title: Robotic remote laparoscopic nephrectomy and adrenalectomy: the initial experience.
abstract: OBJECTIVE
  We evaluated the feasibility of performing laparoscopic nephrectomy and adrenalectomy exclusively by using robotic telepresent technology from a remote workstation and compared outcomes with those of conventional laparoscopy in an acute porcine model.
  
  
  METHODS
  Five pigs underwent bilateral laparoscopic nephrectomy (robotic in 5 and conventional in 4) and adrenalectomy (robotic in 4 and conventional in 3). In the 9 robotic laparoscopic procedures all intraoperative manipulations were completely performed telerobotically from a remote workstation without any conventional laparoscopic assistance on site. Animals were sacrificed acutely.
  
  
  RESULTS
  Robotic laparoscopic nephrectomy required significantly longer total operative (85.2 versus 38.5 minutes, p = 0.0009) and actual surgical (73.4 versus 27.5 minutes, p = 0.0002) time than conventional laparoscopy. However, blood loss and adequacy of surgical dissection were comparable in the 2 groups. Robotic laparoscopic adrenalectomy required longer total operative (51 versus 32.3 minutes, p = 0.13) and actual surgical (38.5 versus 18.7 minutes, p = 0.14) time than conventional laparoscopy. The solitary complication in this study was an inferior vena caval tear during robotic right adrenalectomy, which was adequately repaired by sutures telerobotically in a remote manner.
  
  
  CONCLUSIONS
  To our knowledge we present the initial experience with remote telerobotic laparoscopic nephrectomy and adrenalectomy. Telepresent laparoscopic surgery is feasible.
authors.affiliation: Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: I S
authors.initials: IS
authors.lastname: Gill
authors.forename: G T
authors.initials: GT
authors.lastname: Sung
authors.forename: T H
authors.initials: TH
authors.lastname: Hsu
authors.forename: A M
authors.initials: AM
authors.lastname: Meraney
mesh_terms: D000315:Adrenalectomy; D000818:Animals; D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005260:Female; D007431:Intraoperative Complications; D010535:Laparoscopy; D009392:Nephrectomy; D012371:Robotics; D013552:Swine; D013997:Time Factors