Adult urologyRobotic-assisted laparoscopic partial nephrectomy: Technique and initial clinical experience with daVinci robotic system
Section snippets
Patients
Between November 2002 and August 2003, 13 patients underwent robotic-assisted transperitoneal or retroperitoneal LPN (Table I). All patients had been evaluated with computed tomography to define the mass clearly preoperatively. The inclusion criteria were solitary, enhancing, predominantly exophytic solid or suspicious cystic renal lesions (Bosniak category III or IV) that were found to be satisfactory candidates for LPN, similar to those indications previously described by Gill et al.12
Results
The patient-related demographic data and results are summarized in Table I. In all cases, LPN was performed on an elective basis in the presence of a normal contralateral kidney. A total of 13 daVinci-assisted LPN procedures were performed, with a mean operative time of 215 minutes (range 130 to 262). The mean operative time included the time required for installation of the robot. In all cases, the initial setup of the robot was performed before initiation of the pneumoperitoneum. Overall, the
Comment
Because intracorporeal suturing is perceived by many urologists as technically difficult and time consuming, a variety of alternative hemostatic techniques have been introduced for LPN.3, 4, 5, 6, 7, 8 However, the alternative techniques have at times been less reliable than what is possible with suture closure of the renal defect. A technique of LPN has also been described using intracorporeal suturing with conventional laparoscopic instruments. This approach is increasingly preferred by
Conclusions
In our initial clinical experience, daVinci-assisted LPN was feasible and was able to recapitulate the steps of open partial nephrectomy and conventional LPN. Robotic-assisted LPN can be safely performed using a transperitoneal or retroperitoneal approach. A second scrubbed surgeon is mandatory for this procedure to provide technical assistance using conventional laparoscopic instruments.
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