V08-10: Management of intraoperative complications during robotic renal and ureteral oncologic surgery: the lessons we learned
The rising popularity of robotic surgery has led to changes in potential operative complications, and the capability of surgeons to manage these complications.. Documentation of such complications through the routine collection of intraoperative videos provides valuable material to share with other surgeons for educational purposes. In this video we present four different intraoperative complications during robotic surgery and the way we managed them. Our goal is to facilitate learning from these complications to improve patient care.
The videos from intraoperative complications during robotic surgery were collected. In this report we mainly focused on complications during robotic partial nephrectomy and distal ureterectomy which include diaphragmatic injury, ureteral injury, IVC injury and arterial bleed. The mechanism of injury and necessary steps to manage these complications were discussed.
Diaphragmatic injury should be repaired intraoperatively once recognized. Waterseal repair and evacuation of the air from pleural space prior to closure are the key steps. All ureteral injuries can be repaired robotically. Tension free anastomosis in case of complete transection is important for successful repair. If vena cava injury is suspected, increasing intraabdominal pressure and maximizing the exposure of the potential injury site in crucial to localize the venotomy and repair I with a rescue suture. Arterial bleeding requires immediate compression or clamping. Application of bulldog clamp proximal to the injury site can control the bleeding prior to suture repair.
Complications from surgery are inevitable, but open confidential reporting allows sharing of experience, knowledge, and lessons to be learned by other surgeons. Experience, knowledge of potential complications and systematic approach to manage the complications if they happen are crucial to minimizing the potential impact.