ABSTRACT Introduction A renorrhaphy technique which is effective for hemostasis but does not place undue tension on the branch vessels of the renal sinus remains one of the challenging steps after hilar tumor resection during robotic partial nephrectomy (RPN). The published V-hilar suture (VHS) technique is one option for reconstruction after an RPN involving the hilum. The objective of this video is to show a novel renorrhaphy technique, Hilar Parenchymal Oversew that has been effective for such cases. Materials and Methods We present two cases of RPN for renal hilar tumors. The first case depicts use of the VHS renorrhaphy technique for a tumor that abuts the renal hilum along 20% of its diameter. The second case demonstrates tumor resection and reconstruction for a tumor that has >50% involvement of the hilum along its diameter. After tumor resection, individual sinus vessels can be selectively oversewn with 2-0 Vicryl suture on SH needle. The remaining exposed parenchyma is controlled using the Hilar Parenchymal Oversew technique with a #0 Vicryl on CT-1 needle. Results For the Hilar Parenchymal Oversew surgery operative time was 225 min, estimated blood loss was 140 ml, warm ischemia time was 19 minutes, and there were no intraoperative complications. Pathology was consistent with clear cell renal cancer with negative margins. Conclusion Robotic partial nephrectomy with the Hilar Parenchymal Oversew technique is a good alternative to VHS renorrhaphy in the management of renal hilar tumors “bulging” into the renal sinus with >50% of the tumor diameter abutting the hilum.

PURPOSE: To report our initial experiences with laparoscopic partial cystectomy for urachal and bladder malignancy. MATERIALS AND METHODS: Between March 2002 and October 2004, laparoscopic partial cystectomy was performed in 6 cases at 3 institutions; 3 cases were urachal adenocarcinomas and the remaining 3 cases were bladder transitional cell carcinomas. All patients were male, with a median age of 55 years (45-72 years). Gross hematuria was the presenting symptom in all patients, and diagnosis was established with trans-urethral resection bladder tumor in 2 patients and by means of cystoscopic biopsy in the remaining 4 patients. Laparoscopic partial cystectomy was performed using the transperitoneal approach under cystoscopic guidance. In each case, the surgical specimen was removed intact entrapped in an impermeable bag. One patient with para-ureteral diverticulum transitional cell carcinoma required concomitant ureteral reimplantation. RESULTS: All six procedures were completed laparoscopically without open conversion. The median operating time was 110 minutes (90-220) with a median estimated blood loss of 70 mL (50-100). Frozen section evaluations of bladder margins were routinely obtained and were negative for cancer in all cases. The median hospital stay was 2.5 days (2-4) and the duration of catheterization was 7 days. There were no intraoperative or postoperative complications. Final histopathology confirmed urachal adenocarcinoma in 3 cases and bladder transitional cell carcinoma in 3 cases. At a median follow-up of 28.5 months (range: 26 to 44 months), there was no evidence of recurrent disease as evidenced by radiologic or cystoscopic evaluation. CONCLUSIONS: Laparoscopic partial cystectomy in carefully selected patients with urachal and bladder cancer is feasible and safe, offering a promising and minimally invasive alternative for these patients.

Robotic assisted radical prostatectomy (RARP) is gaining acceptance and popularity among urologists all over the world. Early oncologic and functional results are encouraging. In this manuscript, we describe in detail both approaches for RARP and show the results of the robotic surgery program with over 300 RARP performed at our institution.

Objectives: The last decade has seen tremendous growth of surgical robotics. Popularized for radical prostatectomy, robotic techniques are now increasingly being applied to radical cystectomy. Herein, we review the development and current status of robotic radical cystectomy (RRC) in contemporary urological practice. Methods: Between 1995 and 2007 published literature was reviewed using the National Library of Medicine database and the following key words: robotic, robot-assisted, laparoscopic and cystectomy. Since the first report in 2003, nine published original reports were identified. These were evaluated with regards to the technique, advantages and disadvantages, perioperative and oncological outcomes. Our initial experience, as yet unpublished, is also described. Results: At this writing, all published papers on RRC are based on small number of patients with short-term follow-up. Nevertheless, they have demonstrated the technical feasibility of RRC with encouraging perioperative outcomes. Compared to open radical cystectomy (ORC), RRC appears to be associated with decreased blood loss, hospital stay and analgesic requirement. These advantages are also found with laparoscopic radical cystectomy (LRC) and are a function of the minimally invasive approach. The operating time is longer, markedly so when the bowel work is performed intracorporeally. Conclusions: RRC is in evolution. Technical feasibility has been demonstrated. Initial perioperative outcomes are encouraging. Oncological outcomes are awaited to identify the role of RRC in the management of bladder cancer. Multi-center prospective randomized trials comparing ORC with RRC and LRC are necessary.

