Urology & Kidney Disease News - Cleveland Clinic

26 Urology & Kidney Disease News
Robotic and Laparoscopic
Robotic Surgery Through Natural Body Orifices continued from page 25
10 radical nephrectomies. A single port with 3-cannula was
inserted into a 2.5 cm umbilical skin incision.
Subsequently, a vaginal port was placed through the vagina
under laparoscopic monitoring. The robot telescope and
the first robotic arm were placed through the umbilical
single port, and the second robotic arm was placed through
the vagina.
For dismembered pyeloplasty, the ureteropelvic junction
was transected and the ureter was spatulated. Using robotic
needle drivers, the anastomosis was performed with two 5-0
running sutures. Radical nephrectomy was performed after
completing the pyeloplasty on the same kidney then
extracted transvaginally.
The animal was flipped to the opposite lateral flank position
for partial nephrectomy. Renal hilum was controlled
with bulldog clamps and partial nephrectomy was performed
using cold scissors. Renorrhaphy was performed
using robotic needle drivers with sutures cinched over a
surgical bolster.
All 30 robotic NOTES procedures were performed successfully.
Mean operative time was 154 minutes and mean
estimated total blood loss was 72 cc. Mean warm ischemia
time in the partial nephrectomy group was 25.4 min. There
were no intraoperative complications. There were no
robotic system failures during the entire experiment.
In our study, we inserted a robotic arm through a vaginal
port. Vaginal access allowed a full range of motion for the
robotic arm. It minimized clashing between robotic instru-
Surgical Outcomes
Number of porcine/Total number of procedures 10/30
Mean size of umbilical incision cm (range) 2.55 (2.4 – 2.9)
Mean operative time min (range)
Preparation (n = 10) 20.4 (16 – 30)
Pyeloplasty (n = 10) 41.7 (37 – 50)
Suturing time 24.3 (19 – 28)
Partial nephrectomy (n = 10) 59.5 (52 – 70)
Warm ischemia time 25.4 (22 – 30)
Radical nephrectomy (n = 10) 32.1 (27 – 45)
Total surgery time per animal 153.7 (136 – 285)
Mean estimated blood loss cc (range)
Pyeloplasty (n = 10) 19.5 (10 – 35)
Partial nephrectomy (n = 10) 39.8 (30 – 60)
Radical nephrectomy (n = 10) 13.0 (10 – 20)
Total surgery 72.3 (55 – 95)
Complications None
Robotic scope and instrument inserted through the multichannel port.
ments and made it possible for a surgeon to manipulate an
instrument going through the vagina and another instrument
through the umbilicus at the same time in a manner
impossible to do with conventional laparoscopic approach.
Although the NOTES approach has the potential for a less
morbid and scarless surgery, incorporating robotics into
NOTES will enhance intracorporeal suturing especially
through the challenging translumenal natural orifice
approach. Further development of robots specific to NOTES
would enhance efforts toward clinical applications of natural
orifice surgery.
This article is written for educational purposes only and as a
convenience. Cleveland Clinic has no financial interest in nor is
it endorsing any product or device described in this article.