Dados do Trabalho

Título

INITIAL EXPERIENCE IN MINIMALLY INVASIVE PARTIAL NEPHRECTOMY (MIPN) WITH THE NEW VERSIUS ROBOTIC PLATFORM (VRP)

Introdução e Objetivo

MIPN is well-established for small renal masses and continues to gain space in the setting of complex masses. New robotic platforms have been launched, such as VRP (CMR Surgical, Cambridge, UK). VRP is a novel surgical robotic platform comprising up to four operative bed side units (BSUs). However, there are still few experience reports utilizing these new systems. In this abstract, we aim to present our initial experience with the use of VRM when performing MIPN.  

Método

Retrospective review of 3 patients with suspicious renal mass or complex cyst that were submitted to partial nephrectomy utilizing the VRP in a private tertiary hospital. All 3 surgeries were performed for an experienced robotic surgeon that finished VRP training (AP). Patience profile and operative data were analyzed.

Resultados

Patient's were positioned in lateral decubitus, with placement of 6 trocars, being 4 for the BSUs arms and 2 for use by the assistant surgeon or liver retractor (figures 1a, 1b and 1c). Additionally to the CMR recommended use of 3 BSUs for this surgery, as illustrated in previous published paper, we utilized an extra arm, laterally to the inferior one. Patient information and operative data were summarized in table 1. Considering the complexity of our cases and the small intraoperative EBL comparing to the median 450 ml presented in other case series, we might say that with the use of a fourth arm we explore the robotic platform resources in its totality, giving us much more exposure and possibly playing a major role in this result. We understand that in part the avoidance of the use of this extra arm is due to the possibility of frequent collisions. Nonetheless, it is possible to minimize it by keeping a minimum distance of 8-9 cm between each trocar.   Case 1 Case 2 Case 3 Age 53 65 59 Lesion 6.8 cm Bosniak IV 5.4cm Solid Nodule 3.8cm Bosniak III RENAL 9P 5A 9A Side R R L EBL (ml) 70 50  60 Warm Isq Time (min) 17 0 33 Operative Time (min) 219 162 170 Histology RCC benign benign Pre Op Cr 0.81 0.86 0.91 Discharge 1.04 0.76 0.98  

Conclusão

Although it's still a small series, we identified that performing MIPN with the VRP is feasible and safe. The use of 4 BSU's has the potential to optimize surgery and improve outcomes.