Robotic partial nephrectomy using robotic bulldog clamps.
OBJECTIVE
The need for a skilled assistant to perform hilar clamping during robotic partial nephrectomy is a potential limitation of the technique. We describe our experience using robotic bulldog clamps applied by the console surgeon for hilar clamping.


METHODS
A total of 60 consecutive patients underwent robotic partial nephrectomy, 30 using laparoscopic bulldog clamps applied by the assistant and 30 using robotic bulldog clamps applied with the robotic Prograsp instrument. Perioperative outcomes were compared between groups.


RESULTS
All 30 patients underwent successful hilar clamping during robotic partial nephrectomy using robotic bulldog clamps with no intraoperative complications and without the need for readjustment/reclamping. Robotic bulldog clamps provided adequate ischemia even for tumors >4  cm, hilar, endophytic, multiple tumors, and multiple renal arteries. Both groups had similar baseline characteristics. Perioperative outcomes with robotic bulldog clamps were at least comparable to the laparoscopic bulldog group, with a trend to lower console time, warm ischemia time, and  estimated blood loss.


CONCLUSIONS
Use of robotically applied bulldog clamps is a safe and feasible method of hilar occlusion during robotic partial nephrectomy; they perform at least as well as laparoscopic bulldog clamps while allowing the console surgeon greater autonomy and  precision for hilar clamping.
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
Shyam
S
Sukumar
Firas
F
Petros
Navneet
N
Mander
Roger
R
Chen
Mani
M
Menon
Craig G
CG
Rogers
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation*; D012371:Robotics / Q000295:instrumentation*; D018709:Statistics, Nonparametric; D013525:Surgical Instruments; D016896:Treatment Outcome