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Minerva Urology and Nephrology 2021 Mar 26

DOI: 10.23736/S2724-6051.21.03919-9


language: English

Single-Port robot assisted partial nephrectomy: initial experience and technique with the da Vinci Single-Port platform (IDEAL Phase 1)

Simone FRANCAVILLA 1, 2, 3 , Michael R. ABERN 1, Ryan W. DOBBS 1, Hari T. VIGNESWARAN 1, Susan TALAMINI 1, Alessandro ANTONELLI 4, Claudio SIMEONE 2, Simone CRIVELLARO 1

1 Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA; 2Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy; 3 Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy; 4 Urology Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, Azienda Ospedaliero Universitaria Integrata di Verona, University of Verona, Verona, Italy


BACKGROUND: To evaluate the safety and feasibility of robotic-assisted laparoscopic partial nephrectomy (RAPN) performed using the da Vinci Single-Port (SP) platform.
METHODS: A retrospective review was conducted from December 2018 to December 2019 of 14 consecutive patients with localized renal cancer who underwent SP robot-assisted partial nephrectomy at a single institution. The procedures were performed by 2 experienced robotic surgeons, reproducing the steps of the standard multiport robotic approach to partial nephrectomy. A transperitoneal approach was utilized with a 2.5 cm para-rectus incision with one assistant 12 mm laparoscopic port.
RESULTS: No conversions to open or laparoscopic surgery occurred and no additional laparoscopic assistant ports were required. The median total operative time was 202 (162-231) minutes and the median total room time was 258 (215-295) minutes. The warm ischemia time averaged 20 minutes ± 8 minutes. 2 patients required angioembolization due to postoperative acute bleeding (Clavien-Dindo Grade 3a complication). Trifecta outcome (<25 min warm ischemia, no perioperative complications and negative margins) was achieved in 79% of patients. In one case, a positive margin was present. The median length of stay was of 1 day (Interquartile Range 1-2) with a median pain score on postoperative day 1 of 3.5 (Interquartile Range 2.4-5). 1/14 (7%) patient needed narcotic use at one week from discharge. At a median follow up of 5.0 (4.0-8.0) months, no patients have had evidence of disease recurrence.
CONCLUSIONS: In this initial cohort, considering the introduction of a new technology, we observed satisfactory outcomes for several key perioperative variables including operative time, warm ischemia time, surgical margins, hospital stay, pain requirements in patients undergoing RAPN with the SP platform. For experienced robotic surgeons, RAPN with the SP platform is a safe and feasible approach for single site partial nephrectomy.

KEY WORDS: Single port; Robotic; Partial nephrectomy; Kidney; Cancer

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