Mp23-18 Inter-Hospital Telementoring for Robotic Surgery

and minilaparoscopy ML are still lacking.We present the first prospective double-blind randomized study to compare between LESS and ML for treatment of different upper urinary tract pathologies.METHODS: During the period of January 2013 and June 2015, patients with different upper urinary pathologies who were candied for laparoscopic surgical intervension were blindly randomized to both LESS and CL.ML was done by 3-mm instruments; including 3-mm laparoscope.All procedures were done by a single experienced laparoscopist.Exclusion criteria included children less than 3 years and absolute contraindications of laparoscopy.Both groups were compared regarding patients demographic data, operative time, intraoperative and postoperative complications, estimated blood loss (EBL), hospital stay, analgesic requirement, visual analogue pain scale (VAS) on discharge and cosmetic outcome.Cosmetic outcome was assessed at 6 months postoperatively using the patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS).RESULTS: Included were 60 patients with mean age of 40.7Æ9.2 years and 39.6Æ16.7 years both in LESS and ML, respectively.Mean BMI was 29.5Æ3.4 and 28.6Æ4.37 kg/m2 in LESS and ML groups, respectively.In LESS group there were 2 adrenalectomies, 9 nephrectomies (5 simple and 4 radical), 9 pyeloplasties and 9 cyst marsuplizations and a case of retrocaval ureter.While in ML group there were 3 adrenalectomies, 9 nephrectomies (5 simple and 4 radical), 9 pyeloplasties and 9 cyst marsuplizations.Operative time in LESS was 167 Æ24 min which was longer than that of ML group (145Æ39 min) but statistically insignificant.EBL in LESS was 59Æ34 ml Vs 43Æ 42 ml in ML and the difference was statistically insignificant.VAS was significantly less in LESS group (1.7Æ0.6 in LESS and 2.8Æ0.5 in ML).In LESS group, PSAS was 5.9Æ0.85 while OSAS was 10.6Æ1.98.Meanwhile, In ML group, PSAS was 8.9Æ0.9 and OSAS 13.5Æ6.3.The difference was statistically significant.There were no intra-operative complications in both groups.Postoperative complications were reported in 6.6% and 3.3% both in LESS and ML groups; respectively.Mean hospital stay was 1.8Æ1.3days in LESS Vs 2.1Æ0.8days in ML.Mean analgesic requirements in the post-operative period was 151.7Æ35.6 mg of Diclofenac Na in LESS Vs 169.7Æ47.3mg in ML.There were no conversions to either open surgery or conventional laparoscopy in both groups.5-mm extra port was added in 4 cases of LESS.Meanwhile, in ML group we used a 10-mm port in 12 cases in order to use the Hem-O-lock clip applier.CONCLUSIONS: Both LESS and ML are feasible and safe options for treatment of different upper urinary tract pathologies with comparable operative time, blood loss, hospital stay and complication rate.However, LESS is associated with less analgesic requirement and better cosmetic outcome.Each procedure has its own technical limitations.