Standardized procedure of robotic assisted laparoscopic radical prostatectomy from case 1 to case 1200

ObjectiveTo standardize the procedure of robotic assisted laparoscopic radical prostatectomy (RaLRP) after evolution, learning and modification from 1,200 experienced cases.Materials and MethodsFrom December 2005 to April 2016, 1,200 cases involved patients receiving RaLRP was performed by a single surgeon.A preoperative 3.0-Tesla magnet with a slice thickness <3.0 mm was used for the MRI after 2011. The procedure of RaLRP was evolutive and modified from learning experience. The first step was vas and seminal vesicle dissection with posterior approach. After dropping of urinary bladder (UB), bilateral pelvic lymph node dissection was performed. The bladder neck was identified and transected, which is a crucial step to excision of the prostate. The deep dorsal vascular complex was sutured and ligated to obviate any bleeding from influencing the operative field. Neurovascular bundle (NVB) preservation was assessed according to the D'Amico risk classification, biopsy tumor percentage, and MRI. The urethrovesical anastomosis was modified through the use of Van Velthoven ‘s method. No further posterior pelvic reconstruction was performed now, except for the difficult case. Normal saline of 200 ml for the UB challenge was routinely done.ResultsThe mean age of patients was 65.90 ± 7.66 years, and ASA I/II/III was 9.33%/80.17%/10.50% respectively. Mean PSA: 18.17 ± 28.24 ng/ml and Gleason score: 6.88 ± 1.02. Clinical stage T1/T2/T3–4/N1orM1 was 35.83%/53.75%/9.50%/0.92%. Obese patients (BMI >30), included 6% and 10.5% of prostate volume >70 cm³, 10.5% of previous transurethral resection of prostate, 1.08% of salvage-RALP. The trifecta rate was 83.20% and pentafecta rate was 63.33%. The 3-year, 5-year, and 7-year biochemical recurrence-free survival rates were 79.2%, 75.3%, and 70.2%, respectively.ConclusionsMeticulous preoperative evaluation, MRI planning and a dedicated robotic team to do RALP is essential. The procedure was standardized during each step. Complications were minimized. High risk patients had an acceptable oncologic outcome.     

Laparoscopic splenectomy for a large multilocular splenic cyst with elevated CA19-9: Report of a case

INTRODUCTIONBecause splenic cysts are rare, a definitive treatment regime for these cysts remains unclear. We report a case of a large multilocular splenic cyst with elevated carbohydrate antigen 19-9 (CA19-9) levels, which was successfully treated with laparoscopic splenectomy.PRESENTATION OF CASEA 22-year-old female was admitted to our hospital with severe left upper abdominal pain. Serum CA19-9 level was mildly elevated (65 U/ml). Computed tomography revealed a 25-cm long spleen with multilocular cystic lesions, for which an emergency laparoscopic splenectomy was performed. Histological findings revealed that the lesion was a benign true cyst, and immunostaining analyses showed that the epithelium was CA19-9-positive.DISCUSSIONAlthough some spleen-preserving approaches have been reportedly used, splenic cyst recurrence usually occurs in true cyst cases, wherein the cyst is incompletely removed. Most reported cases of splenic cysts producing CA19-9 are true cysts.CONCLUSIONThe treatment approach should be decided on the basis of the type, shape, location, and even CA19-9 levels of the splenic cyst.     

Robotic repair of retrocaval ureter: A case series

ObjectiveTo present our technique and experience of robotic repair of symptomatic retrocaval ureter.Subjects and methodsThis is a prospective case series of five consecutive patients who underwent robotic retrocaval ureter repair at our institute from August 2006 to September 2009. Pre-operative imaging included intravenous urogram, contrast enhanced CT scan and diuretic renography. All cases were done through a transperitoneal approach using 4 ports. Follow-up was done with intravenous urography and diuretic renography. Relevant data were collected and analyzed regarding perioperative morbidity, complications and functional outcomes.ResultsFive cases of robotic retrocaval ureter repair were performed. Four were male and one was female. The mean operative time was 92 min which included anastomosis time of 40 min. The mean estimated blood loss was 55 ml. The drain was removed on postoperative day 1 in all patients. The average hospital stay was 2 days. On average follow-up of 13.5 months all patients were pain free and renal dynamic scan showed non-obstructed clearance.ConclusionsRobotic retrocaval ureter repair without excision of the retrocaval segment is feasible and an effective alternative to open or laparoscopic retrocaval ureter repair with good anatomical and functional outcome. It may become the procedure of choice along with laparoscopic surgery for retrocaval ureter.     

