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Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique.

ABSTRACT: Objective: To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes. Methods: A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm configuration. In this report we provide a detailed overview of our surgical technique for robotic LDN. The main objective of the study was to evaluate the technical feasibility and safety of the technique, including perioperative surgical complications rate and mid-term functional outcomes. Results: Overall, 36 patients undergoing robotic LDNs were included in the study. Of these, 28 (78%) were left LDNs. Median (IQR) donor pre-operative eGFR was 88 (75.6-90) ml/min/1.73 m². In all cases, robotic LDN was completed without need of conversion. The median (IQR) overall operative time was 230 (195-258) min, while the median console time was 133 (IQR 117-166) min. The median (IQR) warm ischemia time was 175 (140-255) s. No intraoperative adverse events or 90-d major surgical complications were recorded. At a median (IQR) follow-up of 24 months (IQR 11-46), median (IQR) eGFR patients undergoing in living donor nephrectomy was 57.4 (47.9; 63.9) ml/min/1.73 m². Conclusions: In our experience, robotic LDN is technically feasible and safe. The use of robotic surgery for LDN may provide distinct advantages for surgeons while ensuring optimal donors' perioperative and functional outcomes.

SUBMITTER: Serni S

PROVIDER: S-EPMC7844329 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique.

Serni Sergio S Pecoraro Alessio A Sessa Francesco F Gemma Luca L Greco Isabella I Barzaghi Paolo P Grosso Antonio Andrea AA Corti Francesco F Mormile Nicola N Spatafora Pietro P Caroassai Simone S Berni Alessandro A Gacci Mauro M Giancane Saverio S Tuccio Agostino A Sebastianelli Arcangelo A Li Marzi Vincenzo V Vignolini Graziano G Campi Riccardo R

Frontiers in surgery 20210115

<b>Objective:</b> To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes. <b>Methods:</b> A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm con ...[more]

PMID: 33521044

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Project description:BackgroundPartial adrenalectomy has recently been advocated to preserve unaffected adrenal tissue during resection of pheochromocytoma.ObjectiveTo describe a robot-assisted laparoscopic partial adrenalectomy (RALPA) technique and to report on early functional and oncologic outcomes.Design, setting, and participantsFrom 2007 to 2010, 15 RALPA were performed on 12 consecutive patients with pheochromocytoma. Follow-up data of >1 yr are available on 11 procedures. Median follow-up for the entire cohort was 17.3 mo (range: 6-45).Surgical procedurePositioning and port placement is designed for adequate reach and visualization of the upper retroperitoneum. The plane between the adrenal cortex and pheochromocytoma pseudocapsule is identified visually and with laparoscopic ultrasound. The tumor is dissected away from normal adrenal cortex, preserving normal adrenal tissue.MeasurementsPreoperative, perioperative, pathologic, and functional outcomes data were analyzed.Results and limitationsFourteen of 15 cases were completed robotically. Among 15 procedures, 4 were performed on a solitary adrenal gland. Four cases required resection of multiple tumors (up to six) with two performed in a solitary gland. The mean age of the patients was 30 yr, and the mean body mass index was 27. The mean operative time was 163 min, the median estimated blood loss was 161 ml, and the median tumor size was 2.7 cm (range: 1.3-5.5). There was one conversion to an open procedure in a patient requiring reoperation on a solitary adrenal gland. One patient who underwent RALPA on a solitary adrenal gland required postoperative steroid supplementation at last follow-up. At a median follow-up of 17.3 mo (range: 6-45), there were no recurrences or metastatic events. Study limitations include small sample size and short follow-up.ConclusionsRALPA for the treatment of pheochromocytoma is feasible and safe and provides encouraging functional and oncologic outcomes, even in patients with a solitary adrenal lesion or multiple ipsilateral lesions.

Dataset Information

Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique.

Publications

Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique.

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