Single-port robot-assisted retroperitoneal surgery: A feasible approach

• Published in: Actas urológicas españolas (English ed.) 2022-12, Vol.46 (10), p.653-657
• Main Authors: Vazquez-Martul, D., Ponce Diaz-Reixa, J.L., Barbagelata-Lopez, A., Chantada-Abal, V.
• Format: Article
• Language: English
• Subjects: Adrenal; LESS; Retroperitoneal; Robotic surgery; Single port; Single site
• ISSN: 2173-5786; 2173-5786
• DOI: 10.1016/j.acuroe.2022.07.004

The concept of surgery through a single incision has been pursued in the field of minimal invasion for the treatment of different pathologies. This, added to a retroperitoneal approach, implies less aggression for the patient at different levels. We describe the first cases of single-port robot-assisted retroperitoneal surgery (SP-RARS) in our country using the da Vinci Xi® system. We present two cases of patients with right adrenal masses larger than 4 cm. The first case was a 55-year-old woman with an incidental diagnosis of angiomyolipoma, and the second case was a 62-year-old man with a non-functioning adrenal adenoma. Both cases were operated through a single 4-cm subcostal incision using the da Vinci Xi® system, annulling arm 4 without reallocating laterality on the surgeon’s console. Both surgeries were performed with console times of 75 and 150 min, respectively, with access and docking times below 30 min. Bleeding was less than 100 cc in both surgeries without the need to make accessory incisions or leave a drainage tube. The surgical specimens were removed through the same initial incision without the need for enlargement. Postoperative intravenous analgesia was not necessary in any case (VAS 0) and hospital stay was less than 24 h in both patients without reporting any complications. SP-RARS is a feasible approach using the da Vinci Xi® system. La cirugía mediante una única incisión ha sido un concepto perseguido en el campo de la mínima invasión para el tratamiento de diferentes patologías. Este concepto sumado a un abordaje retroperitoneal puede suponer una disminución de la agresión al paciente a diferentes niveles. Describimos los primeros casos de cirugía retroperitoneal asistida por robot mediante puerto único (SP-RARS). Presentamos dos casos de pacientes con masas suprarrenales derechas con un tamaño superior a 4 cm. El primer caso se trataba de una mujer de 55 años con diagnóstico incidental de angiomiolipoma y en el segundo caso un varón de 62 años con adenoma suprarrenal no funcionante. Ambos casos se operaron a través de una única incisión subcostal de 4 cm mediante el sistema da Vinci Xi®, anulando el brazo 4 sin realizar reasignaciones de lateralidad en consola. Ambas cirugías se realizaron con tiempos de consola de 75 y 150 minutos respectivamente con tiempos de acceso y acoplamiento robótico inferiores a 30 minutos. El sangrado fue inferior a 100 cc en ambas cirugías sin necesidad de realizar incisiones accesorias o dejar tubo de