Robotic partial nephrectomy in the setting of prior abdominal surgery

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Prior abdominal surgery presents challenges for subsequent laparoscopic or robotic procedures due to adhesions.
• Transperitoneal access for robotic partial nephrectomy (RPN) in patients with previous abdominal surgery requires careful consideration.
• Evaluating perioperative outcomes and access techniques is crucial for optimizing RPN in this patient population.

Purpose of the Study:

• To assess the feasibility and outcomes of transperitoneal robotic partial nephrectomy (RPN) in patients with a history of abdominal surgery.
• To determine the impact of previous abdominal surgery on perioperative results during RPN.
• To describe a technique for safe intraperitoneal access using direct-vision trocar placement with the robotic camera.

Main Methods:

• A prospective cohort of 95 patients undergoing transperitoneal RPN was analyzed.
• Patients were stratified based on the presence and type of prior abdominal surgery.
• A technique involving direct-vision placement of the initial trocar using an 8 mm robotic camera was employed in the 10 most recent cases.

Main Results:

• Of 95 patients, 41 (43%) had prior abdominal surgery, with no significant differences in BMI, tumor size, operative time, or warm ischemia time compared to controls.
• Complications included one enterotomy and one mesenteric hematoma in the prior surgery group.
• No access-related injuries occurred in the 10 cases utilizing the 8 mm robotic camera for initial trocar placement.

Conclusions:

• Transperitoneal RPN is a feasible and safe procedure for patients with prior abdominal surgery, without increased perioperative complications.
• Direct-vision intraperitoneal trocar placement with an 8 mm robotic camera is an effective technique for improving access safety.
• This approach facilitates RPN in patients with complex surgical histories.