PD13-03 ROBOTIC ANATROPHIC NEPHROLITHOTOMY: IDEA, DEVELOPMENT, EXPLORATION, ASSESSMENT AND LONG-TERM MONITORING (IDEAL) PHASE 0 STUDY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2015PD13-03 ROBOTIC ANATROPHIC NEPHROLITHOTOMY: IDEA, DEVELOPMENT, EXPLORATION, ASSESSMENT AND LONG-TERM MONITORING (IDEAL) PHASE 0 STUDY Akshay Sood, Jay Rohde, Michael Van Winkle, Dean Assimos, Ashok Hemal, James Peabody, Mani Menon, and Khurshid Ghani Akshay SoodAkshay Sood , Jay RohdeJay Rohde , Michael Van WinkleMichael Van Winkle , Dean AssimosDean Assimos , Ashok HemalAshok Hemal , James PeabodyJames Peabody , Mani MenonMani Menon , and Khurshid GhaniKhurshid Ghani View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1067AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We undertook an Idea, Development, Exploration, Assessment and Long-term monitoring (IDEAL) Phase 0 study to evaluate the ability of robotic anatrophic nephrolithotomy (RANL) for removing staghorn calculi. Our aims were: 1, develop a reproducible in vitro stone surgery model; 2, evaluate the utility of Firefly™ (Intuitive Surgical Inc., CA) in identifying the anatrophic plane; 3, assess the feasibility of a novel technique of RANL. METHODS We performed two RANLs in anesthetized female pigs (∼20 kg). The robot was docked to the flank utilizing two robotic ports and a mini-GelPOINT (Applied Medical, CA). For creating the stone, low viscosity DenMat Precision material (DenMat Inc., CA) was injected into the renal pelvis through an incision in the renal pelvis, via a 14F Foley catheter (placed through the mini-GelPOINT). Following dissection of the anterior and posterior divisions of the renal artery, the posterior segment was clamped and 2 mg IV indocyanine green given to aid in identification of the anatrophic plane using near infra-red fluorescence (NIRF) imaging (Firefly). Next, the hilar vessels were clamped with RANL performed under warm and cold ischemia in cases 1 and 2, respectively. For cold ischemia, ice-slush was injected onto the kidney via syringes through the mini-GelPOINT. RESULTS Replica staghorn stones could be created reliably in both pigs (mean size 5.1 cm). DenMat resin material utilized was 45–50 cc; the material solidified within 2–3 minutes. Firefly aided in precise identification of the anatrophic plane (Fig a). In both cases, the replica stones were removed successfully in toto through the anatrophic incision (Fig b). The mean console time was 114 minutes. The warm and cold ischemic times were 36 and 33 minutes, respectively. Cold ischemia led to renal surface temperature of 15.4 °C. Both kidneys were closed successfully using two-layer sliding-clip renorrhaphy. Mean blood loss was 160 cc. CONCLUSIONS The stone model described can be utilized to investigate novel surgical modalities for stone disease. We have demonstrated for the first time that use of NIRF image-guidance accurately identifies the renal avascular plane, thus permitting a true anatrophic robotic approach for staghorn stones. IDEAL Phase 1 studies are needed to validate these findings. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e262-e263 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshay Sood More articles by this author Jay Rohde More articles by this author Michael Van Winkle More articles by this author Dean Assimos More articles by this author Ashok Hemal More articles by this author James Peabody More articles by this author Mani Menon More articles by this author Khurshid Ghani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...