V1028 ROBOTIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY (2011)

You have accessJournal of UrologyKidney & Ureter Oncology1 Apr 2011V1028 ROBOTIC-ASSISTED LAPAROENDOSCOPIC SINGLE-SITE PYELOPLASTY Ephrem Olweny, Sara Best, and Jeffrey Cadeddu Ephrem OlwenyEphrem Olweny Dallas, TX More articles by this author , Sara BestSara Best Dallas, TX More articles by this author , and Jeffrey CadedduJeffrey Cadeddu Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1063AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site surgery (LESS) pyeloplasty is technically challenging due to instrument clashing and difficulty sewing, and usually requires use of an additional 3/5-mm port to facilitate sewing. Application of the da Vinci Si™ robotic surgical system to LESS (R-LESS) may help overcome these challenges. We herein describe our technique and initial clinical experience with R-LESS pyeloplasty. METHODS Since May 2010, we have performed R-LESS pyeloplasty in 5 patients. All patients presented with symptomatic obstruction, which was confirmed by lasix renography. Initial cystoscopy with JJ stent insertion was performed. The peritoneum was entered through a 3-cm umbilical incision, and a GelPOINT™ (Applied Medical, Rancho Santa Margarita, CA) access platform was placed. An inverted-triangle trocar configuration, consisting of a left 8-mm port, a right 5-mm port, and a 12-mm camera port, positioned at least 2-cm apart on the GelPOINT™, was used. A left 5-mm assist port was triangulated off the left sided ports. Ports were placed prior to positioning the GelPOINT™ on the abdomen, which was then insufflated. An 8-mm robotic scissors or hook cautery was placed through the left port, and a 5-mm robotic grasper through the right port, criss-crossing these instruments at the umbilicus so as to maximize separation of the robotic arms. The robotic console was programmed to control these instruments intuitively, such that the right hand controlled the instrument in the left port, and vice versa for the right port instrument. An upward-facing 30-degree robotic camera was used. For the right- side, a 3-mm liver retractor was used, placed through a separate stab incision. Dismembered pyeloplasty was then completed in standard fashion, and the anastomosis completed over the pre-placed stent, without need for an additional port. A surgical drain was then positioned through the umbilicus. RESULTS R-LESS pyeloplasty was successfully completed in all 5 patients, with a mean operative time of 228 min, and estimated blood loss of 56 ml. There were no intra- or postoperative complications. Mean hospital length of stay was 2.3 days. Short and long-term functional outcome data are pending. CONCLUSIONS Initial experience with R-LESS pyeloplasty using the da Vinci Si™ robot is promising; benefits are improved ergonomics, decreased instrument clashing, and avoidance of an extra port for the anastomosis. Development of robotic systems specific to R-LESS is underway, and is expected to further facilitate widespread clinical application. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185 Issue 4S April 2011 Page: e414 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Metrics Author Information Ephrem Olweny Dallas, TX More articles by this author Sara Best Dallas, TX More articles by this author Jeffrey Cadeddu Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...