Step-by-Step robotic heminephrectomy for duplicated renal collecting system
Homayoun Zargar1, Jihad H. Kaouk 1, Oktay Akca1, Riccardo Autorino1, Luis Felipe Brandao1, Humberto Laydner1, Jayram Krishnan1, Dinesh Samarasekera1, Georges P. Haber1, Robert J. Stein 1
1 Center for Laparoscopic and Robotic Surgery, Glickman Urologic & Kidney Institute, Cleveland Clinic
Introduction: A duplicated renal collecting system is a relatively common congenital anomaly rarely presenting in adults.
Int Braz J Urol. 2014; 40 (Video #12): 578-9
In this video by Zargar and colleagues from the Cleveland Clinic, the use of minimally invasive robotic surgery to perform an upper pole heminephrectomy for a non-functional renal segment is very nicely depicted. Clearly, the adoption of robotic minimally invasive surgery to the realm of renal sparing surgery is becoming common place at most academic and community centers internationally. The present video highlights that that this be accomplished in both the benign pathology and oncological setting to address an underlying clinical manifestation requiring surgical resection. Similarly, the authors of the present video have nicely depicted the surgical steps such as vascular control and renal parenchymal apposition techniques that can be employed in a number of surgical procedures and modalities. The impetus lies on us as a surgical community to only advocate such minimally invasive or other innovative surgical approaches only if they can consistently replicate the surgical outcomes of open surgery hence the gauntlet is passed to all of us to consider reproducing the present outcomes in a study setting before it can be recommended within our field. Like all facets of medicine and surgery, an evidence based approach is the standard to which we must strictly adhere to nevertheless, we need to continually strive to optimize our therapeutic outcomes.
Philippe E. Spiess, MD