Category: Robotic Surgery: New Techniques - Malignant
Introduction & Objective :
At times, removal of the entire genitourinary (GU) system, including both kidneys as well as the urinary bladder is indicated in the setting of multiple malignancies or in patients with concomitant end stage renal disease (ESRD) and muscle invasive bladder cancer (MIBC). Various methods have been described to complete an extirpative removal of all urologic organs. Herein, we report a unique robotic-assisted laparoscopic (RAL) technique for complete genitourinary excision.
Our patient is a 77 year old male diagnosed with MIBC and history of ESRD. Due to recurrent hematuria and urinary tract infections, he underwent simultaneous, RAL bilateral nephrectomy and radical cystectomy. The patient was positioned for standard robotic pelvic surgery (i.e. cystectomy or prostatectomy) using 5 total port sites (1 supra-umbilical and 2 lateral ports on the right and left abdomen). Using the da Vinci Xi Surgical System (Intuitive Surgical) we were able to perform a 180 degree "boom shift" to transition from the cystectomy to the nephrectomy portion of the operation. We did not place any new port sites and did not re-position the patient or the robot system.
Our patient was able to successfully undergo simultaneous RAL bilateral nephrectomy and radical cystectomy using a "boom shift" of the da Vinci Xi Surgical System. Estimated blood loss was approximately 450 milliliters. Total operative time was approximately 225 minutes. We did encounter a right renal vein injury, likely due to the uncommon orientation and positioning of the robot during nephrectomy portion of the operation. However, it was repaired robotically without difficulty. All specimens were removed from an extended supra-umbilical port site. The patient did not have any post-operative complications and was discharged on post-operative day number seven.
Robotic surgery has seen an exponential rise over the past decade, specifically for urologic surgeries. Our patient required radical excision of his entire GU system. Using our unique technique, we were able to accommodate the patient with a short operative time, minimal blood loss, and minimal invasiveness. We continue to advance robotic surgery by performing this extensive, radical excision of all genitourinary organs with limited port sites using our robotic expertise to develop a unique and novel approach to an uncommon operation.
Neel Patel– Resident, New York Medical College, Valhalla, New York
Samuel Aly– Resident Physician, Rutgers NJMS, Newark, New Jersey
Mutahar Ahmed– Attending Urologist, Hackensack University Medical Center, Maywood, New York
Gregory Lovallo– Attending Urologist, Hackensack University Medical Center, Maywood, New Jersey
Newark, New Jersey
Samuel Aly, MD fourth year urolog resident at Rutgers New Jersey Medical School
Hackensack University Medical Center
Maywood, New York
Mutahar Ahmed MD FACS
Director of the Center for Bladder Cancer and Reconstructive Urologic Surgery at Hackensack University Medical Center, in Hackensack, NJ
Clinical Assitant Professor Hackensack Meridian Seton Hall School of Medicine
Clinical Assistant Professor Rutgers University School of Medicine