title: Step-by-Step robotic heminephrectomy for duplicated renal collecting system.
abstract: BACKGROUND
  A duplicated renal collecting system is a relatively common congenital anomaly rarely presenting in adults.
  
  
  OBJECTIVE
  In this video we demonstrate our step-by-step technique of Robotic heminephrectomy in a patient with non-functioning upper pole moiety.
  
  
  METHODS
  Following cystoscopy and ureteral catheter insertion the patient was placed in 60° modified flank position with the ipsilateral arm positioned at the side of the patient. A straight-line, three arm robotic port configuration was employed. The robot was docked at a 90-degree angle, perpendicular to the patient. Following mobilization the colon and identifying both ureters of the duplicated system, the ureters were followed cephalically toward, hilar vessels where the hilar anatomy was identified. The nonfunctioning pole vasculature was ligated using hem-o-lok clips. The ureter was sharply divided and the proximal ureteral stump was passed posterior the renal hilum. Ureteral stump was used as for retraction and heminephrectomy is completed along the line demarcating the upper and lower pole moieties. Renorrhaphy was performed using 0-Vicryl suture with a CT-1 needle. The nonfunctioning pole ureter was then dissected caudally toward the bladder hiatus, ligated using clips, and transected.
  
  
  RESULTS
  The operating time was 240 minutes and blood loss was 100 cc. There was no complication post-operatively.
  
  
  CONCLUSIONS
  Wrist articulation and degree of freedom offered by robotic platform facilitates successful performance of minimally invasive heminephrectomy in the setting of an atrophic and symptomatic renal segment.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Oktay
authors.initials: O
authors.lastname: Akca
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Luis Felipe
authors.initials: LF
authors.lastname: Brandao
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Jayram
authors.initials: J
authors.lastname: Krishnan
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Samarasekera
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Georges P
authors.initials: GP
authors.lastname: Haber
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
mesh_terms: D005260:Female; D006801:Humans; D007685:Kidney Tubules, Collecting / Q000002:abnormalities* / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D015203:Reproducibility of Results; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D055815:Young Adult