V04-06 RETROPERITONEAL ROBOT-ASSISTED PARTIAL NEPHRECTOMY WITH HUGO RAS SYSTEM: SURGICAL SETTINGS AND PRELIMINARY RESULTS

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You have accessJournal of UrologyAdrenal/Renal Oncology I (V04)1 May 2024V04-06 RETROPERITONEAL ROBOT-ASSISTED PARTIAL NEPHRECTOMY WITH HUGO RAS SYSTEM: SURGICAL SETTINGS AND PRELIMINARY RESULTS Alessandro Uleri, Josep Maria Gaya, Andrea Gallioli, Alejandra Bravo, Giuseppe Basile, Oscar Rodriguez-Faba, Angelo Territo, Isabel Sanz, Raul Sanchez, Jorge Robalino, Joan Palou, and Alberto Breda Alessandro UleriAlessandro Uleri , Josep Maria GayaJosep Maria Gaya , Andrea GallioliAndrea Gallioli , Alejandra BravoAlejandra Bravo , Giuseppe BasileGiuseppe Basile , Oscar Rodriguez-FabaOscar Rodriguez-Faba , Angelo TerritoAngelo Territo , Isabel SanzIsabel Sanz , Raul SanchezRaul Sanchez , Jorge RobalinoJorge Robalino , Joan PalouJoan Palou , and Alberto BredaAlberto Breda View All Author Informationhttps://doi.org/10.1097/01.JU.0001009444.59519.d3.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retroperitoneal robot-assisted partial nephrectomy (rRAPN) has been associated with similar surgical outcomes to the transperitoneal approach, especially for posteriorly located tumors. Recently, Hugo RAS has emerged as a promising competitor in urologic robotic surgery. The individual robotic arms carts and the open console are the main novelties introduced by Hugo RAS technology. To take full advantage of the system modularity, a proper surgical setting needs to be outlined before implementing this platform in clinical practice, as described for transperitoneal RAPN with Hugo RAS. METHODS: Between February and October 2023 two left and four right rRAPN were performed at our institution using a four-arm configuration. Patients were selected according to lesion location (posterior lesions, preferably located mesorenal or in the lower pole). After patient's positioning, retroperitoneal space was created using a visual pre-shaped inflatable balloon trocar, placed 2 cm anteriorly and under the tip of 12th rib; after that it was replaced with an 11 mm trocar for the endoscope. Second, an 8 mm trocar was placed at the posterior axillary line level. Third, after peritoneum detachment with cold scissors, two 8 mm trocars were positioned following an "inline" configuration. Carts disposition with their respective docking angles were carefully followed to avoid conflicts among robotic arms and the assistant. All cases were performed with arterial clamping and a double layer suture of the parenchyma (3/0 Monocryl running suture for the inner layer and 2/0 Vicryl single stitches for the outer layer). RESULTS: Six patients underwent rRAPN with a median lesion size and PADUA score of 3 (3-4) cm and 8.5 (7-9), respectively. Median operative time was 170 (160-200) minutes and the median docking time of 6 (5.5-6.5) minutes. Median EBL was 100 (70-100) ml and the median warm ischemia time was 16 (14-19) minutes. Median length of hospital stay was 3 (3-4) days. The only postoperative complication that occurred was a wound infection (Clavien-Dindo 2). At final pathology 4 lesions were pT1a and 2 pT1b. No case of positive surgical margin was recorded. CONCLUSIONS: The described surgical setting may be a useful reference standard for rRAPN with Hugo RAS. Furthermore, platform versatility in both transperitoneal and retroperitoneal approaches allows a wide adoption of this novel surgical platform in robotic renal surgery programs. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e197 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alessandro Uleri More articles by this author Josep Maria Gaya More articles by this author Andrea Gallioli More articles by this author Alejandra Bravo More articles by this author Giuseppe Basile More articles by this author Oscar Rodriguez-