Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.
Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.
Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, 3730 7th Terrance, Vero Beach, FL, 32960, USA. hugohdav@gmail.com.|Florida Cancer Specialist at Vero Beach, Vero Beach, FL, USA. hugohdav@gmail.com.|Scully-Welsh Cancer Center, Indian River Urology Associates, Florida State University College of Medicine, 787 37th Street, Suite E-200, Vero Beach, FL, 32960, USA. hugohdav@gmail.com.
Hugo H
HH
Davila
Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, 3730 7th Terrance, Vero Beach, FL, 32960, USA.|Florida Cancer Specialist at Vero Beach, Vero Beach, FL, USA.|Scully-Welsh Cancer Center, Indian River Urology Associates, Florida State University College of Medicine, 787 37th Street, Suite E-200, Vero Beach, FL, 32960, USA.
Raul E
RE
Storey
Scully-Welsh Cancer Center, Indian River Urology Associates, Florida State University College of Medicine, 787 37th Street, Suite E-200, Vero Beach, FL, 32960, USA.
Marc C
MC
Rose
D000368:Aged; D016063:Blood Loss, Surgical; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D056888:Patient Positioning; D065287:Robotic Surgical Procedures / Q000379:methods*; D013048:Specimen Handling / Q000379:methods
Kidney cancer; Laparoscopic nephrectomy; Minimally invasive surgery; Oncology; Radical nephrectomy; Robotic nephrectomy