title: Minimizing Ports During Robotic Partial Nephrectomy.
abstract: OBJECTIVE
  Robotic upper urinary tract surgery is in most of the cases performed utilizing a standard 5 port configuration. Fewer ports can potentially produce a less invasive operation. Taking in consideration the above we report a novel technique for robot assisted laparoscopic partial nephrectomy utilizing fewer ports and we test its feasibility and safety profile.
  
  
  METHODS
  Data on 11 robot-assisted laparoscopic partial nephrectomies performed by using our technique from February 2015 through June 2015 were retrospectively analyzed. The robotic platform used was DaVinci Xi (Intuitive Surgical, Inc., Sunnyvale, California, USA) with a 3-arm setup. The AirSeal system (SurgiQuest, Milford, Connecticut, USA) was used as a port allowing simultaneous introduction of 2 instruments for the bedside surgeon, obviating the need for an additional (fourth) robotic arm. A long suction-and-irrigation device and atraumatic grasping forceps were used. Both instruments were introduced through the trocar of the AirSeal system, making simultaneous introduction and use possible. We preferred the long suction-and-irrigation device, because it minimizes collision of the instruments.
  
  
  RESULTS
  Mean age and BMI of the patients were 55 ±14.6 y and 29.18 ± 6.85, respectively. Seven tumors were on the right side and 4 were on the left. The mean size of the tumors was 32.45 mm (± 11.31). Surgical time was 132.2 minutes (±37.17), with an estimated blood loss and ischemia time of 103.63 mL (±65.92) and 16.72 minutes (±9.52), respectively. One patient had postoperative bleeding that was resolved without transfusion. The median hospitalization period was 3.9 d (±0.53). Loss of intra-abdominal pressure was not observed, and pressure was stable at 10 mm Hg.
  
  
  CONCLUSIONS
  The AirSeal System and its valveless trocar eliminated the need for an additional port placement in our series. The technique is feasible, safe, and reproducible; therefore, it may be implemented in selected cases of robot-assisted partial nephrectomies.
authors.affiliation: Department of Urology, Acıbadem University, Istanbul, Turkey.
authors.forename: Omer Burak
authors.initials: OB
authors.lastname: Argun
authors.affiliation: Department of Urology, Acıbadem University, Istanbul, Turkey.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Mourmouris
authors.affiliation: Department of Urology, Acıbadem University, Istanbul, Turkey.
authors.forename: Ilter
authors.initials: I
authors.lastname: Tufek
authors.forename: Can
authors.initials: C
authors.lastname: Obek
authors.affiliation: Taksim Acıbadem Hospital, Department of Urology, Istanbul, Turkey (Dr Obek); Department of Urology, Aile Hospital, Istanbul, Turkey.
authors.forename: Mustafa Bilal
authors.initials: MB
authors.lastname: Tuna
authors.affiliation: Department of Urology, Acıbadem University, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Keskin
authors.affiliation: Department of Urology, Acıbadem University, Istanbul, Turkey.
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Kural
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D004867:Equipment Design; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods*
keywords: Port placement; Renal cancer; Robotic partial nephrectomy