ESPU Congress 2017 - Abstract book

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286 28TH CONGRESS OF THE ESPU
MATERIAL AND METHODS
A 12 months old boy presented with unilateral impalpable testis was diagnosed to have Persistent
Mullerian Duct Syndrome with Anti-Mullerian Hormone receptor mutation after serial workups.
Robotic assisted laparoscopic excision of Mullerian remnant with bilateral orchidopexies was per-
formed with Da Vinci Xi system. Cystoscopy was performed with cannulation of Mullerian remnant
and bilateral ureteric openings prior to robotic assisted procedure. Three 8mm robotic ports were
placed at supra-umbilical region, left and right flank and one accessory 5mm STEP port at right
upper quadrant. Dissection of Mullerian remnant from both testes was performed safeguarding the
vas deferens. Uterine vessels and broad ligament were cauterized and divided. The remnant was
mobilized until near the insertion at prostatic urethra and divided. The short stump of insertion was
closed with absorbable sutures. Bilateral transverse scrotal incisions were done and both testes
were brought down to the base of scrotum and anchored.
RESULTS
Operative time was 235 minutes and blood loss was minimal. Total length of hospital stay was
5 days. There was no intraoperative or post-operative complication. Both testes remained at base
of scrotum on latest follow up.
CONCLUSIONS
Robotic assisted laparoscopic approach in Mullerian provides excellent anatomical visualization
and enables a more complete excision of the Mullerian remnant to minimize the malignant potential.
VS-10 (VS without presentation)
ROBOTIC ENUCLEATION FOR RENAL MASSES:
OUR INITIAL URO-PEDIATRIC EXPERIENCE
Lorenzo MASIERI1 , Michele LANCIOTTI2, Chiara CINI2 , Francesco SESSA3 ,
Davide VANACORE4 , Davide FACCHIANO4 , Luca LANDI1 , Maria TAVERNA1
and Antonio ELIA1
1) Meyer University Hospital, Pediatric Urology, Florence, ITALY - 2) Meyer University Hospital, Pediatric Urology,
Florence, ITALY - 3) Careggi University Hospital, Urology, Florence, ITALY - 4) Careggi University Hospital, Urology,
Florence, ITALY
PURPOSE
Robotic surgery is becoming increasingly popular also in the pediatric field. Our case shows how
simple enucleation can be achieved even in pediatric patients, despite the small size of the operat-
ing field requires a good experience for the correct positioning of the patient. To avoid internal/
external conflicts the Da Vinci robot Xi finds particular application in pediatric urology.
MATERIAL AND METHODS
After a large case volume of ERASE technique in adult patients, we performed this technique
in a 9 years girl, whose weight was 30 kg. She had a left flank pain, an incidental renal mass,
positioned in the upper pole of left kidney at ultrasound, about 2,3x1,9 cm sized. MRI confirmed the
presence of the renal mass and its nature partly cystic.
RESULTS
It has been used 1 trocar for the camera, two 8 mm robotic trocars, and one 5 mm trocar for
assistant. The technique performed was the simple enucleation, with the removal of the mass
preserving the healthy parenchyma and without clamping the pedicle. We also used the robotic
ultrasound probe to better define the margins of resection. Hemostasis was achieved with Monocryl
4/0 stitches on the cleavage plane of resection and affixing hemostatic material. The operating
time was 110 minutes, it was placed a drainage removed 2 days postoperatively. Hospital stay
was 4 days. There were no intra and post-operative complications. Final pathological examination
revealed a cystic nephroma.