Partial nephrectomy is generally performed in the scenario of a nonfunctiong moiety in a complex duplex system and can concern the upper or the lower pole. The surgery is performed under general anaesthesia. The procedure generally starts with an endoscopy to define the anatomy and place a tube in the identified ureters on the affected side. We always prefer a transperitoneal approach, and the patient is placed in a supine semilateral decubitus. A partial nephrectomy requires four ports. This fourth port is essential to expose the anatomic structures, such as lifting the liver up during right upper pole partial nephrectomy, or for flashing and suctioning in the operating field in case of bleeding. The robot is side-docked. The colon is mobilized from the lateral abdominal wall to expose the kidney and the ureter. The latter is the anatomical landmark for the dissection. The ileum is dissected and selective ligature of the vessels. This should be followed by a discoloration of the ischemic moiety. Intravenous injection of ICG can further enhance the difference between the ischemic and the healthy moiety. The parenchyma is cut along the line of demarcation. A new injection of ICG via the ureteral catheter inserted preoperatively can further confirm the absence of injury to the urinary tract. A sealant glue and sponge are applied on the section margin, and two or three stiches can be applied to approximate the renal capsule. Extraction of the removed pole form the abdomen is generally easier using a standard laparoscopic technique. Irrespective of the approach, the robotic partial nephrectomy follows the same steps of the open procedure. A major innovation is the use of ICG fluorescence technology with Firefly system.

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Robotic-Assisted Partial Nephrectomy

  • Marco Castagnetti,
  • Alfredo Berrettini

摘要

Partial nephrectomy is generally performed in the scenario of a nonfunctiong moiety in a complex duplex system and can concern the upper or the lower pole. The surgery is performed under general anaesthesia. The procedure generally starts with an endoscopy to define the anatomy and place a tube in the identified ureters on the affected side. We always prefer a transperitoneal approach, and the patient is placed in a supine semilateral decubitus. A partial nephrectomy requires four ports. This fourth port is essential to expose the anatomic structures, such as lifting the liver up during right upper pole partial nephrectomy, or for flashing and suctioning in the operating field in case of bleeding. The robot is side-docked. The colon is mobilized from the lateral abdominal wall to expose the kidney and the ureter. The latter is the anatomical landmark for the dissection. The ileum is dissected and selective ligature of the vessels. This should be followed by a discoloration of the ischemic moiety. Intravenous injection of ICG can further enhance the difference between the ischemic and the healthy moiety. The parenchyma is cut along the line of demarcation. A new injection of ICG via the ureteral catheter inserted preoperatively can further confirm the absence of injury to the urinary tract. A sealant glue and sponge are applied on the section margin, and two or three stiches can be applied to approximate the renal capsule. Extraction of the removed pole form the abdomen is generally easier using a standard laparoscopic technique. Irrespective of the approach, the robotic partial nephrectomy follows the same steps of the open procedure. A major innovation is the use of ICG fluorescence technology with Firefly system.