{"title":"Retroperitoneal approach for robot living donor nephrectomy: A step-by-step description of technical nuances.","authors":"Forqan Babu Shaikh, Arvind P Ganpule","doi":"10.4103/jmas.jmas_29_23","DOIUrl":null,"url":null,"abstract":"<p><p>Open, pure or hand-assisted laparoscopic, natural orifice transluminal endoscopic surgical (NOTES) and robotic approaches (Transperitoneal or retroperitoneal) are the described approaches for living donor nephrectomy. We describe the procedural steps of a robotic living donor nephrectomy (RLDN) retroperitoneal (RRLDN) technique using a da Vinci X surgical system and three robotic arms. This is the first reported case with the retroperitoneal robotic approach. The procedure in brief is as follows. First, with the patient placed in full flank position, the camera port is placed at the level of the Petit's triangle apex. Retroperitoneal space is created by turning the index finger in a 180° movement through this port and a gloves balloon. The second 8mm port was inserted, 8 cm far from the first port, The peritoneum is reflected medially and downward off of the transversus abdominis muscle laparoscopically, respectively along the anterior and posterior axillary line; 3-5 cm caudally to the last one, a 12 mm AirSeal® assistant port is placed in the same manner. Only then, the port is placed under direct vision. The robotic ports placement will result in a caudally convex arc. This technique, due to the extensive use of the surgeon index, implies fast access to the retroperitoneum, protects the underlying anatomical structures from damage, and, due to the trocar positioning along an arc, lowers the arm conflict risk.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10898627/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Minimal Access Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/jmas.jmas_29_23","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/7/5 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Open, pure or hand-assisted laparoscopic, natural orifice transluminal endoscopic surgical (NOTES) and robotic approaches (Transperitoneal or retroperitoneal) are the described approaches for living donor nephrectomy. We describe the procedural steps of a robotic living donor nephrectomy (RLDN) retroperitoneal (RRLDN) technique using a da Vinci X surgical system and three robotic arms. This is the first reported case with the retroperitoneal robotic approach. The procedure in brief is as follows. First, with the patient placed in full flank position, the camera port is placed at the level of the Petit's triangle apex. Retroperitoneal space is created by turning the index finger in a 180° movement through this port and a gloves balloon. The second 8mm port was inserted, 8 cm far from the first port, The peritoneum is reflected medially and downward off of the transversus abdominis muscle laparoscopically, respectively along the anterior and posterior axillary line; 3-5 cm caudally to the last one, a 12 mm AirSeal® assistant port is placed in the same manner. Only then, the port is placed under direct vision. The robotic ports placement will result in a caudally convex arc. This technique, due to the extensive use of the surgeon index, implies fast access to the retroperitoneum, protects the underlying anatomical structures from damage, and, due to the trocar positioning along an arc, lowers the arm conflict risk.
开腹、纯腹腔镜或手辅助腹腔镜、自然腔道内镜手术(NOTES)和机器人方法(经腹膜或腹膜后)是活体供体肾切除术的常用方法。我们描述了使用达芬奇 X 手术系统和三个机械臂进行腹膜后机器人活体供体肾切除术(RLDN)的手术步骤。这是第一例腹膜后机器人手术。手术过程简述如下。首先,患者取全侧卧位,将摄像头端口置于佩蒂三角顶点水平。通过该端口和一个手套球囊,将食指旋转 180°,形成腹膜后空间。腹膜分别沿着腋窝前线和腋窝后线从腹横肌的内侧和下侧反射到腹腔镜下;在最后一个端口的尾部3-5厘米处,以同样的方式放置一个12毫米的AirSeal®辅助端口。只有这样,才能在直视下放置端口。机器人端口置入将形成向尾部凸出的弧线。由于广泛使用了外科医生索引,这种技术意味着可以快速进入腹膜后,保护下层解剖结构不受损伤,并且由于套管沿弧线定位,降低了手臂冲突的风险。
期刊介绍:
Journal of Minimal Access Surgery (JMAS), the official publication of Indian Association of Gastrointestinal Endo Surgeons, launched in early 2005. The JMAS, a quarterly publication, is the first English-language journal from India, as also from this part of the world, dedicated to Minimal Access Surgery. The JMAS boasts an outstanding editorial board comprising of Indian and international experts in the field.