Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes

Abstract

The Intuitive Surgical DaVinci SP (“Single Port”) robotic platform was approved in 2014, but, recently, there has been a dissemination of the technology with multiple urological procedures successfully adapted to this robot. There are some important differences from prior models. We aimed to share our early outcomes and lessons learned for performing successful single-port robotic-assisted partial nephrectomy (SP-RAPN). This study is a retrospective review of sequential SP-RAPN cases between 7/2019 and 3/2020. We extracted patient characteristics and early surgical outcomes. Surgical tips and tricks were recorded during these cases and compiled. SP-RAPN was successfully completed in 12 patients. Patients mean age was 57.8 ± 11.0 years and median ASA score was 2. Mean tumor size was 3.1 ± 2.2 cm. The average OR Time was 172 ± 41 min and EBL was 68 ± 75 mL. All cases had warm ischemia time < 25 min. Tumor pathology included 8 RCC (6 pT1a, 1 pT1b, 1 pT2a), 2 AML, and 2 oncocytoma. There were no complications. Our top surgical tips involved: (1) patient positioning, (2) port placement, (3) insufflation, (4) air docking, (5) assistant port placement, (6) dynamic arm control, (7) hilar clamping, (8) camera relocation, (9) tumor excision, and (10) extraction and port closure. SP-RAPN is safe and feasible in this series. There are advantages and disadvantages to this platform. As the technology matures and techniques evolve, SP-RAPN may become more appealing. Future studies should focus on long-term outcomes and cost-effectiveness of the SP system.

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Funding

This study was not funded.

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Contributions

All authors have contributed to the study conception and design. Material preparation, data collection, and analysis were performed by DS and AS. The first draft of the manuscript was written by DS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Devki Shukla.

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Conflict of interest

Devki Shukla, Alexander Small, Reza Mehrazin, and Michael Palese declare that they have no conflict of interest.

Ethical approval

This study was conducted retrospectively from data obtained for clinical purposes. We consulted with the IRB of Mount Sinai who determined our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the Mount Sinai Institutional Review Board. This study was performed in its entirety at the Icahn School of Medicine at Mount Sinai with no outside support.

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Consent to participate given the retrospective design of this article and reporting of de-identified data, this study was approved for consent exemption under IRB approval

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Consent for publication given the retrospective design of this article and reporting of de-identified data, this study was approved for consent exemption under IRB approval

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Shukla, D., Small, A., Mehrazin, R. et al. Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes. J Robotic Surg (2020). https://doi.org/10.1007/s11701-020-01106-2

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Keywords

  • Single port
  • Robotic surgical procedures
  • Minimally invasive surgery
  • Kidney cancer
  • Nephrectomy