Robotic Surgery for Renal Cancer

Preface
Acknowledgements
Contents
About the Editors
Abbreviations
1 Suturing Techniques in Robot-Asssisted Partial Nephrectomy (RAPN)
1.1 Introduction
1.2 Classic Renorrhaphy
1.3 Single Versus Double Layer
1.4 Running Versus Interrupted Suture
1.5 Barbed Versus Nonbarbed Suture
1.6 Hemostatic Agents
1.7 Selective Suturing—Sutureless Technique
1.8 Conclusion
References
2 Resection Techniques Robotic-Assisted Partial Nephrectomy
References
3 Clamping Techniques for Partial Nephrectomy
3.1 Introduction
3.2 Warm-Ischemia Resection
3.3 Off-Clamp Resection
3.4 Early Unclamping
3.5 Superselective Clamping
3.6 Cold Ischemia
3.7 Reclamping
3.8 Summary
References
4 Robotic Retroperitoneal Partial Nephrectomy
4.1 Introduction
4.2 Patient Selection
4.3 Pre-operative Evaluation and Preparation
4.4 Patient Position
4.5 Obtaining Access
4.6 Robot Docking
4.7 Partial Nephrectomy: Techniques
4.8 Special Concerns
4.8.1 Breach of Peritoneum
4.8.2 Selective Artery Clamping
4.8.3 Parenchyma Around Tumour Lights Up with ICG
4.9 Literature Review
4.9.1 Operative Time and Warm Ischemia Time
4.9.2 Estimated Blood Loss and Length of Hospital Stay
4.9.3 Clavien-Dindo Minor (Grade 1 to 2) and Major (Grade 3 to 5) Complications
4.9.4 Decline in Estimated Glomerular Filtration Rate and Upstaging of Chronic Kidney Disease
4.9.5 Positive Surgical Margin and Overall Tumour Recurrence
4.9.6 Summary of Evidence
5 Robotic Partial Nephrectomy
5.1 Indications
5.2 Techniques
5.2.1 Approaches
5.2.2 Pedicle Management
5.2.3 Resection and Suture Techniques
5.2.4 Novel Technologies
5.3 Conclusions
References
6 Pushing the Boundaries in Robot—Assisted Partial Nephrectomy for Renal Cancer
6.1 Pre-operative Planning with 3D Models
6.2 Hilum Control
6.2.1 Off-Clamp Resection
6.2.2 Early Unclamping
6.2.3 Superselective Clamping = “zero Ischemia”
6.2.4 Cold Ischemia
6.3 Tumour Resection Strategy
6.4 Future Perspectives
6.4.1 3D Model Generation
6.4.2 Virtual Models and Augmented Reality
6.5 Conclusions
References
7 Perioperative Surgical Complications in Robotic Partial Nephrectomy
7.1 Introduction
7.2 Definition and Rates
7.3 Pre-operative Prevention of Complications
7.4 Intraoperative Complications
7.4.1 Intraoperative Adverse Events Leading to Bleeding
7.4.2 Intraoperative Tumor Violation (ITV)
7.4.3 Visceral Injuries
7.4.4 Thoracic Complications
7.5 Postoperative Complications
7.5.1 Postoperative Bleeding
7.5.2 Urinary Leak
7.5.3 Acute Kidney Injury
7.6 Conclusions
References
8 Renal Robotic Surgery for Lefties: Left-Handedness in Upper Tract Robotic Surgery
8.1 Introduction
8.2 Upper Tract Robotic Surgery
8.2.1 Instruments
8.2.2 Renal Robotic Surgery: Positioning and Port Placement
8.2.3 Port hopping During (Partial) Nephrectomy
8.2.4 Nephro-Ureterectomy
8.2.5 Cystoureterostomy/Ureterovesical Junction Surgery
8.3 Assisting Upper Tract Robotic Surgery
8.4 Epilogue
References
9 Training with New Robots and How to Transition from One System to the Next in Renal Cancer Surgery
9.1 Introduction
9.2 Console Concept and Display Technology
9.3 Ergonomics
9.4 Master Controllers
9.5 Haptic Feedback
9.6 Learning Pedagogy and Training from Industry
9.7 Summary
References
10 New Robots and How this has Changed Operative Technique in Renal Cancer Surgery
10.1 Introduction
10.2 Background
10.2.1 The Origin of Robotic Surgery and Intuitive Surgical
10.3 The Da Vinci Robotic Surgical System
10.4 New Robots in Renal Cancer Surgery
10.5 Current Evidence
10.5.1 Radical Nephrectomy (RN)—Robotic Versus Laparoscopic Approach
10.5.2 Partial Nephrectomy (PN)—Robotic Versus Open Approach
10.5.3 Partial Nephrectomy (PN)—Robotic Versus Laparoscopic Approach
10.5.4 Surgical Volume, Positive Margins and RAPN
10.6 Future Challenges
10.7 Conclusion
References
11 Use of Indocyanine Green (ICG) During Robotic Surgery for Renal Cancer
11.1 Introduction
11.2 Pharmacodynamics
11.3 Firefly Technology
11.4 Side Effects
11.5 Indications for ICG During Robotic Surgery for Renal Cancer
11.5.1 Vasculature Identification
11.5.2 Dissection of Tumor Margins
11.5.3 Check Tissue Viability After Renorrhaphy
11.5.4 Other Indications for ICG in Robotic Renal Surgery and New Applications
11.6 Conclusions
References
12 3D Virtual Models and Augmented Reality for Robot-Assisted Partial Nephrectomy
