206 / 238
206
29
th
CONGRESS OF THE ESPU
CONCLUSIONS
The laparoscopic approach is safe and feasible for these patients, with all the advantages of
laparoscopy.
VD-15 (VS without presentation)
ROBOT ASSISTED LAPAROSCOPIC ADRENALECTOMY
(RALA) IN A MORBIDLY OBESE CHILD WITH
CUSHING'S SYNDROME
Aparajita MITRA
1
, Rajiv PADANKATTI
1
, Vijay Mahantesh SAMALAD
1
, Thirumalai
GANESAN
2
, Vasantharoopan C
3
and Venkat SRIPATHI
1
1) Apollo Children's Hospital, Pediatric Urology, Chennai, INDIA - 2) Apollo Hospitals, Urology, Chennai, INDIA - 3) Apollo
Hospitals, Anesthesiology, Chennai, INDIA
PURPOSE
Adrenalectomy in a patient with Cushing's syndrome is fraught with problems and can be a surgical
and anesthetic nightmare. We describe a robotic approach to a left adrenalectomy with emphasis
on patient positioning, port placement and dissection technique.
MATERIAL AND METHODS
A morbidly obese (BMI >35) 13 year old girl presented with hypertension and hyperglycaemia.
Endocrine and radiologic workup revealed a left adrenal adenoma. RALA was planned after
physiological optimization. It was especially beneficial for this child where an open or conventional
laparoscopic surgery would have been extremely difficult owing to a thick panniculus and increased
visceral adiposity.
RESULTS
The console time was 100 minutes with minimal blood loss. Post-operative recovery was rapid
although a prolonged hospital stay was necessary to observe the trend in blood pressure and for
glycemic control. There was a weight loss of 2.5 kg, significant improvement in mobility and mood
and a decrease in mean arterial blood pressure. The insulin requirement could be tapered and
gradually discontinued. Serum Cortisol decreased from 30 to 17.
CONCLUSIONS
RALA should be the procedure of choice in a morbidly obese child with multiple co-moribidities. As
this is an uncommon condition, this report, we believe will be a valuable technical guide.
VD-16 (VS without presentation)
ROBOTIC URETERO-CALICOSTOMY AFTER FAILED
PYELOPLASTY
Dario Guido MINOLI, Alfredo BERRETTINI, Mirella MOGIATTI, Erika Adalgisa
DE MARCO and Gianantonio MANZONI
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Pediatric Urology, Milan, ITALY
PURPOSE
In this video we report the robotic approach to a complex case of persistent pyelo-ureteral obstruc-
tion finally solved with uretero-calicostomy.
MATERIAL AND METHODS
A 14 year-old-girl with right flank pain has been diagnosed with a pyelo-ureteral obstruction and
underwent a standard robotic pyeloplasty in 2013.