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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.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.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.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.

To report our experience of percutaneous nephrolithotomy (PCNL) in patients who were treated previously with open stone surgery.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 t test for quantitative variables. A P value0.05 was considered significant.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 vs 80.2 min), but it was not statistically significant. Average drop in hemoglobin level was comparable in both groups (2.3 vs 2.1 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.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.

To demonstrate the technical feasibility of the transmesocolic approach of robotic pyeloplasty for left ureteropelvic junction obstruction (UPJO).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.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.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.