Robotic-assisted Laparoscopic Renal Artery Aneurysm Repair With Selective Arterial Clamping
CUA Online Library. Samarasekera D. 06/22/13; 31456; UP-77
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Abstract
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Introduction & Objective: Renal artery aneurysms represent a rare entity with an incidence of 0.09-0.3%. Endovascular management has largely replaced surgery when treatment is indicated. However not all aneurysms are amenable to this technique due to location, size, and patient factors. As a result, open surgery was the gold standard for definitive repair. However advancements in laparoscopy have lead to the development of minimally invasive approaches. The DaVinciTM(Intuitive, Sunnyvale CA) surgical platform facilitates complex resection and suturing when compared to pure laparoscopy. We present our technique of robotic-assisted renal artery aneurysm repair.
Methods: A 35 year old male presented with right-sided flank pain and was found to have a 1.6 cm saccular right renal artery aneurysm. He was seen by an interventional radiologist who felt it was not amenable to endovascular repair, and was referred for surgery. The patient’s BMI was 23.39 kg/m2, and blood pressure was 119/80 mmHg. Serum Cr was 0.88 mg/dL and eGFR was >60 mL/min/1.73m2. A “three-armed” robotic approach was used with two 8 mm robotic ports, a 12 mm camera port, a 12 mm assistant port, and a 5 mm port for the liver retractor. The hilar and segmental vessels were dissected, to allow for selective clamping and avoidance of global ischemia during repair.
Results: Operative time was 4 hours and estimated blood loss was 200 cc. Regional warm ischemia time was 44 minutes, and there were no intra-operative or post-operative complications. Serum Cr and Hb on discharge were 0.8 mg/dL and 11.9 g/dL, respectively. Renogram at 3 months post-op showed excellent perfusion and a split function of 45.4% for the right kidney.
Conclusion: Robotic-assisted renal artery aneurysm repair is technically feasible. Morbidity and short-term functional outcomes are favorable. The use of the DaVinci surgical platform facilitates complex resection and suturing. Additionally, hilar dissection of segmental vessels facilitates selective clamping and avoidance of global renal ischemia.
Methods: A 35 year old male presented with right-sided flank pain and was found to have a 1.6 cm saccular right renal artery aneurysm. He was seen by an interventional radiologist who felt it was not amenable to endovascular repair, and was referred for surgery. The patient’s BMI was 23.39 kg/m2, and blood pressure was 119/80 mmHg. Serum Cr was 0.88 mg/dL and eGFR was >60 mL/min/1.73m2. A “three-armed” robotic approach was used with two 8 mm robotic ports, a 12 mm camera port, a 12 mm assistant port, and a 5 mm port for the liver retractor. The hilar and segmental vessels were dissected, to allow for selective clamping and avoidance of global ischemia during repair.
Results: Operative time was 4 hours and estimated blood loss was 200 cc. Regional warm ischemia time was 44 minutes, and there were no intra-operative or post-operative complications. Serum Cr and Hb on discharge were 0.8 mg/dL and 11.9 g/dL, respectively. Renogram at 3 months post-op showed excellent perfusion and a split function of 45.4% for the right kidney.
Conclusion: Robotic-assisted renal artery aneurysm repair is technically feasible. Morbidity and short-term functional outcomes are favorable. The use of the DaVinci surgical platform facilitates complex resection and suturing. Additionally, hilar dissection of segmental vessels facilitates selective clamping and avoidance of global renal ischemia.
Introduction & Objective: Renal artery aneurysms represent a rare entity with an incidence of 0.09-0.3%. Endovascular management has largely replaced surgery when treatment is indicated. However not all aneurysms are amenable to this technique due to location, size, and patient factors. As a result, open surgery was the gold standard for definitive repair. However advancements in laparoscopy have lead to the development of minimally invasive approaches. The DaVinciTM(Intuitive, Sunnyvale CA) surgical platform facilitates complex resection and suturing when compared to pure laparoscopy. We present our technique of robotic-assisted renal artery aneurysm repair.
Methods: A 35 year old male presented with right-sided flank pain and was found to have a 1.6 cm saccular right renal artery aneurysm. He was seen by an interventional radiologist who felt it was not amenable to endovascular repair, and was referred for surgery. The patient’s BMI was 23.39 kg/m2, and blood pressure was 119/80 mmHg. Serum Cr was 0.88 mg/dL and eGFR was >60 mL/min/1.73m2. A “three-armed” robotic approach was used with two 8 mm robotic ports, a 12 mm camera port, a 12 mm assistant port, and a 5 mm port for the liver retractor. The hilar and segmental vessels were dissected, to allow for selective clamping and avoidance of global ischemia during repair.
Results: Operative time was 4 hours and estimated blood loss was 200 cc. Regional warm ischemia time was 44 minutes, and there were no intra-operative or post-operative complications. Serum Cr and Hb on discharge were 0.8 mg/dL and 11.9 g/dL, respectively. Renogram at 3 months post-op showed excellent perfusion and a split function of 45.4% for the right kidney.
Conclusion: Robotic-assisted renal artery aneurysm repair is technically feasible. Morbidity and short-term functional outcomes are favorable. The use of the DaVinci surgical platform facilitates complex resection and suturing. Additionally, hilar dissection of segmental vessels facilitates selective clamping and avoidance of global renal ischemia.
Methods: A 35 year old male presented with right-sided flank pain and was found to have a 1.6 cm saccular right renal artery aneurysm. He was seen by an interventional radiologist who felt it was not amenable to endovascular repair, and was referred for surgery. The patient’s BMI was 23.39 kg/m2, and blood pressure was 119/80 mmHg. Serum Cr was 0.88 mg/dL and eGFR was >60 mL/min/1.73m2. A “three-armed” robotic approach was used with two 8 mm robotic ports, a 12 mm camera port, a 12 mm assistant port, and a 5 mm port for the liver retractor. The hilar and segmental vessels were dissected, to allow for selective clamping and avoidance of global ischemia during repair.
Results: Operative time was 4 hours and estimated blood loss was 200 cc. Regional warm ischemia time was 44 minutes, and there were no intra-operative or post-operative complications. Serum Cr and Hb on discharge were 0.8 mg/dL and 11.9 g/dL, respectively. Renogram at 3 months post-op showed excellent perfusion and a split function of 45.4% for the right kidney.
Conclusion: Robotic-assisted renal artery aneurysm repair is technically feasible. Morbidity and short-term functional outcomes are favorable. The use of the DaVinci surgical platform facilitates complex resection and suturing. Additionally, hilar dissection of segmental vessels facilitates selective clamping and avoidance of global renal ischemia.
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