Category: Laparoscopic/ Robotic: Renal
Introduction & Objective :
Robotized 3 dImension laparoscopic approach for nephron sparing surgery is in infant stage and practiced at very few centers of the world. Oncological principle, organ preservation and maximum comfort to the surgeon while doing this complicated surgery which involves precise excision of mass and reconstruction was the aim.
Methods : Patient was evaluated initially with basic blood and urine examination contrast enhanced CT scan. Bowel preparation was done with polyethylene glycol day before the procedure. Patient is given kidney position and 4 port transperitoneal approach was made. Kocherisation of duodenum was done and right kidney exposed. Gerota’s fascia was opened and all perinephric fat was removed exposing the parenchyma preserving the fat over tumor site. Next surgical exercise was hilar dissection and Renal artery and renal vein exposure. Tumor site was marked in the parenchyma with monopolar hook. Renal artery was secured with vascular loop. Partial nephrectomy was done ensuring gross tumor free margin status with robotized scissors. The 360 degree rotation and various angular movement of scissors which was controlled from switches in ergonomic robotic handle which was hassle free and precise. The base of the partial nephrectomy was fulgrated with spatula. Renorrhapy done with V-LOC continuous suture using ROBOTISED NEEDLE HOLDER with same features of scissors gave a perfect renorrhaphy and pressure maintenance by haemolock clips. No separate calyceal suturing on stent was placed. Kidney was covered with perinephric fat. The specimen is kept in the bag and retrieved out extending the port incision. Peritoneal toileting done and drain placed
Results : Operative time was 60 minutes and ischemic time was 19 mts. Blood loss was minimal orals started on post operative day 1 and hospital stay was 3 days. There were no intraoperative and postoperative complications.
Conclusions : Robotised 3 Dimension laparoscopy is feasible at an affordable cost with good oncological outcome, nephron preservation with maximum comfort to the surgeon and minimal morbidity to patient at an affordable cost. No Bolster/No stenting technique is safe.
Krishna Mohan Ramaswami– Senior Consultant Urologist and Transplant Surgeon, MIART, MICC , Thondayadu bypass , calicut , kerala , India, CALICUT, Kerala, India
Harigovind Pothiyedath– Chief Consultant Urologist and Transplant Surgeon, CALICUT, Kerala, India
Pankaj Bhirud– Consultant Urologist, Calicut, Kerala, India
Mohammed Saleem– Consultant Urologist, Calicut, Kerala, India
Senior Consultant Urologist and Transplant Surgeon
MIART, MICC , Thondayadu bypass , calicut , kerala , India
CALICUT, Kerala, India
Dr. Krishna mohan . R,
MS, DNB ( urology) , FICS ( urology) , senior condulatnt urologist and rensl transplant surgeon
MIART, calicut , india
Chief Consultant Urologist and Transplant Surgeon
CALICUT, Kerala, India