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Minimizing Ports During Robotic Partial Nephrectomy.

Argun OB, Mourmouris P, Tufek I, Obek C, Tuna MB, Keskin S, Kural AR - JSLS (2016 Apr-Jun)

Bottom Line: 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.The AirSeal System and its valveless trocar eliminated the need for an additional port placement in our series.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Acıbadem University, Istanbul, Turkey.

ABSTRACT

Background and 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

Extracorporeal view of insertion of both instruments through an AirSeal trocar.
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Figure 1: Extracorporeal view of insertion of both instruments through an AirSeal trocar.

Mentions: From February 2015 through June 2015, 11 robot-assisted laparoscopic partial nephrectomies were performed with this novel technique. The patient was positioned in a modified flank position with the diseased side up and then flexed using the table break at the level of anterior superior iliac crest. The outward-facing arm was tucked to the side. The robotic platform used was DaVinci Xi (Intuitive Surgical Inc., Sunnyvale, California, USA) with a 3-arm setup for all surgical cases. Pneumoperitoneum was established with a Veress needle. The port setup used is depicted in Figure 1. An 8-mm port was placed 3 cm lateral to the umbilicus. Two additional 8-mm ports were placed under endoscopic guidance. The first one was placed lateral to the rectus sheath and 8 cm cranial to the camera port. The second one was placed caudal to the camera port on the same line. A 12-mm assistant port was placed on the midline, 5 cm cranial to the umbilicus. A suction device and the grasping forceps were both used through the AirSeal system trocar, either alone or simultaneously in all cases, obviating the need for an additional trocar for the fourth robotic arm. A long suction-and-irrigation device was preferred, to minimize instrument collision with the atraumatic grasping forceps (Figure 2, 3).


Minimizing Ports During Robotic Partial Nephrectomy.

Argun OB, Mourmouris P, Tufek I, Obek C, Tuna MB, Keskin S, Kural AR - JSLS (2016 Apr-Jun)

Extracorporeal view of insertion of both instruments through an AirSeal trocar.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4920592&req=5

Figure 1: Extracorporeal view of insertion of both instruments through an AirSeal trocar.
Mentions: From February 2015 through June 2015, 11 robot-assisted laparoscopic partial nephrectomies were performed with this novel technique. The patient was positioned in a modified flank position with the diseased side up and then flexed using the table break at the level of anterior superior iliac crest. The outward-facing arm was tucked to the side. The robotic platform used was DaVinci Xi (Intuitive Surgical Inc., Sunnyvale, California, USA) with a 3-arm setup for all surgical cases. Pneumoperitoneum was established with a Veress needle. The port setup used is depicted in Figure 1. An 8-mm port was placed 3 cm lateral to the umbilicus. Two additional 8-mm ports were placed under endoscopic guidance. The first one was placed lateral to the rectus sheath and 8 cm cranial to the camera port. The second one was placed caudal to the camera port on the same line. A 12-mm assistant port was placed on the midline, 5 cm cranial to the umbilicus. A suction device and the grasping forceps were both used through the AirSeal system trocar, either alone or simultaneously in all cases, obviating the need for an additional trocar for the fourth robotic arm. A long suction-and-irrigation device was preferred, to minimize instrument collision with the atraumatic grasping forceps (Figure 2, 3).

Bottom Line: 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.The AirSeal System and its valveless trocar eliminated the need for an additional port placement in our series.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Acıbadem University, Istanbul, Turkey.

ABSTRACT

Background and 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus