studied period. RRN and RPN use is significantly higher at urban teaching facilities. Patients with higher comorbidity burden are more likely to undergo MIS. Uninsured patients are less likely to have access to robotic nephrectomy. Source of Funding: Sanjana Ranganathan is a Burroughs Wellcome Fund Scholar supported by a Burroughs Wellcome Fund Physician Scientist Institutional Award to the Texas A&M University Academy of Physician Scientists © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1051 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjana Ranganathan More articles by this author Carlos Riveros More articles by this author Jiaqiong Xu More articles by this author Courtney Chang More articles by this author Michael Geng More articles by this author Raj Satkunasivam More articles by this author Expand All Advertisement PDF downloadLoading ...

V03-08 BILATERAL ROBOTIC NEPHRECTOMY USING A SUPINE ROBOTIC APPROACH WITHOUT REPOSITIONING THROUGH 8-18mm INCISIONS IN A YOUNG FEMALE WITH FOCAL AND SEGMENTAL GLOMERULOSCLEROSIS: A VIDEO CASE REPORT

You have accessJournal of UrologyCME1 Apr 2023V03-08 BILATERAL ROBOTIC NEPHRECTOMY USING A SUPINE ROBOTIC APPROACH WITHOUT REPOSITIONING THROUGH 8-18mm INCISIONS IN A YOUNG FEMALE WITH FOCAL AND SEGMENTAL GLOMERULOSCLEROSIS: A VIDEO CASE REPORT Luca Antonelli, Adrian Duss, Leutrim Zahiti, Agostino Mattei, and Christian D. Fankhauser Luca AntonelliLuca Antonelli More articles by this author , Adrian DussAdrian Duss More articles by this author , Leutrim ZahitiLeutrim Zahiti More articles by this author , Agostino MatteiAgostino Mattei More articles by this author , and Christian D. FankhauserChristian D. Fankhauser More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal segmental glomerulosclerosis (FSGS) is a histologic pattern that is associated with nephrotic syndrome in children and adults and represents an important cause of end-stage renal disease worldwide. The underlying podocytopathy is a consequence of multiple pathways either individually or collectively. The associated heavy proteinuria represents a perioperative risk factor for complications after transplantation. Therefore, a bilateral nephrectomy before transplantation is recommended to stop protein loss by the kidneys. METHODS: A 19 years-old woman with therapy resistant FSGS had a persistently low serum albumin level requiring 70g human albumin supplementation each week. A bilateral kidney embolization or surgical removal before listing for a kidney transplantation was required. To improve perioperative outcomes and cosmesis in a young female patient, she was scheduled for a robotic subumbilical access to avoid scar tissue in the upper abdomen.The patient was positioned in a supine position with 30° head down. Four robotic 8mm trocars were placed in a subumbilical line and a 5mm and 12mm assistant trocar were positioned laterally of the medial umbilical ligaments. No repositioning of the patient during the whole case was required. The peritoneum was incised at the level of the ileocecal valve up to the ligament of Treitz. A hammock-like barrier is created by suturing both lateral edges of the parietal peritoneum to the anterior abdominal wall. Subsequently the renal hilus was dissected and the kidney mobilized. The renal vessels were clipped. A 18mm laparoscopic morcellator was introduced after extending the 12mm assistant trocar incision and the kidneys were removed through the morcellator. RESULTS: Blood loss was <50 mL and theatre time 325 minutes. After the surgery the patient had mild bruises on both shoulders because of the long-time period in the Trendelenburg position but resolved without further treatment. Postoperative length of stay was 4 days. After successful removal of both kidneys, the patient was listed for a kidney transplant with priority given her age < 20 years. CONCLUSIONS: Bilateral robotic nephrectomy using a subumbilical access and removal of the kidney using a morcellator is technically demanding but feasible. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e248 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Antonelli More articles by this author Adrian Duss More articles by this author Leutrim Zahiti More articles by this author Agostino Mattei More articles by this author Christian D. Fankhauser More articles by this author Expand All Advertisement PDF downloadLoading ...

