Category: Clinical Stones: Outcomes

MP8-13 - Utilizing daVinci® Robotic Surgical System to Treat Complicated Urologic Stones (CUS) 

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

The role of open surgery for kidney stone is continuously declining . Open stone surgery is reserved for stone that failed minimally invasive intervention such as ESWL, PNCL, ureteroscopy. Robotic assisted surgery is gradually replacing open surgery in the field of urology. We utilized the Da Vinci® robotic system instead of open surgery to treat CUS. Here, we are sharing our experience in utilizing Da Vinci® robotic surgical system to treat patient with CUS. 

Methods :

After IRB approval, we reviewed our prospectively collected data of patients who underwent robotically assisted stone surgery (RASS). Between September 2009 and March 2018, we utilized the da Vinci ® to treat 21 renal unit with CUS were treated at our institute.  The CUS was defined as the stone that could not be treated /or had failed attempt of treatment with the traditional minimally invasive approaches like ESWL, ureteroscopy, or PCNL. Cases in which removal of the stone was part of other robotic procedure was considered CUS, such as pyeloplasty, partial nephrectomy, or ureteral reconstruction. 

Results :

A total of 19 patient had RASS a our institute by single surgeon.The indication for RASS was morbid obesity (n=8, mean BMI 56.4 kg/m2¬), need for concurrent renal surgery (n=5) . severe contractures limiting positioning for retrograde endoscopic or percutaneous nephrolithotripsy (n=2). Symptomatic calyceal diverticular stone with failed endoscopic approach (n=4) and after failed PCNL (n=4). Patients had an average of 2.3 stones and total stone volume of 16.5 cm3 measured by CT scan. The average blood loss was 57.8 CC (range 25 -300). The mean operative time was 110 min (range 50 -180) minutes with mean hospital stay was 2.5 days (range 1-8). The mean follow up was 54 days and 91 % of renal units were rendered stone free on the follow up CT scan. Four patients (4%) developed complications. one patient developed candidemia 5% (Clavien-Dindo IV). One patient 5% developed urine leak that necessitated prolonged stenting and catheterization (Clavien-Dindo IIIa). Two patients 9% developed wound infection (Calven II) 

Conclusions :

The treatment of urologic stone can be challenging and RASS is a promising method to to treat CUS with high stone free rate. RASS should be considered as an option to replace open stone surgery. RASS is not an alternative to ESWL, PCNL or Ureteroscopy and should be used stricly in the the event of failure or inablitly to perform the above mentioned less less invasive treatment.

Mohamad Salkini

Associate Professor of Urology/ Division Chief of Urologic Oncology
West Virginia Univerisity
Morgantown, West Virginia

Mohamad W. Salkini,MD, FACS
Associate Professor of Urology
Chief, Division of Urologyic Oncology
Director of Robotic Surgery

Graduate of Damascus Univeristy Medical School with MD in 1998, Masters Degree from Damascus University Speciality Board 2003.
Former Clinical Fellow and Visiting Specialist at University of Heidelberg 2004.
Former Research Fellow with the Department of Surgery and Division of Urology at University of Arizona (2004-2007)
Fellow of the Endourological Society after 2 years fellowship at Univeristy of Cincinnait, in 2009

Morris Jessop

West Virginia University
Morgantown, West Virginia

I earned my MD for West Virginia University School of Medicine.
I am practicing urologist and former resident at WVU.

Bamah AlTinawi

Research Fellow
West Virginia University
Ar Riyad, Ar Riyad, Saudi Arabia

I am medical student in my final year at AlFaisal Univeristy Medical School.
I had the oprtunity to have elective at West Virginia University.
I was also research fellow with Dr. Salkini, Department of Urology at West Virginia Univerisity