Published online Jun 16, 2014. doi: 10.12998/wjcc.v2.i6.224
Revised: February 14, 2014
Accepted: April 17, 2014
Published online: June 16, 2014
We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ‘‘V’’configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPN was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperative period: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.
Core tip: Very few papers have been reported concerning simultaneous bilateral robot assisted partial nephrectomy. We think that our technique was noteworthy for some important aspects: the number of the ports was minimized, the disposition of the operatory room allows the quick rotation of the patient’s bed and the redocking of the robot, the operative time was acceptable, the unclamping technique decreased the risk of renal insufficiency, the cost for two nephrectomies was decreased. In conclusion, our technique was safe, feasible, time and cost effective with a cosmetic benefit for the patient.