MULTI-QUADRANT SINGLE-PORT SURGERY: CONCOMITANT ROBOTIC PARTIAL NEPHRECTOMY AND RADICAL PROSTATECTOMY
Aim: To present in a video format a concomitant single-port robotic partial nephrectomy and radical prostatectomy, using the purpose-built da Vinci SP® surgical platform.
Methods: A 66-year-old male with confirmed diagnoses of Localized Prostate Cancer - Adenocarcinoma Gleason 8 (4+4), 10mm PI-RADS 3 lesion in the transitional zone and an incidental finding of an enhancing complex left renal cyst on CT scan. Positioning and approach: The patient was placed in lithotomy and Trendelenburg position and a 3 cm supraumbilical incision was done, dissection of the abdominal wall was carefully performed until reaching the intraperitoneal space. Port-placement: a GelPOINT standard (purple) advanced access platform (Applied Medical, Rancho Santa Margarita, CA) was inserted and a dedicated 25-mm multichannel robotic single-port cannula was placed through the gel-seal cap, an additional 12 mm laparoscopic port was inserted in the left hemi-abdomen close to the GelPOINT, and the da Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA) was docked. The transperitoneal single-port radical prostatectomy was performed. After undocked the robot for the extraction of the prostate, the surgical table was leaned to the right side, facilitating retrieval of the specimen and at the same time positioning the patient for the partial nephrectomy. The robot was re-docked to perform the second procedure without changes in the operation room distribution or additional port placement. The partial nephrectomy them carried on.
Results: Total operative time was 256 minutes (min) —108 min for radical prostatectomy console time and 101 min for the partial nephrectomy console time, with a warm ischemia time of 26min. Total estimated blood loss was 250cc. Blood transfusion was not needed. The final pathology report for prostate was adenocarcinoma pT3N0, Gleason 7 (4+3), positive extra-prostatic extension (focal) with negative margins, classified as a pT3N0. The pathology report for the kidney lesion was renal cell carcinoma, papillary type, 4.8cm, ISUP grade 2, negative margins, classified as a pT1b. Two months after surgery, PSA was undetectable and no complications or recurrence from the renal cell carcinoma were detected.
Conclusion: The availability of a purpose-built single port device gives us another option for the approach of concurrent intra-abdominal surgeries, especially when faced by bilateral lesions or multi-quadrant diseases.
single-port, concomitant surgery, concurrent surgery, robotic, da vinci sp, partial nephrectomy, radical prostatectomy
Cleveland Clinic - - Estados Unidos
Guilherme V Sawczyn, Rair Valero, Jihad Kaouk