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Robot-assisted laparoscopic partial nephrectomy: initial experience Introduction The ready transition to robotic prostatectomy for surgeons with an established.

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Presentation on theme: "Robot-assisted laparoscopic partial nephrectomy: initial experience Introduction The ready transition to robotic prostatectomy for surgeons with an established."— Presentation transcript:

1 Robot-assisted laparoscopic partial nephrectomy: initial experience Introduction The ready transition to robotic prostatectomy for surgeons with an established background in laparoscopic prostatectomy is well described. Similarly international series suggest a short learning curve for surgeons undertaking robotic partial nephrectomy, who are already proficient in laparoscopic partial nephrectomy. Conclusions In this series, initial oncological and peri-operative outcomes comparable to mature multi-institutional series were achieved. These outcomes suggest a smooth transition to robotic partial nephrectomy for surgeons who have an established background in advanced, complex laparoscopy. Results 9 cases, median age 70 years (57 – 74). 5 males and 4 females, 6 left and 3 right sided lesions. Median lesion size was 2.5 cm (1.3 – 5). This included a 5 cm heminephrectomy as the third case of the series (Fig 1). There were 8 exophytic and 1 endophytic lesions. Median operating time was 180 mins (180 – 260). Median warm ischaemia time was 13 mins (8 – 13). There were no intensive care admissions, no transfusions and no open conversions. One patient had a transient, self-limiting neuralgia (Clavien Dindo grade 1). Postoperative renal function was within normal limits at 6 months follow up. Methods Prospective database - robot-assisted partial nephrectomy  Placement of an ipsilateral ureteric catheter  Transperitoneal - 4 arm approach - da Vinci S  Renal hilum was dissected, kidney defatted, colonic mobilisation.  Intra-operative ultrasound used to assist tumour margin  Renal artery and vein seperately clamped – Scanlan robotic bulldog clamps  Tumour excised - cold scissor dissection  Collecting system defects repaired - integrity assessed with retrograde instillation of methylene blue  Renorrhaphy - 2/0 V-loc suture  Vascular clamps released - bleeding vessels suture ligated  Cortical reconstruction - single, running horizontal mattress 12 inch 0/0 V-LOC suture. Floseal applied. Acknowledgements Aim To report the initial robot-assisted partial nephrectomy experience of 2 fellowship-trained surgeons established in laparoscopic partial nephrectomy in an Australian context. References Rogers et al. (2008). Robotic partial nephrectomy: a multi-institutional analysis. J Robotic Surg 2(3): Kevin Lah 1, Devang Desai 1, Charles Chabert 2, Troy Gianduzzo 1,2 1 Royal Brisbane and Women’s Hospital, Queensland, Australia 2 Wesley Private Hospital, Brisbane, Queensland, Australia No. 191 Posters Proudly Supported by: ParametersRogers, Bhayani et alOur study Study population148 (6 centres)9 (1 centre) Study period5 years12 months Surgeons92 DemographicsUSABrisbane, Australia TypeRetrospectiveProspective Age25-83 yrs57-74 yrs Tumour size0.8 – 7.5 cms1.3 – 5 cms Cancer : Benign109 : 398 : 1 pT1a : 1b : 2 : 3a87 : 15 : 3 : 47 : 1 : 0 : 0 Mean Operative time197 mins190 mins Mean Warm ischaemic time 27.8 mins15.7 mins Blood loss mls mls +ve margin rates60 Fig 1. 5 cm renal mass


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