An unusual presentation of a rectal duplication cyst

INTRODUCTIONIntestinal duplications are rare developmental anomalies that can occur anywhere along the gastrointestinal tract. Rectal duplication cysts account for approximately 4% of all duplication cysts. They usually present in childhood with symptoms of mass effect, local infection or more rarely with rectal bleeding from ectopic gastric mucosa.PRESENTATION OF CASEA 26 year old male presented with a history of bright red blood per rectum. On examination a mucosal defect with an associated cavity adjacent to the rectum was identified. This was confirmed with rigid proctoscopy and CT scan imaging. A complete transanal excision was performed.DISCUSSIONRectal duplication cysts are more common in pediatric patients. They more frequently present with symptoms of mass effect or local infection than with rectal bleeding. In adult patients they are a rare cause of rectal bleeding. Definitive treatment is with surgical excision. A transanal, transcoccygeal, posterior sagittal or a combined abdominoperineal approach may be used depending on anatomic characteristics of the duplication cyst.conclusionWe present a rare case of a rectal duplication cyst presenting in adulthood with rectal bleeding, managed with transanal excision.     

Abordaje combinado para la nefrectomía parcial en lesiones renales complejas

ObjectiveTo develop a combined surgical approach (laparoscopic and open) that allows an increased vascular control and decreased ischemia time, maintaining the advantages of pure laparoscopic partial nephrectomy (LPN).Material and methodsDuring the laparoscopic phase, dissection of the kidney and its pedicle is achieved. Then, an open approach is initiated through a mini-laparotomy, with the kidney being brought to the incision, improving the identification and exposition of the tumors. Following tumor identification by ultrasound, exeresis of the lesion is performed with or without vascular clamping.ResultsThrough this approach we performed the excision of complex lesions in 6 patients. Mean surgical time was 192 minutes (range 180-210) and mean warm ischemia time was 13 minutes (0-22), with a mean blood loss of 267 mL (100-500). Average pre and postoperative glomerular filtration rate was 51.5 (28-90) and 48.8 mL/min/1.73 m² (19-90), respectively. In one patient, suture repair of the pelvicaliceal system was needed, with no other perioperative morbidities being reported.ConclusionsThis combined approach is a minimally invasive surgical alternative, reproducible and safe which preserves the virtues of pure LPN. It allows a better control of the vascular pedicle, reducing the risk of hemorrhage and the warm ischemia time. This technique may be either considered in the treatment of renal masses with indication for partial nephrectomy but of complex laparoscopic approach or as a surgical approach in the early learning curve of the LPN.     

腹腔镜精囊囊肿切除术

目的:探讨腹腔镜下精囊囊肿切除术的方法及临床疗效。方法:我院近期采用腹腔镜技术对2例伴有临床症状的精囊囊肿患者实施精囊囊肿切除术。术前经超声及CT等检查明确诊断,精囊囊肿大小为3.3cm×3.7cm×2.5cm,4.1cm×4.3cm×5.3cm。结果:2例手术均顺利完成,手术时间为140、100min,术中出血约50、20ml,术后6d出院。分别随访6、7个月,患者术前症状消失,无并发症发生,复查超声,均未见囊肿复发。结论:腹腔镜下精囊囊肿切除术具有视野清晰、操作精细、创伤小、恢复快等优点,是一种安全、有效的微创手术方式。     

Giant adrenal cyst in a young female patient: A case report

Adrenal cysts are rare cystic masses that arise from the adrenal gland. They are usually non-functional, asymptomatic and less than 10 cm in diameter when discovered incidentally. However, giant adrenal cysts are cysts of the adrenal gland which are larger than 10 cm in diameter. They pose a diagnostic conundrum to the surgeon as localization of the origin of the cyst is very difficult. Indications for surgical intervention include a size exceeding 10 cm in diameter, the presence of symptoms, endocrine abnormalities, intracystic bleeding and suspicion of malignancy. The current treatment of choice is adrenalectomy, either open or laparoscopic. Ultrasound-guided percutaneous drainage is an alternative, especially when there is no doubt regarding the diagnosis. Following, we report on one of the rare cases of a giant adrenal cyst.     

