Presented by: Fahad Sheckley MD
Hackensack University Medical Center

Introduction

Since its FDA approval in 2018, Intuitive Surgical DaVinci Single Port (SP) robotic platform has been a successfully used technology for multiple urological procedures. Single-port robot-assisted partial nephrectomy (SP-RAPN) was performed with a transperitoneal peri-umbilical incision or a subcostal incision for the retroperitoneal approach. An oblique lower quadrant incision perpendicular to the spoinoumbilical line, termed Single Port Ahmed Modification (SPAM), was used in this study. The purpose is to share our early intraoperative and perioperative outcomes and potential benefits for performing a successful incision for SPRAPN, especially in performing either a trans- or retroperitoneal approach through this incision, and to ease the transition to the retroperitoneum for a beginner.

Materials

This study is a prospective review of 78 SP Partial Nephrectomy cases between 03/2021 and 01/2023 by an experienced robotic surgeon. A single 2-3 cm oblique incision parallel to the external oblique muscle, one-third of the distance between the iliac crest and umbilicus, was used to insert the multichannel port to perform the RAPN. We extracted intra- and perioperative data of these patients to share the outcomes of this approach.

Results

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SPRAPN was successfully completed in 78 patients (38 females and 40 males) without conversion to open or laparoscopic techniques. The mean age was 61.2 ± 12.1 years. The mean tumor size was 3.0 ± 1.2 cm, 43 were right-sided masses, and 35 were left-sided. The R.E.N.A.L Nephrometry score ranged from (4-11) with an average of 7.0 ± 1.9. Average operating room time was 90.5 ± 24.6 min, estimated blood loss was 88.3 ± 134 ml and length of stay of 1.07 ± 0.7 days. 40/78 cases required clamping of the renal artery with average warm ischemia time 19.4 ± 6.7 min in patients who underwent clamping. No complications in all of 78 patients.

Conclusion

This study demonstrates the feasibility and reproducibility of SP-RAPN using SPAM incision. This incision provides a standardized approach for surgeons to transition to the retroperitoneal approach using the SP platform.

Funding

N/A

Lead Authors

Mutahar Ahmed, MD
Hackensack University Medical Center

Co-Authors

Jennifer Nguyen,
Hackensack University Medical Center

Mubashir Billah, MD
Hackensack University Medical Center