Introduction: Intuitive introduced Single Port Robotic Assisted Laparoscopic Surgery in 2018. Our institution started to use this technology in 2019 and quickly adopted this technology to partial nephrectomy. There were early hurdles associated with this new technology but there have been many evolutions in regards to technique, approach and use of the single port robot in partial nephrectomy. In this video, we demonstrate a completely novel approach to single port partial nephrectomy.
Methods: This is a video of an 80-year female with a 3.6 centimeter mass in her right kidney. This surgery was completed by an experienced surgeon with greater than 15 years of robotic experience.
Results: A three centimeter incision is placed at one third of the distance from the iliac crest to the umbilicus. The retroperitoneal space is manually dissected and the robot is docked in this position. The peritoneum can be incised at this point or during the case to provide peritoneal access. Partial nephrectomy was then performed using standard institutional techniques to complete the case either via the retroperitoneum or peritoneum.
Conclusions: The novel technique has never been described in the literature or at public conferences. This is a unique approach invented by the author and provides key advantages. In standard retroperotineal partial nephrectomy, the incision is placed subcostal and it is 3cm long. Given the location and increased length of the incision compared to multiport, we noted an increased incidence of muscle bulging at the incision site likely due to nerve injury. With this approach and incision location, we have eliminated this possibility. Furthermore, this technique provides greater functionality and choice to the surgeon. With this approach, the surgeon can easily move between the retroperitoneum and the peritoneum as needed for the tumor resection or hilar access. Another key advantage of this approach, is that the incision location places the robot in line with the key anatomy. This is uniquely important with the single port robot as this makes it easy for instrument manipulation with the robotic arms and for the assistant port. This novel approach to single port partial nephrectomy has many key advantages and our institution is collected further data to analyze outcomes compared to the traditional approaches.
.jpg)
.jpg)