Robotic-assisted laparoscopic radical cystectomy: evaluation of functional and oncological results

Purposeradical cystectomy remains the most effective treatment for patients with localized, invasive bladder cancer and recurrent noninvasive disease. We report our experience with 84 consecutive cases of robotic assisted laparoscopic radical cystectomy with regard to perioperative results, pathological outcomes and surgical complications.Materials and methodsa total of 84 consecutive patients (70 male and 14 female) underwent robotic radical cystectomy and urinary diversion at our institution from January 2007 to August 2010 for clinically localized bladder cancer. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes and complication rate.Resultsmean age of this cohort was 65.5 years (range 28 to 82). Of the patients 62 underwent ileal conduit diversion, 22 received a neobladder. Mean operating room time for all patients was 261 min. (range: 243-618 min.) and mean surgical blood loss was 298 ml (range: 50-2000 ml). 29% of the cases were pT1 or less disease, 38% were pT2, 26% and 7% were pT3 and T4 disease respectively, 15% were node positive. Mean number of lymph nodes removed was 15 (range 1 to 33). In 2 cases (2.4%) there was a positive surgical margin. Mean days to flatus were 2.12, bowel movement 2.87 and discharge home 17.7 (range: 10-33). There were 45 postoperative complications with 11.9% having a major complication (Clavien grade 3 or higher). At a mean followup of 16.7 months 10 patients (11%) had disease recurrence and 2 died of disease.Conclusionsour experience with robotic radical cystectomy for the treatment of bladder cancer suggests that in proper hands this procedure provides acceptable surgical and pathological outcomes.     

Endoscopic removal of large orbito-ethmoidal osteoma in pediatric patient: Case report

INTRODUCTIONOsteoma is a benign slow growing bone tumor with a prevalence of 3% of all benign paranasal sinuses tumors, with a peak incidence between the fourth and sixth decades, mostly involving frontal sinuses.¹PRESENTATION OF CASEWe present a case of a large right ethmoidal sinus osteoma in a 12-year-old boy, complaining of frontal headaches and excessive lacrimation of the right eye. CT scan showed a very large tumor in the right anterior ethmoidal sinus (30 mm × 25 mm × 15 mm).DISCUSSIONLarge osteomas of the paranasal sinuses are usually resected by external approaches. However, the minimally invasive endonasal approach, which minimizes external facial scarring, is challenging for such large lesions in pediatrics. In the presented case, the osteoma was successfully resected exclusively by endoscopy-guided endonasal approach assisted by neuronavigation, with no peri or postoperative complications.CONCLUSIONAn endoscopic approach assisted with neuronavigation may be a minimally invasive and safe procedure for managing large osteoma of the ethmoidal sinus in pediatrics patients.     

Laparoscopic and Retroperitoneoscopic Radical Nephrectomy: Techniques and Outcome

ObjectivesMinimally invasive radical nephrectomy has gained widespread acceptance in the urological community. Both the laparoscopic and retroperitoneoscopic approach have been established and advocated for radical surgery. Our experience and the advantages and indications for each procedure are analyzed in this article.MethodsData from two clinics that routinely perform either laparoscopic or retroperitoneoscopic nephrectomy for localized tumours are compared. At the Charité Urology Clinic, Campus Mitte, the transperitoneal laparoscopic approach is the preferred technique for T1 and selected T2 tumours. At the Basel University Hospital, the preferred technique for patients with clinical T1 renal tumours is retroperitoneoscopy.ResultsDuring a period of 5 yr, 163 patients underwent minimally invasive nephrectomy using either the laparoscopic (n = 125) or the retroperitoneoscopic (n = 38) approach. There were no major intraoperative complications with either technique. Intra- and postoperative data were comparable and oncological outcome was similar for both techniques, at a mean follow-up of 25 mo.ConclusionsBoth retro- and transperitoneal approaches of minimally invasive radical nephrectomy are safe procedures that achieve the same standard and duplicate oncological principles established for open surgery.     

Vesiculectomy with laparoscopic partial prostatectomy in the treatment of primary adenocarcinoma of the seminal vesicle with carcinomatous transformation of the ejaculatory duct

