Robot -assisted laparoscopic partial nephrectomy: initial experience

1. No. 191 Robot-assisted laparoscopic partial nephrectomy: initial experience Kevin Lah1, Devang Desai1, Charles Chabert2, Troy Gianduzzo1,2 1 Royal Brisbane and Women’s Hospital, Queensland, Australia 2 Wesley Private Hospital, Brisbane, Queensland, Australia Posters Proudly Supported by: 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 (ClavienDindo grade 1). Postoperative renal function was within normal limits at 6 months follow up. 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. Aim To report the initial robot-assisted partial nephrectomy experience of 2 fellowship-trained surgeons established in laparoscopic partial nephrectomyin an Australian context. • 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-locsuture • Vascular clamps released - bleeding vessels suture ligated • Cortical reconstruction - single, running horizontal mattress 12 inch 0/0 V-LOC suture. Floseal applied. 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. Fig 1. 5 cm renal mass Acknowledgements References Rogers et al. (2008). Robotic partial nephrectomy: a multi-institutional analysis. J Robotic Surg 2(3):141-143.