Robotic nephropexy in case of symptomatic nephroptosis.

We found only a recent report of robotic-assisted nephropexy, in a young female with associated dismembered pyeloplasty. Herein we present the first case of isolated robotic nephropexy. A 34-year old female was referred to our Urological Division history of right flank pain and evidence at intravenous urography of a 5-6 cm descent of right kidney moving from supine to erect position. The robotic nephropexy was performed with a transperitoneal approach and 4 trocars. The kidney was wrapped up with a Parietex Composite (PCO) mesh (Tyco Healthcare), previously precut in an hockey stick shape to obtain a "spoon effect" to push up the lower pole of kidney. Despite the laparoscopic or retroperitoneoscopic procedures, the robotic-assisted nephropexy appears easier, with the particular advantages of the intracorporeal suturing and a better intraoperative view. The use of mesh, in our opinion, is preferable respect the decapsulation of the kidney, to avoid unnecessary blood loss and possible scarring.

Asymptomatic chronic urachal abscess mimicking a bladder tumor.

A 72-year-old man was admitted with a lower abdominal mass, occasionally detected during a previous laparoscopy. The cystoscopy revealed a bulging mass 5 cm in diameter at the vesical dome. The computed tomography (CT) scan showed an extravescical extension in close relationship with the posterior abdominal wall. Two consecutive endoscopic biopsies and a CT-guided percutaneous biopsy were not helpful. At surgery, a mass about 10 cm in diameter was found at the vesical dome and removed "en-block". The microscopic examination showed a chronic urachal abscess. To our knowledge, this is the second case of asymptomatic urachal abcess mimicking a bladder neoplasm. The reasons of a surgical approach are discussed.

Robotic-assisted laparoscopic prostatectomy in Italy: perioperative data on the first 150 patients.

BACKGROUND: In 2004 we performed the first robot-assisted laparoscopic prostatectomy (RALP) at Aosta, Italy. METHODS: Data about our first 150 RALPs are presented. RESULTS: Mean patient age was 65.2 (range 51-75) years; mean preoperative PSA level 7.9 (range 1.8-25.0) ng/ml. Nerve sparing was performed in 109 cases (72.7%) with lymph nodes dissection in 27 (18.0%). Operative time: patients 1-50, mean 213.3 (range 185-290) min; patients 51-100, 207.3 (range 185-335) min; patients 101-150, 171.7 (range 123-270) min. Two procedures were converted to open. Mean blood loss was 235 (range 20-1000) ml with two blood transfusions. One patient was reoperated for anastomotic leakage. Four patients were treated by colostomy and rectal suture for rectal injury (n = 3) or recto-urethral fistula (n = 1). The overall complication incidence was 13.3% (20 events), while mortality was nil. CONCLUSIONS: The incidence of complications is slightly higher than in major pilot centres but it is comparable, hence RALP also appears feasible in our italian peripheral centre.