IntroductionPrimary adenocarcinoma of the seminal vesicle is an extremely rare condition. Some cases have been described in relation to congenital seminal vesicle cysts, which is often also associated with agenesia or ipsilateral renal disgenesia. The rareness of this type of lesions makes it difficult to plan a regulated surgical approach for them, although they are often treated by simple exeresis or exenteration, depending on their stage at the beginning.Materials and methodsWe present a new surgical technique that consists of radical vesiculectomy associated with laparoscopic partial prostatectomy (total segmentary) of the central area to successfully treat primary seminal vesicle adenocarcinoma in a young man who was diagnosed through an azoospermia study.ResultsA study of the scan (MRI) with diffusion and the transrectal biopsy of the mass allowed us to make a thorough preoperative evaluation of the case, confirming the malignity and precociousness of the lesion. The laparoscopic approach allowed us to perform a pelvic lymphadenectomy and transperitoneal exeresis, including the central prostate area and suture of the posterior face of the urethra at the height of the apex of the prostate. The wall of the seminal cyst lesion confirmed infiltrating clear cell adenocarcinoma and non-invasive adenocarcinoma in the prostate segment of the central gland in the light of the ejaculatory conduct with “in situ” growth. Thus, the surgical specimen allowed radical exeresis with negative margins, guaranteeing minimally invasive surgery with preservation of continence and erection.ConclusionWe describe a new integral approach for the radical surgery of localized primary adenocarcinoma of the seminal vesicle. Despite its exceptional nature, the case allowed for a double reflection: a) The study of diffusion with MRI may suggest the diagnosis of malignity in this type of lesions; and b) Radical surgical treatment must include exeresis of the central portion of the prostate gland.     

Laparoscopic management of retrovesical cystic disease: Washington University experience and review of the literature.

BACKGROUND AND PURPOSE: Recently, the laparoscopic approach to the management of seminal vesicle cysts has been described. This report outlines the Washington University experience and reviews the present literature to evaluate the results of the laparoscopic approach to the excision of retrovesical cysts of seminal vesicle and Müllerian origin. PATIENTS AND METHODS: The hospital and office records of three patients undergoing laparoscopic excision of seminal vesicle and Müllerian duct cyst disease between April 1993 and March 1999 were reviewed for the operative time, the estimated blood loss, total hospital stay, total analgesia required postoperatively, the time to resumption of oral intake, and the postoperative recovery. A literature search revealed two additional reports of laparoscopic management of cystic disease of the seminal vesicle, comprising only one and two patients. An additional review of the literature was performed to compare the laparoscopic procedure with the transvesical, transurethral, open transvesical, and open retrovesical approach for the management of the disease. RESULTS: For the three patients at Washington University, the operative time averaged 4 hours (range 1.8-6.1 hours), and the mean estimated blood loss was 150 mL (range 50-200 nL). The patients required a mean of 43 mg of morphine sulfate for postoperative pain control, had a mean hospital stay of 2.6 days, and resumed oral intake 5.8 hours postoperatively. In combination with the three other cases reported in the literature, the average operative time for laparoscopic retrovesical cyst excision was 2.9 hours, and the average hospital stay was 2.2 days. With an average follow-up of 17 months, all six patients had excellent resolution of their preoperative symptoms. There have been no major or minor complications or any need for further operative therapy. CONCLUSION: Laparoscopic excision of retrovesical cystic disease is an effective surgical procedure, associated with minimal postoperative morbidity, short hospitalization, and a rapid recovery for the patient.     

Cirugía robótica multicuadrante concomitante para prostatectomía radical y nefrectomía parcial izquierda. Dos procedimientos mediante un solo abordaje

IntroductionTo present the first case of a concomitant robotic radical prostatectomy and a left robotic partial nephrectomy performed by a single-port approach using the SP® da Vinci surgical system (Intuitive Surgical, Sunnyvale CA, EE.UU.).Patient and methodsA 66-year-old male diagnosed with localized prostate cancer and a left kidney renal mass incidentally found on computed tomography (CT) scan during prostate cancer evaluation. Procedures were performed using a single supra-umbilical 3 cm incision, plus one additional laparoscopic port, utilizing a standard Gelpoint® (Applied Medical, Rancho Santa Margarita, CA, EE.UU.) and replicating the technique previously described for single-port transperitoneal radical prostatectomy and partial nephrectomy with the use of the SP® robotic platform.ResultsTotal operative time was 256 minutes (min) with a console time of 108 min for radical prostatectomy, and 101 min for the partial nephrectomy respectively, including a warm ischemia time of 26 min. Estimated blood loss was 250 cc. Blood transfusion was not needed. Final pathology for prostate was adenocarcinoma Gleason 7 (4 + 3) and for the kidney lesion was renal cell carcinoma. After two months of follow-up, PSA was undetectable and no complications or recurrence were detected.ConclusionsThe single-port approach has advantages as easier surgical planning and transition for combined and multi-quadrants surgeries: faster recovery, minimal postoperative pain and need for opioids, and excellent cosmetic outcome. We suggest that combined procedures should be performed only in high volume institutions by surgeons with vast experience in robotic surgery in selected patients.     