Ürolojik robotik cerrahilerde bölgesel analjezi tekniklerinin etkinliği: retrospektif klinik çalişma

Objective: The advantages of robot-assisted surgery include shorter incisions, less postoperative pain, perioperative blood loss, and a faster return to daily functions. Thoracic epidural analgesia (TEA) provides highly satisfactory analgesia in abdominal surgery. However, its hypotensive effect, particularly in minimally invasive procedures, exceeds its contribution to rapid recovery. Fascial plane blocks may be more beneficial in that context. This study evaluated the effects of regional analgesia techniques in robotic prostatectomy, nephrectomy, and cystectomy operations. Material and Methods: Following IRB Ethics Committee approval (2021.467.IRB1.134), the records of patients who had undergone robotic prostatectomy, nephrectomy, and cystectomy surgeries were retrospectively reviewed between January 2018 and January 2022. Results: One hundred and forty patients with full documentation were included in this study. Various regional analgesia methods were used. Fascial plane blocks were seen to be used in addition to epidural analgesia. Transversus abdominis plane (TAP) and rectus sheath blocks exhibited satisfactory results in robotic prostate surgeries and TAP blocks in robotic nephrectomy operations. Conclusion: In robotic prostatectomy and nephrectomy operations, we recommend fascial plane blocks as the first-choice method for postoperative analgesia. Keywords: regional anesthesia, robotic surgery, radical prostatectomy, minimally invasive surgery, fascial plane blocks, recovery after surgery

VE14 - Bilateral robotic nephrectomy using a supine robotic approach without repositioning through 8-18mm incisions in a young female with focal and segmental glomerulosclerosis: A video case report

VE14 - Bilateral robotic nephrectomy using a supine robotic approach without repositioning through 8-18mm incisions in a young female with focal and segmental glomerulosclerosis: A video case report

PE07 - Robotic nephrectomy for autosomal dominant polycystic kidney disease is superior to the open approach – A retrospective review of cases in Australia

PE07 - Robotic nephrectomy for autosomal dominant polycystic kidney disease is superior to the open approach – A retrospective review of cases in Australia

Simultaneous Robotic-Assisted Bilateral Native Nephrectomy and Kidney Transplantation for Autosomal Dominant Polycystic Kidney Disease in Recipients With High Body Mass Index: Report of 2 Cases

Robotic kidney transplantation is a safe, reproducible, and less morbid technique in high body mass index and end-stage renal disease. Polycystic kidney disease is a relative contraindication to robotic-assisted kidney transplantation because of the mass effect of the native kidneys on the patient's pelvis that prevents ideal exposure. We report the first 2 cases of robotic-assisted simultaneous bilateral nephrectomy and kidney transplantation for patients with obesity and adult polycystic kidney disease. The recipients were 2 males, 50 and 53 years old, with a body mass index of 35.1 41.6 kg/m2 and 41.6 kg/m2, respectively. Both recipients had suitable living donors. The average operating time was 395 minutes and the estimated blood loss was on average 250 mL. The postoperative course was uneventful and the patients were discharged home on days 4 and 5. Performing robotic nephrectomies simultaneously with kidney transplantation can be done safely, allowing patients with obesity and polycystic kidney disease needing bilateral nephrectomy, to take full advantage of minimally invasive kidney transplantation.

Donor Nephrectomy Through Mini-Flank Incision: A Single-Centre Experience Among Nigerian Patients.

Background and objectiveThe field of kidney transplantation in sub-Saharan Africa is still in the rudimentary stages. The majority of patients with chronic kidney disease have no access to renal replacement therapy, leading to very high mortality rates. Donor nephrectomy (DN) is an important aspect of kidney transplantation. Over the last two decades, open DN (ODN) has given way to minimally invasive techniques like laparoscopic DN (LDN) and robotic-assisted DN. In this study, we aimed to describe our experience with mini-flank incision donor nephrectomy (MIDN) at a Nigerian renal transplant center.Materials and methodsWe conducted a retrospective review of all DN cases performed at a single Nigerian kidney transplantation center over a three-year period. Information obtained from these patients was classified into pre-, intra-, and postoperative. The data included sociodemographic characteristics, preoperative preparation, details of intraoperative techniques, and postoperative findings. These were entered into a proforma and analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY).ResultsA total of 230 patients underwent ODN during the study period. The majority of the donors were males (92.8%) with a mean age of 30.83 ±8.43 years. The body mass index (BMI) of most (76.1%) of the donors was within the normal range (18.5-24.9 kg/m2). The duration of DNs ranged from 72 to 154 minutes with a mean duration of 130 ±28 minutes. The length of flank incisions ranged from 7.8 to 12 cm with a mean incision length of 10.8 ±1.0 cm. Donors who had MIDN attained satisfactory postoperative pain control with about 90% of them having a BMI of <30 kg/m2. Oral intake and ambulation were commenced on the first postoperative day, and the cosmetic outcomes were deemed acceptable in over 90% of kidney donors.ConclusionMini-incision for DN through the flank approach is a suitable alternative to LDN in the developing world where facilities and skills for LDN or robotic nephrectomies are largely unavailable. It offers a short recovery time, early ambulation, and excellent allograft outcomes.