Objetivos: En la última década hemos visto un tremendo crecimiento en la implantacion y desarrollo de los robots quirúrgicos. Popularizados por la prostatectomía radical, las técnicas robóticas están siendo, en la actualidad, muy aplicadas en la cistectomía radical. Trataremos aquí de revisar el desarrollo y estado actual de la cistectomía radical robótica (CRR) en la práctica contemporánea de la urología. Métodos: Se ha revisado toda la literatura publicada, entre 1995 y 2007, en la base de datos de la Biblioteca Nacional de Medicina (MEDLINE) utilizando las palabras clave: robótica, asistido por robot, laparoscópica y cistectomía. Desde el primer trabajo en 2003, se han encontrado 9 originales publicados. Se valoraron con respecto a la técnica, ventajas y desventajas perioperatorias y resultados oncológicos. Describimos asimismo nuestra experiencia inicial, aún no publicada. Resultados: En este momento todos los artículos publicados sobre la CRR se basan en un número pequeño de pacientes con seguimientos a corto plazo. No obstante, demuestran la viabilidad de la CRR con resultados perioperatorios esperanzadores. Comparada con la cistectomía radical abierta (CRA), la CRR parece estar asociada con menor pérdida de sangre, estancia hospitalaria y necesidades analgésicas. Estas ventajas se encuentran asimismo en la cistectomía radical laparoscópica (CRL) y son una función del abordaje mínimamente invasivo. El tiempo quirúrgico es mayor, de forma considerable cuando el tiempo intestinal se realiza de manera intracorpórea. Conclusiones: La cistectomía radical robótica está en evolución. La viabilidad técnica ha sido demostrada. Los resultados perioperatorios iniciales son prometedores. Los resultados oncológicos esperan identificar el papel de la misma en el manejo del cáncer de vejiga. Se necesitan ensayos prospectivos y aleatorizados comparando la CRA con la CRR y la CRL.

OBJETIVO: Relatar os resultados oncológicos após 5 anos de seguimento em pacientes submetidos a nefrectomia radical laparoscópica para tratamento do câncer renal, comparando esses com os resultados obtidos com um grupo de pacientes submetidos a nefrectomia radical aberta. MÉTODOS: Foram analisadas retrospectivamente as informações obtidas de 88 pacientes submetidos a nefrectomia radical para o tratamento do carcinoma renal realizadas previamente a Janeiro de 2000. Destes pacientes, 45 foram tratados com nefrectomia radical laparoscópica e 43 com nefrectomia radical aberta. Foram incluídos pacientes com tumores localizados com tamanho máximo de 15 cm, sem adenopatia ou sinal de envolvimento de veia renal na avaliação radiologica pré-operatória. As informações sobre o seguimento dos pacientes foram obtidas a partir de prontuários, laudos de exames radiológicos e ligações telefônicas para pacientes e/ou familiares. O seguimento foi calculado desde a data da cirurgia até a última consulta médica ou data de falecimento. RESULTADOS: Todos os procedimentos laparoscópicos foram realizados sem conversão para a técnica aberta. O tamanho médio tumoral foi de 5.8 e. 6.2 cm (P=0.44), perda sanguínea estimada de 183 e. 461 mL (P=0.004), e tempo operatório de 2.8 e. 3.7 horas (P<0.001) , respectivamente para os grupos nefrectomia radical laparoscópica e nefrectomia radical aberta. O tempo de seguimento médio foi de 5 anos para o grupo nefrectomia radical laparoscópica e 6 anos para o grupo nefrectomia radical aberta. A sobrevida global após 5 anos foi de 81% e 79% (P=0.47), e a sobrevida específica para cancer foi de 90% e 92% (P=0.70), para os grupos nefrectomia radical laparoscópica e nefrectomia radical aberta respectivamente. CONCLUSÃO: A nefrectomia radical laparoscópica tem resultados oncológicos em 5 anos similares a técnica convencional aberta.

PURPOSE: To report the 5-year oncological outcomes of patients undergoing laparoscopic radical nephrectomy for renal cancer compared to a cohort of patients undergoing open radical nephrectomy. METHODS: We retrospectively analyzed the data of 88 patients undergoing radical nephrectomy for renal cell carcinoma prior to January 2000. Of these, 45 patients underwent laparoscopic radical nephrectomy, and 43 patients underwent open radical nephrectomy. Inclusion criteria comprised clinically organ-confined tumors of 15 cm or less in size without concomitant lymphadenopathy or vena cava thrombus. Oncological follow-up data were obtained from charts, radiological reports, and phone calls to patients or their families, and were calculated from the date of surgery to the date of last appointment with physician or date of death. RESULTS: All laparoscopic procedures were completed without open conversion. On comparing the laparoscopic radical nephrectomy and open radical nephrectomy groups, mean tumor size was 5. 8 vs 6.2 cm (P = . 44), mean blood loss was 183 vs 461 mL (P = . 004), and mean operative time was 2.8 vs 3.7 hrs (P < . 001). Over a mean follow-up of 5 years in the laparoscopic radical nephrectomy group and 6 years in the open radical nephrectomy group, the overall survival was 81% vs 79% (P = . 47), and cancer-specific survival was 90% vs 92% (P = . 70) , respectively. CONCLUSIONS: Laparoscopic radical nephrectomy for renal cancer confers equivalent 5-year oncological outcomes to those of open surgery.