Application of "cinch/tie" technique to robotic-assisted nephropexy for posterior abdominal wall fixation

Scott M. Castle, Watid Karnjanawanichkul, Raymond J. Leveillee

Research output: Contribution to journalArticle

Abstract

Nephropexy remains standard for symptomatic nephroptosis, and several minimally-invasive techniques have been described. Triangulation sutures placed between the abdominal wall and the renal capsule are often difficult to tie tightly due to the confined working space. We propose a technique modification to fixate the kidney utilizing the da Vinci Surgical System robot and Lapra-Ty absorbable suture clips. Four female patients with symptomatic nephroptosis diagnosed via kidney hypermobility demonstrated on intravenous urography (IVU) underwent robotic-assisted laparoscopic nephropexy (RALNP) from February 2008 to April 2010. After complete mobilization and stripping of perirenal fat, several 0 Vicryl sutures were placed in a "figure of eight" fashion and tied loosely. Subsequently we utilized a Lapra-Ty to tighten the stitch serially and fixate the kidney. The mean age was 46 years (43-52); one patient underwent simultaneous pyeloplasty and one underwent partial nephrectomy in the ipsilateral kidney. There were no intraoperative complications and two postoperative complications, both Clavien grade I. All patients were asymptomatic postoperatively at a mean follow-up of 9.2 months (1-28), and had no evidence of kidney hypermobility on upright IVU or diuretic renal scintigraphy (RS) scan at 6 weeks postoperatively. RALNP is a viable option in the treatment of symptomatic nephroptosis. Secure placement of several "pexing" sutures helps to ensure appropriate security of these itinerant kidneys. Our technique modification corrects kidney hypermobility while improving symptoms related to nephroptosis.

Original languageEnglish
Pages (from-to)155-157
Number of pages3
JournalJournal of Robotic Surgery
Volume6
Issue number2
DOIs
StatePublished - Jun 1 2012
Externally publishedYes

Fingerprint

Robotics
Abdominal Wall
Kidney
Sutures
Urography
Confined Spaces
Polyglactin 910
Intraoperative Complications
Nephrectomy
Diuretics
Surgical Instruments
Radionuclide Imaging
Capsules
Fats

Keywords

  • Kidney
  • Nephropexy
  • Nephroptosis
  • Robotic-assisted surgery

ASJC Scopus subject areas

  • Surgery
  • Health Informatics

Cite this

Application of "cinch/tie" technique to robotic-assisted nephropexy for posterior abdominal wall fixation. / Castle, Scott M.; Karnjanawanichkul, Watid; Leveillee, Raymond J.

In: Journal of Robotic Surgery, Vol. 6, No. 2, 01.06.2012, p. 155-157.

Research output: Contribution to journalArticle

Castle, Scott M. ; Karnjanawanichkul, Watid ; Leveillee, Raymond J. / Application of "cinch/tie" technique to robotic-assisted nephropexy for posterior abdominal wall fixation. In: Journal of Robotic Surgery. 2012 ; Vol. 6, No. 2. pp. 155-157.
@article{a956ce299f344cb78e17f06298ee5c61,
title = "Application of {"}cinch/tie{"} technique to robotic-assisted nephropexy for posterior abdominal wall fixation",
abstract = "Nephropexy remains standard for symptomatic nephroptosis, and several minimally-invasive techniques have been described. Triangulation sutures placed between the abdominal wall and the renal capsule are often difficult to tie tightly due to the confined working space. We propose a technique modification to fixate the kidney utilizing the da Vinci Surgical System robot and Lapra-Ty absorbable suture clips. Four female patients with symptomatic nephroptosis diagnosed via kidney hypermobility demonstrated on intravenous urography (IVU) underwent robotic-assisted laparoscopic nephropexy (RALNP) from February 2008 to April 2010. After complete mobilization and stripping of perirenal fat, several 0 Vicryl sutures were placed in a {"}figure of eight{"} fashion and tied loosely. Subsequently we utilized a Lapra-Ty to tighten the stitch serially and fixate the kidney. The mean age was 46 years (43-52); one patient underwent simultaneous pyeloplasty and one underwent partial nephrectomy in the ipsilateral kidney. There were no intraoperative complications and two postoperative complications, both Clavien grade I. All patients were asymptomatic postoperatively at a mean follow-up of 9.2 months (1-28), and had no evidence of kidney hypermobility on upright IVU or diuretic renal scintigraphy (RS) scan at 6 weeks postoperatively. RALNP is a viable option in the treatment of symptomatic nephroptosis. Secure placement of several {"}pexing{"} sutures helps to ensure appropriate security of these itinerant kidneys. Our technique modification corrects kidney hypermobility while improving symptoms related to nephroptosis.",
keywords = "Kidney, Nephropexy, Nephroptosis, Robotic-assisted surgery",
author = "Castle, {Scott M.} and Watid Karnjanawanichkul and Leveillee, {Raymond J.}",
year = "2012",
month = "6",
day = "1",
doi = "10.1007/s11701-010-0237-4",
language = "English",
volume = "6",
pages = "155--157",
journal = "Journal of Robotic Surgery",
issn = "1863-2483",
publisher = "Springer London",
number = "2",

