Society of Robotic Surgery 2017: Concepts for Port Placement for Renal Surgery

Miami, Florida USA (UroToday.com) Akshay Bhandari, MD, Mt. Sinai Medical Center in Miami, Florida, discussed the use of port placement in renal surgery. Specifically, he discussed port placement in upper tract surgery. Patients are often put in the modified flank position, with the table tilted to determine how acutely in the flank position the surgeon wishes the patient to be situated. Orthopedic hip may help position and fix the individual to the table. Modifications include eliminating bean bags or kidney rests, but flex of the bed may be permitted. A key factor is to always think about the hilum when deciding where to place the ports. After locating the camera port, explore the abdomen, find the kidney, and place the remaining ports, taking external clashing into account (includes assistant port placement). Keep it simple, and think about positioning remaining ports as one would for a robotic prostatectomy. If using the Xi, you can place the ports along the paramedian line with at least one handbreadth between each port. If using the Si, then attempt a baseball-diamond approach to the hilum with assistant ports in between as needed (right side-5 mm port for liver retraction). Use of a 15 mm assistant port is preferred for specimen extraction. This alignment may be used for upper tract as well as nephrectomy-alone cases, but no redocking is needed. Regarding adrenalectomies and pyeloplasties, the fourth arm is not necessarily needed. Advanced applications include retroperitoneal lymph node dissection and inferior vena cava thrombectomy. Single-port placement has been explored with GelPOINT.

Presented By: Akshay Bhandari, MD, Mt. Sinai Medical Center, Miami, Florida

Contributed by Stephen B. Williams, MD, Assistant Professor, The University of Texas Medical Branch at Galveston, Galveston, TX

at the 2017 Society of Robotic Surgery - February 24 - 26, 2017 – Miami, Florida USA

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