2005 SAGES Abstracts

POSTER ABSTRACTS
Materials and Methods: We retrospectively reviewed the charts
of 10 consecutive patients undergoing hand-assisted bilateral
nephrectomy between March 2002 and October 2004 using the
following technique. With the patient in the supine position, a
5-7cm periumbilical incision is made through which a hand
assist device is positioned. Port sites are created at 5cm
(12mm) and 8cm (5mm) lateral to the umbilicus on the side of
the initial nephrectomy. After pneumoperitoneum is established,
one hand is employed for blunt dissection while the
other hand is used for instrumentation; the right hand is
inserted for right nephrectomy and the left hand for left
nephrectomy. A 5mm laparoscope is used interchangeably
between port sites. The renal hilum is dissected. The renal vessels
are divided with a vascular stapler and the ureter is divided
using plastic locking clips. The kidney is mobilized using
the surgeon?s intra-abdominal hand. Finally, a 12mm curette is
inserted through the 12mm port site. The suction curettage
machine is used to aspirate cysts on the anterior and medial
surface of the kidney providing a significant decrease in the
overall size and allowing easy extraction through the 5-7cm
midline incision.
Results: All 10 patients underwent successful laparoscopic
bilateral nephrectomy with a mean operative time of 193 minutes.
The average size of the kidneys removed was 717g and
average length was 19cm. No intraoperative complications or
deaths occurred. All patients did well postoperatively with
complete resolution of their presenting symptoms. Patients
with renal allografts had stable function at the time of discharge.
Conclusion: In patients with symptomatic ADPKD, laparoscopic
bilateral hand-assisted nephrectomy using suction curettage to
minimize the size of the kidneys is fast, safe and effective.
P384–Robotics
TEACHING ROBOTIC SURGERY: A STEPWISE APPROACH,
Mohamed R Ali MD, Bobby Bhasker-Rao MD,Bruce M Wolfe
MD, University of California, Davis
Background: As robotic surgery becomes more established,
strategies should be developed to integrate this technology
into MIS education. After an initial institutional experience
with 50 robotic-assisted laparoscopic Roux-en-Y gastric bypass
procedures, a curriculum was developed for fellow training in
robotic surgery. Methods: The MIS fellow was required to
attend a structured training seminar and complete a laboratory
training program in robotic suturing. Thirty consecutive robotic
gastric bypasses were then performed using the Zeus robotic
surgical system to fashion a 2-layer gastrojejunostomy (GJ).
Three robotic suturing tasks (posterior layer (A), inner layer
(B), and anterior layer (C)) were assigned to the trainee in
cumulative order in 10-case increments (cases 1-10=task A,
cases 11-20=tasks A+B, cases 21-30=tasks A+B+C). The surgical
staff performed tasks B+C in cases 1-10 and task C in cases
11-20. Results: Total robotic operative time did not vary significantly
as the trainee gained more operative responsibility
(cases 1-10=65min, 11-20=56min, 21-30=61min, NS by
ANOVA). Similarly, mean robotic task time did not vary significantly
over the fellow’s experience. There was no statistically
significant difference between trainee and staff, respectively, in
mean time for task B (18.3min vs. 19.1min, p=0.16) but a significant
difference for task C (21.3min vs. 17.1 min, p