12.1 Introduction
12.2 What is a 3D Model?
12.3 How to Create a 3D Model?
12.4 How to Review the 3D Models?
12.5 Applications of 3D Models for Robotic Partial Nephrectomy
12.5.1 Patient Counselling
12.5.2 Surgical Training
12.5.3 Surgical Planning
12.6 Surgical Navigation
12.7 Conclusions
References
13 Open Partial Nephrectomy: Current Status in the Minimally-Invasive Surgery Era
13.1 Indications
13.2 Technical Points
13.3 Open Versus Minimally-Invasive Partial Nephrectomy: Comparison of Oncological, Functional and Perioperative Outcomes
References
14 Decision-Making for Patients with Localized Renal Masses
References
15 Management of Localized Renal Masses: The European Association of Urology (EAU), American Urological Association (AUA) and American Society of Clinical Oncology (ASCO) Guidelines’ Perspective
References
16 Active Surveillance and Watchful Waiting in Renal Cancer
References
17 Ablative Therapies in Renal Cancer
17.1 Radiofrequency
17.2 Microwave Ablation
17.3 Cryoablation
17.4 Ablation Planning
17.5 Complications
17.6 Ablative Techniques Versus Surgery
References
18 Open Radical Nephrectomy
18.1 Surgical Technique
18.2 Flank Approach
18.3 Anterior Subcostal Approach
18.4 Thoracoabdominal Approach
References
19 Transperitoneal and Retroperitoneal Port Placement
19.1 Introduction
19.2 General Principles of Pneumoperitoneum Obtaining
19.2.1 Closed Technique and Creating Pneumoperitoneum
19.2.2 Open (Hasson) Technique
19.2.3 Optical Technique
19.3 Robotic Nephrectomy: Transperitoneal Approach
19.3.1 Operative Room Setup and Patient Positioning
19.3.2 Port Placement for Da Vinci Xi®
19.3.3 Port Placement for Da Vinci Si®
19.3.4 Robot Docking
19.4 Robotic Nephrectomy: Retroperitoneal Approach
19.4.1 Operative Room Setup and Patient Positioning
19.4.2 Retroperitoneal Access
19.4.3 Trocar Placement for Da Vinci Si®
19.4.4 Trocar Placement for Da Vinci Xi®
19.4.5 Robot Docking
19.5 Complications of the Port Placement
References
20 Robot Assisted Laparoscopy for Renal Cancer: Transperitoneal Versus Retroperitoneal Approach
20.1 Introduction
20.1.1 Indications: Transperitoneal and Retroperitoneal Robotic Surgery
20.2 Transperitoneal Indications
20.2.1 Larger Working Volume
20.2.2 Stage 3 Tumours
20.2.3 Anterior and Lower Pole Tumours
20.2.4 Posterior Tumours
20.2.5 Prior Surgeries and Percutaneous Procedures
20.2.6 Xanthogranulomatous Pyelonephritis
20.3 Retroperitoneal Indications
20.3.1 Surgeon Experience
20.3.2 Small Tumours (Stage T1-2)
20.3.3 Posterior Tumours
20.3.4 Anterior Tumours
20.3.5 Prior Major Abdominal Surgery
20.4 Technical Considerations: Transperitoneal and Retroperitoneal Robotic Surgery
20.4.1 Positioning and Docking
20.4.2 Robotic Platform and Ports
20.4.3 Obesity
20.4.4 Paediatric and Petite Patients
20.4.5 Laterality of Lesion
20.4.6 Redo Surgeries
20.5 Outcomes of Robotic Transperitoneal Versus Robotic Retroperitoneal Approaches
20.6 Intraoperative Outcomes
20.6.1 Operative Time
20.6.2 Estimated Blood Loss and Warm Ischemia Time
20.6.3 Operative Duration
20.6.4 Intraoperative Injuries
20.7 Postoperative Outcomes
20.7.1 Length of Hospital Stay
20.7.2 Post-Operative Renal Function
20.7.3 Post-Operative Complications
20.7.4 Post-Operative Intraabdominal Adhesions
20.8 Oncological Outcomes
20.8.1 Local and Distant Recurrence
20.8.2 Port Site Recurrence and Crepitus
20.9 Conclusions
References
21 Robotic Radical Nephrectomy
References
22 Preoperative Setting-Up of Patients Undergoing Robotic Inferior Vena Cava Thrombectomy
22.1 Introduction
22.2 Patient Selection
22.2.1 Clinical Staging
22.3 Patient Evaluation
22.3.1 Imaging
22.3.2 Additional Pertinent Testing
22.4 Preoperative Procedures
22.4.1 Angioembolization
22.4.2 Placement of IVC Filter
22.5 Preoperative Considerations
22.5.1 Preoperative Medical Therapy
22.5.2 Anti-coagulation
22.5.3 Consultations
References
23 Renal Cell Carcinoma with Tumor Thrombus: A Review of Relevant Anatomy and Surgical Techniques for the General Urologist
23.1 Introduction
23.2 Anatomy of the IVC and Tributaries Related to Renal Surgery
23.3 Kidney and Liver Venous Drainage and Anatomy
23.4 Supra-Diaphragmatic Vena Cava Anatomical Relations
23.5 Key Retroperitoneal Anatomical Landmarks Relevant to Renal Surgery (Diaphragm, Cysterna Chili, Lymph Nodes, Pleura)
23.6 Modern Imaging, Role of CT, MRI, and US in RCC with Vein Thrombus
23.7 Surgical Approaches
23.8 Liver Transplant Techniques
23.9 Extracorporeal Circulation and Combined Cardiothoracic Approaches
23.10 Robotic RCC Thrombus Removal
References
24 Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma
24.1 Introduction
24.2 Evidence for Cytoreductive Nephrectomy in the New Era of Systemic Therapy
24.3 Patient Selection for Cytoreductive Nephrectomy
24.4 Minimally Invasive Surgery for Cytoreductive Nephrectomy
24.5 Metastasectomy
24.6 Conclusions
References