Robotic Nephrectomy

Advanced robotic technology has previously been utilized for nephrectomy in clinical and experimental studies (5,10,16). Bowersox and Cornum initially evaluated a prototype master-slave robotic system for open nephrectomy, cystotomy closures, and ureteroureterostomies (16). Using the experimental system, all procedures were successful, and no intraoperative complications were encountered. Prolonged operative times were one disadvantage suggested by the authors for the experimental robotic system. Using the Zeus robotic system, Gill et al. first reported feasibility of laparoscopic telero-botic nephrectomy and adrenalectomy in the animal model (10). In the study, the performance of standard laparoscopic nephrectomy and adrenalectomy was compared to that of the corresponding telerobotic procedures in five farm pigs. The robot-assisted techniques required longer operative times, but the adequacy of surgical dissection and blood loss were equivalent.

The initial report of a telerobotic laparoscopic nephrectomy in humans was reported by Guillonneau et al. using the Zeus robotic system in 2001 (17). All steps of telerobotic nephrectomy were successfully performed with the robotic system. The procedure was safely performed with an operative time of 200 minutes and an estimated blood loss of <100 cc (17). To date, there remains a paucity of published results for robotic nephrectomy performed with either the da Vinci robotic system or the Zeus robotic system. Robotic nephrectomy has been slow to gain wide clinical acceptance, possibly related to the complexity of the procedure. The procedure requires that the assistant surgeon perform essential steps of the operation including ligation of the renal vessels and placing the specimen in the retrieval bag. Thus, the assistant surgeon must possess advanced laparoscopic skills to perform the procedure.

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