}

TY - JOUR

T1 - Application of "cinch/tie" technique to robotic-assisted nephropexy for posterior abdominal wall fixation

AU - Castle, Scott M.

AU - Karnjanawanichkul, Watid

AU - Leveillee, Raymond J.

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Nephropexy remains standard for symptomatic nephroptosis, and several minimally-invasive techniques have been described. Triangulation sutures placed between the abdominal wall and the renal capsule are often difficult to tie tightly due to the confined working space. We propose a technique modification to fixate the kidney utilizing the da Vinci Surgical System robot and Lapra-Ty absorbable suture clips. Four female patients with symptomatic nephroptosis diagnosed via kidney hypermobility demonstrated on intravenous urography (IVU) underwent robotic-assisted laparoscopic nephropexy (RALNP) from February 2008 to April 2010. After complete mobilization and stripping of perirenal fat, several 0 Vicryl sutures were placed in a "figure of eight" fashion and tied loosely. Subsequently we utilized a Lapra-Ty to tighten the stitch serially and fixate the kidney. The mean age was 46 years (43-52); one patient underwent simultaneous pyeloplasty and one underwent partial nephrectomy in the ipsilateral kidney. There were no intraoperative complications and two postoperative complications, both Clavien grade I. All patients were asymptomatic postoperatively at a mean follow-up of 9.2 months (1-28), and had no evidence of kidney hypermobility on upright IVU or diuretic renal scintigraphy (RS) scan at 6 weeks postoperatively. RALNP is a viable option in the treatment of symptomatic nephroptosis. Secure placement of several "pexing" sutures helps to ensure appropriate security of these itinerant kidneys. Our technique modification corrects kidney hypermobility while improving symptoms related to nephroptosis.

AB - Nephropexy remains standard for symptomatic nephroptosis, and several minimally-invasive techniques have been described. Triangulation sutures placed between the abdominal wall and the renal capsule are often difficult to tie tightly due to the confined working space. We propose a technique modification to fixate the kidney utilizing the da Vinci Surgical System robot and Lapra-Ty absorbable suture clips. Four female patients with symptomatic nephroptosis diagnosed via kidney hypermobility demonstrated on intravenous urography (IVU) underwent robotic-assisted laparoscopic nephropexy (RALNP) from February 2008 to April 2010. After complete mobilization and stripping of perirenal fat, several 0 Vicryl sutures were placed in a "figure of eight" fashion and tied loosely. Subsequently we utilized a Lapra-Ty to tighten the stitch serially and fixate the kidney. The mean age was 46 years (43-52); one patient underwent simultaneous pyeloplasty and one underwent partial nephrectomy in the ipsilateral kidney. There were no intraoperative complications and two postoperative complications, both Clavien grade I. All patients were asymptomatic postoperatively at a mean follow-up of 9.2 months (1-28), and had no evidence of kidney hypermobility on upright IVU or diuretic renal scintigraphy (RS) scan at 6 weeks postoperatively. RALNP is a viable option in the treatment of symptomatic nephroptosis. Secure placement of several "pexing" sutures helps to ensure appropriate security of these itinerant kidneys. Our technique modification corrects kidney hypermobility while improving symptoms related to nephroptosis.

KW - Kidney

KW - Nephropexy

KW - Nephroptosis

KW - Robotic-assisted surgery

UR - http://www.scopus.com/inward/record.url?scp=84861462187&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861462187&partnerID=8YFLogxK

U2 - 10.1007/s11701-010-0237-4

DO - 10.1007/s11701-010-0237-4

M3 - Article

AN - SCOPUS:84861462187

VL - 6

SP - 155

EP - 157

JO - Journal of Robotic Surgery

JF - Journal of Robotic Surgery

SN - 1863-2483

IS - 2

ER -