PURPOSE: To describe a new technique for the right template RPLND able to offer a optimal exposure of surgical field, minimal bowel mobilization, and enabling a more "openlike dissection" technique. METHODS: We used a variant of the aortic lymphadenectomy previously described by Magrina et al. for gynecologic malignancies. The patient is placed in a steep Trendelenburg, supine position and the robot column, at the patient's head. The trocar position is specular to that used for RALP and known for generating no collision between the robotic arms. The node dissection of the right template, including laterocaval and interaortocaval nodes, is carried out like in the "open" split-and-roll technique. RESULTS: The docking time was 15', the console time was 192', the blood loss was irrelevant (50 mL), and the number of retrieved nodes was 19. The exposure of the infrarenal vein region of the operatory field resulted optimal without extensive bowel mobilization. The dissection perfectly mimicked the open procedure. CONCLUSIONS: As the left RPLND template includes only para-aortic lymph nodes, the left full flank position seems adequate. On the contrary, it enables a less good exposure of the more extensive right RPLND template, requiring excellent robotic surgical skills to overpass related deadlocks. On the contrary, our technique allows adequate and safe performance of the robotic. It enables a good view of the retroperitoneal space reducing the need of bowel mobilization to obtain a good exposure of the operatory field. Moreover, the patient's supine position makes the procedure more similar to the open technique.
PURPOSE: To describe a new technique for the right template RPLND able to offer a optimal exposure of surgical field, minimal bowel mobilization, and enabling a more "openlike dissection" technique. METHODS: We used a variant of the aortic lymphadenectomy previously described by Magrina et al. for gynecologic malignancies. The patient is placed in a steep Trendelenburg, supine position and the robot column, at the patient's head. The trocar position is specular to that used for RALP and known for generating no collision between the robotic arms. The node dissection of the right template, including laterocaval and interaortocaval nodes, is carried out like in the "open" split-and-roll technique. RESULTS: The docking time was 15', the console time was 192', the blood loss was irrelevant (50 mL), and the number of retrieved nodes was 19. The exposure of the infrarenal vein region of the operatory field resulted optimal without extensive bowel mobilization. The dissection perfectly mimicked the open procedure. CONCLUSIONS: As the left RPLND template includes only para-aortic lymph nodes, the left full flank position seems adequate. On the contrary, it enables a less good exposure of the more extensive right RPLND template, requiring excellent robotic surgical skills to overpass related deadlocks. On the contrary, our technique allows adequate and safe performance of the robotic. It enables a good view of the retroperitoneal space reducing the need of bowel mobilization to obtain a good exposure of the operatory field. Moreover, the patient's supine position makes the procedure more similar to the open technique.
Authors: Michael W Gardner; Timur M Roytman; Cathy Chen; Steven B Brandes; Adam S Kibel; Robert L Grubb; Sam B Bhayani; Robert S Figenshau Journal: J Endourol Date: 2011-09-21 Impact factor: 2.942
Authors: Nicholas G Cost; Daniel G DaJusta; Candace F Granberg; Raven M Cooksey; Carrie E Laborde; Jonathan E Wickiser; Patricio C Gargollo Journal: J Endourol Date: 2012-01-25 Impact factor: 2.942
Authors: Octavio A Castillo; Juan Manuel Alvarez; Gonzalo Vitagliano; David Ramírez; Manuel Díaz; Rafael Sánchez-Salas Journal: Arch Esp Urol Date: 2007 Jan-Feb Impact factor: 0.436
Authors: Javier F Magrina; Jaime B Long; Rosanne M Kho; Dobie L Giles; Regina P Montero; Paul M Magtibay Journal: Int J Gynecol Cancer Date: 2010-01 Impact factor: 3.437