J Yeungnam Med Sci.  2024 Jan;41(1):48-52. 10.12701/jyms.2023.01032.

DaVinci SP-based simultaneous bilateral partial nephrectomy from the midline transperitoneal approach: a case report

• Ko YH
• Ha JG
• Jang JY
• Kim YU

• KMID: 2551334
• DOI: http://doi.org/10.12701/jyms.2023.01032

Abstract

While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

Keyword

Partial nephrectomy; Renal cell carcinoma; Robotics

Figure

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  Fig. 1. The coronary images on preoperative computed tomography show (A) a 1.5-cm right and (B) a 2.0-cm left endophytic mass (arrows).

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  Fig. 2. The configuration for the robotic assessment port and additional laparoscopic port is designed to (A) the bilateral access to the renal mass and (B) postoperative status 3 days after surgery at the time of discharge. Note that the drain for both sides was inserted via a single midline port for the assistant.

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  Fig. 3. (A) Preparation for the right-side procedure after undocking the robotic instrument for the left-side procedure. (B) Note that all the trocars inserted into the peritoneum were maintained utilizing surgical drape material.

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  Fig. 4. The coronary images on postoperative computed tomography taken 3 months after surgery demonstrate no evidence of recurrence or urine leakage (arrows).

Reference

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