Robotic Radical Nephrectomy – Transperitoneal approach
- Patient positioning
- Trocar placement
- Final position of patient
- Preparation of operative field
After placing a urinary catheter, and under general anesthesia, the patient is placed in a lateral position (with the side to be operated upon in the superior position). The bony prominences of the lower limbs protected with a foam support. The patient is securely strapped to the operating table, and the table is broken at a the umbilical level to a 10-15°. The upper limbs are placed in arm boards, at the appropriate angles (100-110° towards the head). Pressure points are generously padded to prevent nerve compression. Back supports are placed in the upper thoracic area (scapular area) and gluteal area.
For left sided surgery (Radical nephrectomy / Partial nephrectomy / Pyeloplasty)
The camera is inserted on the anterior axillary line, and two robotic two robotic working trocars are placed on the midclavicular line . A fourth robotic trocar is positioned on the lateral margin of the rectus muscle near the pubic bone. The assistant’s conventional trocar is placed on a paraumbilical site.
For right sided surgery (Radical nephrectomy / Partial nephrectomy / Pyeloplasty)
For the right-sided procedure, the robotic and assistant trocar positions remain the same, with an additional conventional trocar placed below the xiphoid for liver retraction.
Positioning of trocars may have to be altered in obese patients, in order to minimize the distance between the trocar sites and the surgical field.
Dissection of Toldt’s line from colonic flexure to iliac vessels
On the left side the spleen must be completely mobilized
Preparation of the renal hilum
Once preparation of the kidney’s vessels is complete, they are ligated en-bloc with a linear stapler (EndoGIA)
The specimen is placed in a laparoscopic bag and retrieved through an extended incision