V08-05 Robotic Repair of Right External Iliac Vein Injury During Robotic Cystectomy With Root Cause Analysis of Injury

You have accessJournal of UrologyBladder & Urothelial Upper Tract Oncology (V08)1 May 2024V08-05 ROBOTIC REPAIR OF RIGHT EXTERNAL ILIAC VEIN INJURY DURING ROBOTIC CYSTECTOMY WITH ROOT CAUSE ANALYSIS OF INJURY Sina Hassan Beygi Monfared, Utsav Bansal, Kenneth Softness, Philip Kim, Peter Steinberg, Peter Chang, and Andrew A. Wagner Sina Hassan Beygi MonfaredSina Hassan Beygi Monfared , Utsav BansalUtsav Bansal , Kenneth SoftnessKenneth Softness , Philip KimPhilip Kim , Peter SteinbergPeter Steinberg , Peter ChangPeter Chang , and Andrew A. WagnerAndrew A. Wagner View All Author Informationhttps://doi.org/10.1097/01.JU.0001009440.59296.9f.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present the case of a 68-year-old male with a known history of extensive high grade T1 urothelial carcinoma of the bladder with new CT findings concerning for right upper tract disease who presented for robotic nephroureterectomy and radical cystoprostatectomy. During the right pelvic lymph node dissection, sudden monopolar scissor motion created an injury to the right external iliac vein. We performed a repair of the injury as well as a root cause analysis (RCA). METHODS: After completing the right nephroureterectomy, we began the robotic pelvic lymph node dissection. During dissection, the right external iliac vein was punctured through and through by the robotic monopolar scissors during an exchange of the monopolar cautery cords. We gained proximal and distal vessel control using bulldog clamps and repaired both the anterior and posterior defects with 5-0 Prolene suture. We then completed an RCA by speaking with all team members, reviewing case video, performing field testing of Davinci Xi robot arm movement, evaluating raw clutching data from the robot, and comparing the clutching data to the surgery video. RESULTS: The operative time was 8 hours and 3 minutes with an estimated blood loss of 1.5L. The patient required 2 units of packed red blood cells intraoperatively. Following repair no further complications occurred and the patient was discharged on day 5, after our standard robotic radical cystectomy post-operative pathway. Our RCA showed that that an assistant at the bedside unintentionally clutched the arm while placing the monopolar cautery cord with the instrument inside the patient, leading to sudden and unexpected forward scissor movement without resistance. CONCLUSIONS: Robotic repair of near-catastrophic pelvic vessel injury is possible using proximal and distal vascular control and robotic suturing techniques. The available second-by-second robotic motion data can assist with root cause analysis of robotic complications. The bedside assistants should always remove an instrument prior to inserting cautery cords. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e558 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sina Hassan Beygi Monfared More articles by this author Utsav Bansal More articles by this author Kenneth Softness More articles by this author Philip Kim More articles by this author Peter Steinberg More articles by this author Peter Chang More articles by this author Andrew A. Wagner More articles by this author Expand All Advertisement PDF downloadLoading ...