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Journal of Robotic Surgery

, Volume 10, Issue 3, pp 285–288 | Cite as

Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique

  • Hugo H. DavilaEmail author
  • Raul E. Storey
  • Marc C. Rose
Tips & Tricks

Abstract

Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.

Keywords

Radical nephrectomy Kidney cancer Oncology Minimally invasive surgery Laparoscopic nephrectomy Robotic nephrectomy 

Notes

Compliance with ethical standards

Conflict of interest

Hugo H. Davila, Raul E. Storey and Marc C. Rose declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Supplementary material 1 (MP4 80870 kb)

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Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Hugo H. Davila
    • 1
    • 2
    • 3
    Email author
  • Raul E. Storey
    • 1
    • 2
    • 3
  • Marc C. Rose
    • 3
  1. 1.Florida Healthcare Specialist, Urology and Minimally Invasive SurgeryVero BeachUSA
  2. 2.Florida Cancer Specialist at Vero BeachVero BeachUSA
  3. 3.Scully-Welsh Cancer Center, Indian River Urology AssociatesFlorida State University College of MedicineVero BeachUSA

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