Robotic retroperitoneal approach in urological pathology – experience of Robotic Urologic Surgery Center Cluj-Napoca, Romania

Calin Neiculescu, Nicolae Crisan, Zoltan Attila Mihaly, Victor Dan Ona, Carmen Lapusan and Ioan Coman

Robotic Surgery Center, Clinical County Hospital, Cluj-Napoca, Romania

Introduction& objectives:
This study wants to evaluate the implementation of retroperitoneal robotical approach in a highly experienced center in laparoscopy and lomboscopic surgical approach.

Matherial & method:
Between November 2009 – September 2011, 80 robotic assisted urologic surgeries were performed in our department, 25 of this by retroperitoneal approach: three simple nephrectomy, two partial nephrectomy, four adrenalectomy, 15 pyeloplasty and one nephropexy. We performed a particular surgical approach, which consisted of a triangle placing of the trocars and the placement of the robot at the patient’s head.

The retroperitoneal space was prepared in 10 minutes and the insertion of the four trocars took 17 minutes, with a 8 minutes docking. The operating time varied from 50 minutes for simple nephrectomy to 180 minutes for partial nephrectomy. None of the surgeries were converted. The blood loos was minimal. All of the patients recovered the intestinal transit in the first postoperatory day. The hospital lenghts of stay was 48 hours for simple nephrectomy and 5 days for partial nephrectomy. We use triangle placing of the trocars, placement of the robot at patient’s head and in this way we avoid conflict between the robot arms.

Although our surgical team has recently started learning and performing the robotic assisted surgery, our previous experience in laparoscopy and retroperitoneoscopy, the triangle arrangement of the trocars and the particular plasment of the robotic system facilitated the retroperitoneal robotic approach.