218 The Impact on Minimally Invasive Urological Cancer Surgery During the Covid-19 Pandemic

AimLearned bodies recommended restricted use of, or extensive precautions when using, laparoscopic/robotic surgery during the Covid-19 pandemic. We aimed to determine whether minimally invasive surgery (MIS) in uro-oncology patients was safe for patients and staff.MethodFrom 16 March to 16 June 2020, patients having MIS in a tertiary referral urology centre were identified from a prospectively collected database. Patient characteristics, operative details and 30-day follow-up for adverse events were recorded including Covid-19 tests and results. Any theatre staff Covid-19 event was traced back 14 days to determine any involvement in these cases.Results87 patients were eligible for inclusion (33 robotic prostatectomies, 38 laparoscopic prostatectomies, 11 laparoscopic nephrectomies, 5 robotic nephrectomies). All patients were assessed for symptoms of Covid-19 on the day of theatre. 18(21%) patients had pre-operative screening (all swabs, no CT chest). 46(53%) underwent 14 days pre-operative self-isolation. 38(44%) cases were performed with FFP3 protection. No modification to operating procedure was made for any cases. No patients tested positive for Covid-19 in the 30-day postoperative period. No staff member involved tested positive in the postoperative period. 1 patient tested positive pre-operatively, delaying the operation by 7 weeks. No patients tested positive after the introduction of mandatory screening.ConclusionsBased on our case-series MIS urological surgery appears to be safe for patients and staff, with no increased risk of Covid-19 complications in patients who are asymptomatic pre-operatively. The introduction of mandatory pre-operative swabs for elective patients, and the use of FFP3 protection, did not significantly alter results.

Evidence-Based Recommendations for Opioid Prescribing After Endourological and Minimally Invasive Urological Surgery.

Introduction: Procedure-specific guidelines for postsurgical opioid use can decrease overprescribing and facilitate opioid stewardship. Initial recommendations were based on feasibility data from limited pilot studies. This study aims to refine opioid prescribing recommendations for endourological and minimally invasive urological procedures by integrating emerging clinical evidence with a panel consensus. Materials and Methods: A multistakeholder panel was convened with broad subspecialty expertise. Primary literature on opioid prescribing after 16 urological procedures was systematically assessed. Using a modified Delphi technique, the panel reviewed and revised procedure-specific recommendations and opioid stewardship strategies based on additional evidence. All recommendations were developed for opioid-naive adult patients after uncomplicated procedures. Results: Seven relevant studies on postsurgical opioid prescribing were identified: four studies on ureteroscopy, two studies on robotic prostatectomy including a combined study on robotic nephrectomy, and one study on transurethral prostate surgery. The panel affirmed prescribing ranges to allow tailoring quantities to anticipated need. The panel noted that zero opioid tablets would be potentially appropriate for all procedures. Following evidence review, the panel reduced the maximum recommended quantities for 11 of the 16 procedures; the other 5 procedures were unchanged. Opioids were no longer recommended following diagnostic endoscopy and transurethral resection procedures. Finally, data on prescribing decisions supported expanded stewardship strategies for first-time prescribing and ongoing quality improvement. Conclusion: Reductions in initial opioid prescribing recommendations are supported by evidence for most endourological and minimally invasive urological procedures. Shared decision-making before prescribing and periodic reevaluation of individual prescribing patterns are strongly recommended to strengthen opioid stewardship.

V33 - Robotic nephrectomy with inferior vena cava thrombectomy: A good indication also in case of haemodinamic instability

V33 - Robotic nephrectomy with inferior vena cava thrombectomy: A good indication also in case of haemodinamic instability

Using explainable deep learning in da Vinci Xi robot for tumor detection

Abstract Deep learning has proved successful in computer-aided detection in interpreting ultrasound images, COVID infections, identifying tumors from computed tomography (CT) scans for humans and animals. This paper proposes applications of deep learning in detecting cancerous cells inside patients via laparoscopic camera on da Vinci Xi surgical robots. The paper presents method for detecting tumor via object detection and classification/localizing using GRAD-CAM. Localization means heat map is drawn on the image highlighting the classified class. Analyzing images collected from publicly available partial robotic nephrectomy videos, for object detection, the final mAP was 0.974 and for classification the accuracy was 0.84.