Utility of a 3 mm Bipolar Instrument in Laparoscopic Renal Surgery Using the Senhance Robotic System

摘要

We report our initial experience and the utility of 3 mm bipolar forceps in laparoscopic renal surgery using the Senhance robotic system. We performed laparoscopic nephroureterectomy for upper tract urothelial carcinoma in two patients: an 80-year-old female with a left renal pelvic tumor and an 80-year-old male with a right ureteral tumor. Both surgeries were successfully completed without conversion to conventional laparoscopic surgery or laparotomy. The console times for the procedures were 101 and 108 minutes, with estimated blood losses of 5 and 50 milliliters, respectively. The postoperative courses were uncomplicated, with histopathological examinations confirming high-grade urothelial carcinoma with negative surgical margins in both patients. The 3 mm Maryland bipolar instrument was able to grasp membranes with sufficient gentleness and precision. The relatively narrow diameter of the shaft posed a challenge in terms of shaft strength; however, it did not deflect even when it was used to lift the kidney, indicating sufficient robustness. When utilized in the cutting mode, the incision capacity of the 3 mm Maryland bipolar instrument was higher than that of the 5 mm instrument, which allowed for expedient and precise incision. Since only the tissue held by the forceps was incised, it was possible to perform a safe incision even in areas near blood vessels and other organs. Although the tip of the 3 mm Maryland instrument is more sharply pointed than that of the 5 mm instrument, no tissue damage was observed even when the 3 mm instrument was used for blunt dissection. Our initial results suggest that the 3 mm Maryland bipolar instrument is efficacious for performing laparoscopic renal surgery. The instrument may be suitable for a range of surgical procedures in laparoscopic renal surgery using the Senhance system. Further studies are necessary to establish the role and effectiveness of this instrument in broader clinical applications.