Adnexal torsion with paraovarian cysts in pediatric and adolescent populations: A retrospective study

BackgroundDetermination of the clinical characteristics associated with adnexal torsion involving paraovarian cysts in pediatric and adolescent populations.MethodsRetrospective review of all cases of paraovarian cysts operated on in our department between 2007 and 2019. Demographic characteristics, clinical and sonographic findings were reviewed.ResultsThe cohort was composed of 39 pediatric and adolescent patients with an operative diagnosis of adnexal masses located in the paraovarian area. The patients were classified into two groups: 19 girls (48.7%) with a confirmed operative diagnosis of adnexal torsion and 20 girls (51.3%) without torsion. The preoperative diagnosis of adnexal torsion was correct in ≈ 70% of the cases. The mean BMI were similar in both groups. The preoperative sonographic detection rate of paraovarian cysts was also similar (11/19 [57.9%] vs. 14/20 [70.0%]; P = 0.514). The mean cyst diameter did not differ between groups, nor did the classification into cyst size groups (≤ 50 mm, 51–99 mm and ≥ 100 mm).ConclusionAdnexal torsion is a common complication diagnosed in girls undergoing surgery for paraovarian cysts, and is not associated with sonographic appearance or cyst diameter. In order to prevent torsion, surgical removal of paraovarian cysts should thus be considered in young girls undergoing surgery for paraovarian cysts.Type of studyRetrospective case series.Level of evidenceIV     

Laparoscopic excision of a giant adrenal myelolipoma and review of the literature

Introduction

Adrenal myelolipoma is a rare benign tumor. It is usually asymptomatic with variable sizes, where the small lesions are usually managed conservatively and the large and symptomatic ones indicate open or laparoscopic adrenalectomy.

Influencia del acceso laparoscópico en la mortalidad cáncer-específica de los pacientes con cáncer de vejiga en un estadio pTa-2pN0R0 tratados con cistectomía radical

Introduction and objectiveMinimally invasive surgery represents an attractive surgical approach in radical cystectomy. However, its effect on the oncological results is still controversial due to the lack of definite analyses. The objective of this study is to evaluate the effect of the laparoscopic approach on cancer-specific mortality.Material and methodA retrospective cohort study of two groups of patients in a pT0-2pN0R0 stage, undergoing open radical cystectomy (ORC) (n = 191) and laparoscopic radical cystectomy (LRC) (n = 74). Using Cox regression, an analysis has been carried out to identify the predictor variables in the first place, and consequently, the independent predictor variables related to survival.Results90.9% were males with a median age of 65 years and a median follow-up period of 65.5 (IQR 27.75-122) months. Patients with laparoscopic access presented a significantly higher ASA index (P = .0001), a longer time between TUR and cystectomy (P = .04), a lower rate of intraoperative transfusion (P = .0001), a lower pT stage (P = .002) and a lower incidence of infection associated with surgical wounds (P = .04). When analyzing the different risk factors associated with cancer-specific mortality, we only found the ORC approach (versus LRC) as an independent predictor of cancer-specific mortality (P = .007). Open approach to cystectomy multiplied the risk of mortality by 3.27.ConclusionsIn our series, the laparoscopic approach does not represent a risk factor compared to the open approach in pT0-2N0R0 patients.     

Fluoroscopic percutaneous lumbar zygapophyseal joint cyst rupture: a clinical outcome study

