Concurrent upper and lower urinary tract robotic surgery: strategies for success.

Concurrent upper and lower urinary tract robotic surgery: strategies for success. Research Abstract Details 

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Concurrent upper and lower urinary tract robotic surgery: strategies for success. Abstract Text:

Daniel Eun,Akshay Bhandari,Ronald Boris,Craig Rogers,Mahendra Bhandari,Mani Menon,Daniel Eun,Akshay Bhandari,Ronald Boris,Craig Rogers,Mahendra Bhandari,Mani Menon,

OBJECTIVE: To assess the feasibility of combined upper and lower urinary tract robot-assisted laparoscopic surgery (RALS) during one operative session. MATERIALS AND METHODS: We describe strategies for port placement and the use of the new da Vinci S surgical system (Intuitive Surgical, Sunnyvale, CA, USA), equipped with a fourth arm, for concurrent surgeries in a porcine model and in humans within one operative session. We studied various schemes of port placement, patient positioning and robotic arm manoeuvring while doing concurrent ipsilateral upper and lower urinary tract surgery on six pigs. The operative times and estimated blood loss were recorded prospectively. Qualitative data such as robotic arm ergonomics, advantages and disadvantages of various port placement strategies were noted. During the various surgical exercises, particular attention was given to the extent and the limits of instrument arm reach and mobility of the various port-placement schemes. These concepts for port placement and patient positioning were then further evaluated in a cadaver followed by demonstration of feasibility by performing a robot-assisted laparoscopic surgery (RAL) right nephroureterectomy in a patient. RESULTS: We describe a four-port 'baseball diamond' strategy to allow instrument access to the entire ipsilateral urinary tract in one operating session without repositioning the patient and re-docking the robot. Furthermore, if additional instrument length is required to reach the deep pelvis, we describe a novel 'pivoting triangle' manoeuvre that incorporates the fourth arm and allows dual-port cannulation and lens telescoping. CONCLUSION: Single session, concurrent multiple quadrant RALS is facilitated by using the da Vinci S surgical system with a 'baseball diamond' port-placement strategy.

Concurrent upper and lower urinary tract robotic surgery: strategies for success. Publishing Authors By Initials

D Eun,A Bhandari,R Boris,C Rogers,M Bhandari,M Menon,D Eun,A Bhandari,R Boris,C Rogers,M Bhandari,M Menon,

For similar male urogenital diseases: urologic diseases research abstracts see: male urogenital diseases: urologic diseases research

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Concurrent upper and lower urinary tract robotic surgery: strategies for success. Journal Published:

PUBLICATION TYPE: Journal Article

Journal: BJU international

VOLUME: 100

Page Numbers: 1121-5

Journal Abbreviation: BJU Int.

ISSN: 1464-4096

DAY: 3

MONTH: 09

YEAR: 2007

Concurrent upper and lower urinary tract robotic surgery: strategies for success. Information

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LANGUAGE: eng

NlmUniqueID: 100886721

Concurrent upper and lower urinary tract robotic surgery: strategies for success. Keywords Mesh Terms:

KEYWORDS: Urologic Diseases

MESH TERMS: surgery

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Grant and Affiliation Information for Concurrent upper and lower urinary tract robotic surgery: strategies for success.

AFFILIATION: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA. mbhanda1@hfhs.org

Country: England

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MEDLINETA: BJU Int

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