Robotic remote laparoscopic nephrectomy and adrenalectomy: The initial experience

Purpose: We evaluated the feasibility of performing laparoscopic nephrectom y and adrenalectomy exclusively by using robotic telepresent technology fro m a remote workstation and compared outcomes with those of conventional lap aroscopy in an acute porcine model. Materials and Methods: Five pigs underwent bilateral laparoscopic nephrecto my (robotic in 5 and conventional in 4) and adrenalectomy (robotic in 4 and conventional in 3). In the 9 robotic laparoscopic procedures all intraoper ative manipulations were completely performed telerobotically from a remote workstation without any conventional laparoscopic assistance on site. Anim als were sacrificed acutely. Results: Robotic laparoscopic nephrectomy required significantly longer tot al operative (85.2 versus 38.5 minutes, p = 0.0009) and actual. surgical (7 3.4 versus 27.5 minutes, p = 0.0002) time than conventional laparoscopy. Ho wever, blood loss and adequacy of surgical dissection were comparable in th e 2 groups. Robotic laparoscopic adrenalectomy required longer total operat ive (51 versus 32.3 minutes, p = 0.13) and actual surgical (38.5 versus 18. 7 minutes, p = 0.14) time than conventional laparoscopy. The solitary compl ication in this study was an inferior vena caval tear during robotic right adrenalectomy, which was adequately repaired by sutures telerobotically in a remote manner. Conclusions: To our knowledge we present the initial experience with remote telerobotic laparoscopic nephrectomy and adrenalectomy. Telepresent laparo scopic surgery is feasible.