HIdES for bilateral RAL Pyeloplasties

[pcasale]

#176

Had a run of bilateral Pyeloplasties where I utilized Patricio Gargollo’s HIdES approach. Was challenging without the upper midline assistant port but wanted to keep as much as I could below the umbilicus. I used a 14 GA angiocath subxyphoid with a rigid cysto grasper to help stabilize things. Moved the patient bed instead of the robot with angst from anesthesia when the head was on the other side of the robot away from their monitors. Figured we would start a discussion on how to make this approach easier for bilateral cases. HIdES is much easier than conventional approach for bilateral cases. Thought about writing it up but figured let’s talk about it to see if there’s a better way. Any ideas or thoughts on this approach?

[nsiddiqui]

#178

Pat, how old these patients? Do you make measurements and what is the minimum distance between the trocars? And do you insert the trocar to the remote center?

[nsiddiqui]

#184

Any pictures available to see the set-up? Was dissection transmesenteric or was the colon mobilized?

[pkokorowski]

#187

Trying to imagine where the ports were placed. In addition to the umbilical and the low midline port, did you use separate port sites for the left and right sides respectively?

[nsiddiqui]

#189

Pat, Paul- pictures would be very helpful

[pgargollo]

#198

Hi All,
Thought I would chime in. I think this is an awesome way to do bilateral cases and even multi-site cases (upper and lower tract. Here are some pictures. I know Michael Kurtz has tried this approach and seemed to like it. There are two ways to do it. First way is with 3 trocars total. The camera swaps to the port contralateral to the working site. So if doing a right UPJ the camera is the port medial to the LEFT ASIS (Picture 1). When you switch to the left UPJ camera moves to medial to the RIGHT ASIS. Other way if you want an assist port id to place 3 ports at the Pfanensteil line (rather than 2). In this port configuration you to use the contralateral most port as an assist (I.e. if working on a right UPJ the Pfanensteil port medial to the LEFT ASIS is your assist, camera in the Pfanensteil mid line and left working arm medial to right ASIS, right working arm at the umbo). (Picture 2)
Craig Peters (and others) make fun of this port configuration but the post-op appearance is awesome and once you get a bit used to some of the differences it works great.

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[pgargollo]

#200

sorry…not sure what happened here is the 3 port configuration

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