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AbstractPurpose:To assess the feasibility, describe the technique, and report our experience with use of the da Vinci S robotic surgical system in the management of pheochromocytoma.Patients and Methods:For four patients with metabolically active adrenal pheochromocytoma (two right, two left), standard preoperative preparation was performed. A robotic transperitoneal approach was used for all cases. Sparing of the adjacent normal parenchyma was performed in all cases. All relevant perioperative details were collected and analyzed.Results:Mean operative time was 77.5 minutes (range 40–140 min), and blood loss was 97.5 mL (range 50–160 mL). There were no conversions or perioperative complications. Average tumor size was 4.7 cm. There were three episodes of intraoperative hypertension necessitating therapeutic intervention. Average analgesic requirement was 150 mg of diclofenac, and patients were allowed oral intake after 6 hours. The drain was removed within 24 hours, with average hospital stay of 4 days. The histopathology report confirmed pheochromocytoma in all patients with free surgical resection margins. Average follow-up was 9 months (range 4–14 mos) with no evidence of recurrence or extra-adrenal tumor.Conclusion:Robot-assisted excision of pheochromocytoma is feasible, safe, and efficacious in our early experience. Sparing of the normal adjacent adrenal parenchyma is possible with little detrimental effect on the oncologic efficacy of the surgery. Long-term studies are needed to further confirm this issue. [ABSTRACT FROM AUTHOR]

AbstractObjective:To describe the technique, feasibility, and effectiveness of robotic ureteric tapering (intra- or extracorporeal) and ureteroneocystostomy with and without ureteric stones retrieval in patients with symptomatic primary obstructive megaureter.Materials and Methods:Seven patients (one bilateral) (mean age: 28.3 years) with symptomatic or complicated congenital primary obstructive megaureter were considered for robot-assisted laparoscopic reconstruction. All surgical steps were performed purely robotically via transperitoneal access by single surgeon including ureteric reimplantation and retrieval of ureteral stones, except in two patients where ureteral tapering was done extracorporeally. The relevant perioperative details, complications, and functional outcomes were analyzed. Besides clinical follow-up, objective evaluation was done with diuretic renogram and intravenous urography.Results:Total mean operative time and surgeon's console time were 142.5 and 127.5 minutes (range: 115–230 and 100–210), respectively, with an estimated blood loss of less than 50 mL. Mean analgesic requirement was 175 mg of diclofenac sodium and oral feeds were started after 12 hours (range: 7–16). Average hospital stay was 3.2 days (range: 2–6). Complications included one case of perioperative urinary tract infection. Average follow-up period was 16 months (range: 11–20). Follow-up ultrasonography and intravenous urography confirmed reduction of hydronephrosis and good drainage. The mean split renal function of the salvaged kidney was 41.2% at last follow-up when compared with preop average value of 41.3%.Conclusions:Robotic repair and removal of ureteric stones in primary symptomatic obstructive megaureter is safe, feasible, and effective with either intracorporeal or extracorporeal ureteric tapering. It has minimal perioperative morbidity and durable success as demonstrated with subjective and objective evaluation. [ABSTRACT FROM AUTHOR]

AbstractPurpose:To demonstrate the technical feasibility of the transmesocolic approach of robotic pyeloplasty for left ureteropelvic junction obstruction (UPJO).Patients and Methods:Between July 2006 and December 2007, 60 patients underwent robot-assisted pyeloplasty that included 33 cases on the right side and 27 cases on the left side. Of the 27 left-side cases, 24 were performed using a transmesocolic approach. Three left-side surgeries were performed by mobilizing the colon because of associated accessory vessel and renal calculi. A pure robot-assisted dismembered reduction pyeloplasty with excision of the ureteropelvic junction was performed in all cases.Results:The mean operative time was 125.33 minutes. The time to perform the anastomosis was 43.58 minutes, and mean blood loss 38.7 mL. Average hospital stay was 2.5 days, and the drain was removed within 48 hours. One patient had prolonged drainage with fever because of a misplaced ureteral stent. Of the 24 patients, 23 were followed for 1 year and 1 was lost to follow-up. No patient demonstrated clinical or radiographic evidence of repeated obstruction.Conclusion:In the transmesocolic approach, mobilization of the colon is not necessary, and the UPJO can be approached directly after incising the mesocolon. This approach is safe and feasible in patients with a thin mesentry and when extensive mobilization of the kidney is not needed for any associated problems. The technique is highly effective with durable success rates similar to those of open surgery. [ABSTRACT FROM AUTHOR]

AbstractPurpose:To report our experience of percutaneous nephrolithotomy (PCNL) in patients who were treated previously with open stone surgery.Patients and Methods:Sixty-six patients with a history of open stone surgery (group 1) were compared with 90 patients without previous surgical intervention (group 2). Both groups were almost similar in demographic profile (age, sex, laterality, stone burden and success rate, body mass index, and location of stones. Patients who had tubeless or bilateral PCNL were excluded from the study. Antibiotics were administered prophylactically to all the patients. Patients with positive urine culture were treated with appropriate antibiotics, and sterile urine was ensured before surgery. Normal saline was used as irrigation fluid. Statistical analysis was performed using the chi-square test for qualitative variables and the Student ttest for quantitative variables. A Pvalue <0.05 was considered significant.Results:Mean time interval between previous open surgery to PCNL in group 1 was 7.6 (range 1–18) years. Mean operative time was longer in group 1 (88.4 min vs80.2 min), but it was not statistically significant. Average drop in hemoglobin level was comparable in both groups (2.3 vs2.1 g/dL). A significant number of patients in group 1 needed a metallic dilator for tract dilation. Hospital stay and postoperative analgesic requirement were similar in both groups. Postoperative and intraoperative complications were also similar in both groups.Conclusion:Previous open stone surgery does not alter the outcome of subsequent PCNL significantly except that these patients more frequently need relook procedures for achieving complete clearance. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the feasibility and safety of two concomitant robot-assisted procedures in the same patient in one anesthesia setting.Patients and MethodsData were reviewed for 15 patients for whom two concomitant robot-assisted surgeries at our center were planned. Preoperative details, port position, intraoperative problems encountered, surgical and anesthesia time, blood loss, complications, hospital stay, and postoperative recovery were analyzed.ResultsFifteen patients underwent two concomitant robot-assisted procedures; at least one of the two surgeries was a urologic procedure. The second procedure added <50 mL of blood loss. Surgical time was increased by 58 minutes and 30 minutes in cases in which the primary procedure involved the upper and lower urinary tract, respectively, while anesthesia time was increased by 82 minutes and 30 minutes, respectively. There were no added complications during the second procedure, and hospital stay was not increased, being limited only by the first procedure.ConclusionPlanned robot-assisted surgery for two different operations is feasible in one anesthesia session, thereby reducing cost and overall hospital stay for the patient without any increased risk of perioperative morbidity. The decision to continue with the second procedure depends on the successful completion of the first procedure in a reasonable time and without any complications. [ABSTRACT FROM AUTHOR]