Renal Hilar Clamping With a Standard Robotic Bulldog Clamp Using the Single Port da Vinci Robot.

Background: Renal hilar clamping during a robotic partial nephrectomy is essential for a successful, nephron-sparing tumor resection. Standard robotic bulldog clamps are modified to accommodate multiport robotic surgical systems with alterations including knobs to fit robotic forceps and reduced spring tension. Despite the lower spring tension, a standard robotic bulldog clamp cannot be loaded and opened using one Single Port robotic arm. The angled path instrument cables take through multiple robotic arm articulations lowers the maximum force generated by Single Port instruments to below what is necessary to load and open a robotic bulldog clamp.

Objective: To share institutional knowledge gained regarding safe and efficient hilar clamp placement and removal using the da Vinci Single Port Surgical System with a standard robotic bulldog clamp. As the da Vinci Single Port system gains wider use, knowledge of this technique will reduce surgeon trial-and-error during first experiences using the Single Port system with bulldog clamps.

Material: Video obtained during two partial nephrectomies, da Vinci Single Port Surgical System, Scanlan Reliance 25 mm curved robotic bulldog clamp, Final Cut Pro video editing software.

Results: A controlled sequence of steps for renal hilar clamping and subsequent clamp removal using a standard robotic bulldog clamp with the da Vinci Single Port Surgical System.

Conclusion: The demonstrated technique for intracorporeal loading, opening, and placement of a standard robotic bulldog clamp using the da Vinci Single Port Surgical System is feasible and efficient.