Robotic-assisted Laparoscopic Reconstruction of the Upper Urinary Tract: Tips and Tricks

Thiel, David D.; Leroy, Timothy J.; Winfield, Howard N.; Igel, Todd C.

doi:10.1016/j.urology.2009.10.036

Cited by 10 publications

(9 citation statements)

References 17 publications

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“…In obese patients, the assistant port may need to be moved to the subxiphoid region (square) or the midline (triangle) (assuming that the robotic ports have been moved laterally). (Figure adapted from [5] with permissions from the puplisher). …”

Section: Figurementioning

confidence: 99%

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Navigating the Difficult Robotic Assisted Pyeloplasty

Thiel

2012

ISRN Urology

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Pyeloplasty is the gold standard therapy for ureteropelvic junction obstruction. Robotic assisted pyeloplasty has been widely adopted by urologists with and without prior laparoscopic pyeloplasty experience. However, difficult situations encountered during robotic assisted pyeloplasty can significantly add to the difficulty of the operation. This paper provides tips for patient positioning, port placement, robot docking, and intraoperative dissection and repair in patients with the difficult situations of obesity, large floppy liver, difficult to reflect colon (transmesenteric pyeloplasty), crossing vessels, large calculi, and previous attempts at ureteropelvic junction repair. Techniques presented in this paper may aid in the successful completion of robotic assisted pyeloplasty in the face of the difficult situations noted above.

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Section: Figurementioning

confidence: 99%

“…This creates a 60 degree angle with the patient's spine and helps instrument mobility in the upper quadrants. (Figure adapted from [5] with permissions from the publisher.) …”

Section: Figurementioning

confidence: 99%

Navigating the Difficult Robotic Assisted Pyeloplasty

Thiel

2012

ISRN Urology

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“…2). 10 An extra 5-mm port may be needed for liver retraction. Ports may need to be shifted laterally in obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…All ports should be one fist breadth away from each other to provide optimal robotic arm working space. 10 The assistant port was placed in the supra-pubic midline, but the assistant port location may vary based on body habitus. The assistant port may need to be placed in the contra-lateral midline in obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…This is best accomplished in some cases with purely laparoscopic techniques. 10 Intracorporeal suturing remains the limiting factor for widespread use of laparoscopy to treat conditions requiring complex reconstruction. 13 We utilized the da Vinci robot for reconstruction secondary to the aid and precision it provides for intracoporeal suturing.…”

Section: Discussionmentioning

confidence: 99%

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Robot-Assisted Laparoscopic Reconstruction of Retrocaval Ureter: Description and Video of Technique

Leroy

Thiel

Igel

2011

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Ureteral obstruction secondary to retrocaval ureter is rarely reported in the urologic literature. Symptomatic retrocaval ureters usually present in the 3rd and 4th decade of life. Standard treatment involves ureteroureterostomy approximating the ureter anterior to the vena cava. We describe the initial presentation, imaging, port placement, and operative technique including video presentation of a robot-assisted laparoscopic repair of a retrocaval ureter.

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