title: The role of intraoperative ultrasound in small renal mass robotic enucleation.
abstract: BACKGROUND
  As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass.
  
  
  METHODS
  A total of 22 robotic enucleations were performed on &lt; 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8) using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826).
  
  
  RESULTS
  Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2), the exact position of the lesion could be easily identified in all cases (22/22), even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13) and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22). No complications due to the use of the ultrasound probe were observed.
  
  
  CONCLUSIONS
  The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during surgical dissection.
authors.affiliation: Urology Unit, Forlì Hospital, Romagna Local Health Service. roberta.gunelli@auro.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Gunelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Fiori
authors.forename: Cristiano
authors.initials: C
authors.lastname: Salaris
authors.forename: Umberto
authors.initials: U
authors.lastname: Salomone
authors.forename: Marco
authors.initials: M
authors.lastname: Urbinati
authors.forename: Alexia
authors.initials: A
authors.lastname: Vici
authors.forename: Teo
authors.initials: T
authors.lastname: Zenico
authors.forename: Mauro
authors.initials: M
authors.lastname: Bertocco
mesh_terms: D004867:Equipment Design; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D065287:Robotic Surgical Procedures; D025321:Surgery, Computer-Assisted; D018084:Ultrasonography, Interventional