UROFAIR Virtual 2020

UROFAIR Virtual 2020 Abstracts V-10165 Supine Micro Endoscopic Combined Intra Renal Surgery (mECIRS) with “All Seeing Needle” for Percutaneous Nephrolithotomy (PCNL): The Singapore Experience Chloe Ong (1) , Sarvajit Biligere (1) , Wy Keat Tay (1) , Heng Chin Tiong (1) , Vineet Gauhar (1) (1) Ng Teng Fong General Hospital Introduction and Objectives: Micro PNL helps reduce morbidity, hasten recovery. We Aim to evaluate efficacy and outcomes of Supine mECIRS in French position, combining Micro PCNL and RIRS with High power laser on renal calculus management. Methods: Prospective single centre study between November 2019 and January 2020 with all symptomatic patients of any age, stone size, habitus included 6 patients underwent Micro PCNL with 4fr “all seeing optical needle” (Polydiagnost, Germany) and RIRS with Lithovue,Boston Scientific +11/13 access sheath. Results: Total number of patients – 6, male 2 (33.3%) female 4 (66.7%), > 70 yrs age 2 (33.3%), anticoagulation 3 (50%), lower limb flexion deformity 2 (33.3%), complex renal anatomy 4 (66.7%), previous PCNL 1 (16.6%). Stone characteristics – stone > 2 cm 4 (66.7%), multiple stones 3 (50%), partial staghorn 2 (33.3%), diverticular stones 3 (50%). Intra-op findings – supine with split leg 4 (66.7%), supine only 2 (33.3%), avg op time 57.6 min, PCN in 1 try 6 (100%), pre op stenting 3 (50%), post op stenting 5 (83.3%), nephrostomy 0. Post op hospital stay – < 48 hrs 5 (83.3%), avg pain score 6/10, fever < 38º C 2 (33.3%), stone free Rate 100%. Conclusions: Albeit small, it is the first series in the world for supine mECIRS with all seeing needle in French position with 100% success and nil significant morbidity. Sepsis was mitigated by use of access sheath allowing good drainage subserving as conduit for stone extraction and maintaining good vision thereby allowing complete stone clearance in all. Larger series will establish its supremacy as the procedure of choice for renal stonemanagement. The Benefit of Robotic Surgery in Post-Radio Recurrent Invasive Bladder Cancer Daanesh Huned (1) , Raj Tiwari (1) , Kae Jack Tay (2) , Lui Shiong Lee (1) (1) Sengkang General Hospital, (2) Singapore General Hospital Introduction and Objectives: Recurrence of invasive bladder cancer after radiation therapy poses a surgical challenge with significant morbidity described for salvage cystectomy cases. We present the first regional series of robotic assisted salvage radical cystectomy (RSRC) with detailed description of the key steps, in addition to perioperative and oncological outcomes. Methods: With IRB approval, 4 patients who underwent RSRC were identified from a prospective database. The key steps of RSRC presented in the video include posterior dissection aided by magnification and 3D vision of the robotic system, completion of cystectomy, adequate lymphadenectomy and intracorporeal ileal conduit reconstruction. Results: The median age was 63 years and all ECOG status 1 or better. The pre-operative clinical staging were cT3N0M0 in all cases. The median console operative time was 450 mins, estimated blood loss 200 ml, length of stay 5 days, duration of ileus 3 days, and there were no transfusions. There was 1 patient with prolonged ileus (7 days) but there were no other Clavien-Dindo III and above complications. There were no rectal or vascular injuries. The pathological stages include pT4 (n = 2), pT3 (n = 1) and pT2 (n = 1). The median node count was 25, and n = 1 patient was node positive. At a median follow-up of 18 months, 2 patients developed systemic recurrence Conclusions: We present the first regional case series of RSRC demonstrating that it is safe and oncologically feasible. The robotic vision aids meticulous dissection in a irradiated surgical field, and minimal invasive surgery aids good peri-operative outcomes. V-10167 V-10166 Video-Endoscopic Inguinal Lymph Node Dissection by Lateral Approach Tarun Jindal (1) (1) Tata Medical Center, Kolkata Introduction and Objectives: Inguinal lymphadenectomy is a morbid procedure associatedwith significant risks of flap necrosis, wound dehiscence, infection, lymphedema, lymphorrhoea, etc. Although the majority of the complications are self-limiting, flap necrosis and wound dehiscence often require re-do surgery and flap coverage. Video-endoscopic inguinal lymph (VEIL) node dissection is a minimally invasive alternative to open inguinal node dissection and has been found to provide similar oncological outcomes with significantly fewer wound complications. The conventional approach of VEIL either by the laparoscopic or robotic platform has been along the long axis of the thigh and the saphenous vein. Methods: We describe a lateral approach for VEILwhich is more ergonomic, hastens the identification of the saphenous vein and has similar outcomes as conventional VEIL. Results: The technique was used in 15 patients of carcinoma penis with clinically negative groins, over the span of 15 months. None of the patients had any wound-related complications. All the patients could be discharged by the second postoperative day. The mean duration for drain removal was 7 days post-surgery. Conclusions: VEIl by lateral approach is a safe alternative to conventional VEIL. Posterior Radial Nephrotomy in Laparoscopic Partial Nephrectomy for Intra-Hilar Renal Tumours Mallikarjuna Chiruvella (1) (1) Asian Institute of Nephrology And Urology, Hyderabad Introduction and Objectives: Centrally located endophytic renal hilar tumors pose a technical challenge to the surgeons especially through a minimally invasive approach. Hereby, we narrate a new technique of radial nephrotomy for laparoscopic enucleation of such tumors, applying an age old surgical principle of radial nephrotomy in the intersegmental plane to remove renal stone. Methods: A 55-year-old female, chronic kidney disease-stage 1, presented with left flank pain since 6 months. On evaluation, ultrasound and MRI showed 3 cm, endophytic, left intra-hilar renal tumour. After transperitoneal access, kidney was mobilized and flipped to expose the posterior aspect. Dissection of renal sinus was done in the Gilvernet’s plane. Intraoperative ultrasound was done to locate the tumor and the adjacent vasculature. The incision was given in the arbitrary plane between posterior and inferior arterial segments. Renal artery was clamped, radial nephrotomy was made at this plane, tumor was exposed, dissected around the pseudocapsule, enucleated in-toto. Haemostatic figure of eight sutures were taken over small vessels supplying the tumour. Nephrotomy closure was performed by sliding renorraphy technique using 1-0 V-Loc. Haemostasis was confirmed after declamping the renal artery and nephropexy performed. Results: There was minimal blood loss with warm ischemia time of 18 minutes. Intra and peri-operative periods were uneventful. Histopathology suggestive of renal hamartoma with clear margins. Conclusions: Dissecting the renal sinus in the Gilvernet’s plane followed by posterior radial nephrotomy in the plane between the posterior and inferior renal arterial segments facilitated the exposure of intra-hilar space and enucleation of the renal tumour. V-10160 27