Robotic Partial Nephrectomy
The robot-assisted surgical removal of a localized tumor from the kidney while maintaining the integrity and function of the remaining healthy renal tissue.
Surgical instruments
9 on this table — tap a photo to zoom, the name for its full card.
The case
Spark notes
The 30-second rundown — scan this outside the room.
- Assemble robotic trocars.
- Swap instruments as needed.
- Identify bleeders and control bleeding.
- Excise the tumor and use a robotic needle driver with suture loaded to help reconstruct.
- Remove the specimen with a bag in the abdomen.
- Close incisions using a mayo-hegar needle driver, straight mayo scissors, and adsons.
Walkthrough
What the surgeon does — and what to have in your hand before they ask.
Preparing for Surgery
Before the surgery begins, it is essential to assemble the robotic trocars, which are kept in the robot sets. The surgeon will use a regular camera, light cord, and scope to make their initial incisions with either a 15 or an 11 blade attached to a #3 knife handle. Once the surgeon is satisfied with the port placements, they will break scrub and run the robot. At this point, the surgical tech will play a vital role in the procedure.
Swapping Instruments
During the surgery, the surgeon will require several instruments to perform the procedure. The laparoscope will be swapped out for the robotic scope. Additionally, grasping instruments, such as scissors and cautery, will be needed to mobilize the bowel, and any attachments on the liver will need to be dissected. The ureters will be identified and lifted to create an area to locate the renal hilum to dissect. The tech will need to be aware of what instruments the surgeon needs and swap them out as necessary.
Identifying Bleeders
To control any bleeding during the surgery, laparoscopic bulldog clamps may be used to clamp the renal hilum. Arteries and veins will also need to be clamped. During this step, it is important to ensure that all bleeders are identified and controlled to prevent complications.
Excising the Tumor
Once the bleeding is controlled, the surgeon will excise the tumor. A robotic needle driver with suture loaded may be used to help reconstruct the excised area. The tech will need to be prepared to provide the necessary instruments for this step.
Removing the Specimen
After the tumor has been excised, the clamps can be taken off, and a bag will be placed in the abdomen to take out the specimen. The tech will need to assist in removing the specimen.
Closing the Incisions
Once the specimen has been removed, hemostasis is ensured, and the incisions can be closed. Closing the incisions will require a mayo-hegar needle driver, straight mayo scissors, and adsons. The tech will need to provide these instruments as necessary.
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