Background contextLumbar zygapophyseal joint (Z-joint) synovial cysts can cause low back pain (LBP), spinal stenosis, and lower extremity radiculopathy. In the literature, there are several minimally invasive techniques described with mixed results. Typical recommended treatment is surgical resection of the cyst. Currently, there is little information available concerning the efficacy and outcome with treatment of Z-joint synovial cyst by percutaneous, fluoroscopic, contrast-enhanced distention, and rupture.PurposeTo evaluate the therapeutic value and safety of Z-joint cyst rupture in symptomatic patients.Study design/settingRetrospective cohort study in an academic outpatient physiatric spine practice.Patient sampleThirty-two patients with moderate-to-severe LBP and leg pain (18 women and 14 men with an age range of 46–86 y; mean age, 66 y) with an average preprocedure symptom duration of 5 months. The patient's clinical symptoms correlated with magnetic resonance imaging studies documenting the presence of a synovial cyst at the corresponding level and side of symptoms. Patients had at least 6 months follow-up (range, 6–24).Outcome measuresNumerical Pain Rating Scale, Roland-Morris Disability Questionnaire, North American Spine Society four-point patient satisfaction survey, recurrence of synovial cyst requiring repeat rupture, and need for surgical intervention.MethodsPatients with symptomatic lumbar Z-joint synovial cyst were identified and their charts were reviewed. Patients included in the study either had symptomatic lumbar LBP or LBP with associated lower extremity radiculopathy. All patients in the study had magnetic resonance imaging's documenting Z-joint synovial cyst that corresponded with the patients' clinical symptoms. All patients received fluoroscopically guided, contrast-enhanced, percutaneous facet cyst distention and rupture followed by an intra-articular facet joint injection of 1 cc kenalog and 1 cc of 1% lidocaine. Seventeen of the patients also received a transforaminal epidural steroid injection just before facet cyst rupture. Telephone follow-up was conducted on all patients.ResultsExcellent long-term (average follow-up 1 y; range, 6–24 mo) pain relief was achieved in 23 (72%) of 32 patients undergoing facet cyst rupture. Twelve patients (37.5%) had synovial cyst recurrence and 11 chose to undergo repeat rupture, which resulted in 5 patients (45%) obtaining complete relief of symptoms and 6 patients (55%) requiring surgical intervention for cyst removal. Fisher exact test demonstrated that all patients who did not have a cyst recurrence were a success and obtained complete relief of symptoms (p<.0002). Patients who underwent a repeat rupture had a 50% chance of a successful outcome. There was no statistical significance between a successful outcome and level of facet cyst rupture, the presence of spondylolisthesis, sex, age, or having a transforaminal epidural steroid injection at the time of the procedure. Wilcoxon signed-rank test demonstrated that the difference in Numerical Pain Rating Scale and Roland-Morris Disability Questionnaire scores before and after the procedure was statistically significant (p<.0001). No complications were reported.ConclusionsFluoroscopic percutaneous Z-joint cyst rupture appears to be a safe and effective minimally invasive treatment option. This procedure should be considered before surgical intervention.     

Tumor seeding incidentally found two years after robotic—Assisted radical nephrectomy for papillary renal cell carcinoma. A case report and review of the literature

INTRODUCTIONPort-site metastasis or peritoneal spread after laparoscopic surgery for urological malignancies is a rare phenomenon accounting for 0.09% and 0.03% of the cases respectively.PRESENTATION OF CASEWe present a case of tumor seeding in the omentum found in a female patient after previous transperitoneal robotic-assisted radical nephrectomy (RARN) for papillary renal cell carcinoma (RCC). Two years after the robotic operation, the patient was diagnosed with cervical clear cell carcinoma and underwent radical hysterectomy with lymphadenectomy and omentectomy. A neoplastic omental nodule was incidentally identified intraoperatively. Pathological characteristics and immunohistochemistry revealed features of papillary RCC. Two years after the hysterectomy, the patient is clinically cancer free, without any adjuvant therapy for her cervical cancer.DISCUSSIONTo the best of our knowledge, we report the first case of tumor seeding in the omentum following RARN for organ confined low grade papillary (T2aN0M0) RCC. No risk factors that could explain the tumor seeding were identified. The neoplastic cells had a low proliferative index (Ki-67 < 5%) and a decreased capability to metastasize.CONCLUSIONTumor seeding as a result of robotic assisted laparoscopic nephrectomy, although rare, might represent a novel way of tumor inoculation deprived of or with low malignant potential.     

Robotic partial nephrectomy: an initial experience in 25 consecutive cases

ObjectiveTo report our initial experience with robotic partial nephrectomy (RPN) in a series of 25 consecutively-operated patients.Material and methodsA series of 25 consecutive patients who underwent RPN from April 2010 to February 2011 were studied. We used the da Vinci S HD robotic system with transperitoneal approach. Total renal hilum control was used 22 cases and 3 patients underwent selective renal parenchymal compression with an ad-hoc device.ResultsMean age was 55.8 years (26-77) with a male/female ratio of 2:1. Mean operative time was 117.6 minutes (54-205) and the warm ischemia time was 20.2 minutes (9-34). Mean estimated blood loss was 440 ml (20-2000) and the mean tumor size was 3.25 cm (1-5.3). Five patients (20%) had complications, the most frequent being intraoperative bleeding (Clavien II). There was no conversion to open or laparoscopic surgery. Mean hospital stay was 3.5 days (1-7). The pathological study revealed renal cell carcinoma in 19 cases and benign lesions in 6 patients. There were no positive surgical margins and no mortality.ConclusionsOur preliminary results show that RPN is a feasible surgical approach in small-sized renal tumors.