Vídeos

Clipless Robot-Assisted Radical Prostatectomy with Hood Technique and Neurovascular Bundle Preservation

A 77-year-old patient was diagnosed with clinically localized high-risk prostate cancer. Multiparametric MRI demonstrated a 27-g prostate with a 7-mm PI-RADS 4 lesion located in the apical third of the right peripheral zone, showing diffusion restriction and early contrast enhancement. Targeted prostate biopsy revealed acinar adenocarcinoma, Gleason score 4+4=8, ISUP Grade Group 4, involving the targeted core, with cribriform morphology. The patient underwent robot-assisted radical prostatectomy using a clipless approach, combined with the Hood technique and neurovascular bundle preservation. Pelvic lymph node dissection was also performed. Final pathology demonstrated acinar adenocarcinoma, Gleason 4+4=8, ISUP Grade Group 4, with 75% pattern 4 and 25% pattern 3, involving approximately 24% of the prostate. Final pathological stage: pT2 pN0. The procedure was performed safely. The patient achieved early urinary continence and recovery of erectile function. Limited and selective use of energy, when required, did not adversely affect the functional outcome in this case. This video highlights the key surgical steps of a clipless robot-assisted radical prostatectomy with Hood technique and neurovascular bundle preservation, emphasizing meticulous dissection and preservation of periprostatic structures.

Carlos Alberto Toledo Martínez

Laparoscopic Simple Nephrectomy: Step by Step for a Safe and Efficient Procedure

A 30-year-old female patient with a history of recurrent nephrolithiasis associated with multiple episodes of recurrent urinary tract infections, some requiring hospitalization and intravenous antibiotic therapy. Computed tomography demonstrated a chronically damaged kidney associated with stone disease. Renal scintigraphy confirmed a non-functioning kidney. Given the loss of renal function and recurrent infectious episodes, laparoscopic simple nephrectomy was indicated. The procedure was completed uneventfully, with an operative time of 52 minutes and estimated blood loss of 0 mL. The patient had an uncomplicated postoperative course and was discharged on postoperative day 1 (POD 1).

Carlos Alberto Toledo Martínez

Upfront Robotic Approach Without Chemotherapy for Interaortocaval Metastasis of Germ Cell Tumor with Predominant Teratoma

We present the case of a 22-year-old patient who previously underwent radical orchiectomy for a testicular germ cell tumor. Histopathological analysis revealed a mixed tumor composed of 20% seminoma, 20% yolk sac tumor, and 60% teratoma. Post-orchiectomy tumor markers were negative, and abdominal imaging demonstrated a 4-centimeter interaortocaval retroperitoneal lymph node metastasis.This clinical scenario raised an important therapeutic question. In the setting of a metastatic germ cell tumor with predominant teratomatous component and negative serum markers, the expected response to chemotherapy is limited, since teratoma is well recognized as a chemoresistant histology. For that reason, we elected to proceed with an upfront surgical approach rather than neoadjuvant chemotherapy. Our goal was to achieve complete oncologic control through primary retroperitoneal lymph node dissection, avoiding delay in definitive treatment and sparing the patient unnecessary systemic toxicity.The procedure was performed robotically through a supine approach. Initial exposure was obtained by mobilizing the bowel to access the aorta and vena cava, allowing a wide and safe retroperitoneal dissection. The operation progressed smoothly, without intraoperative complications. Of note, the surgical field showed no desmoplastic reaction and no significant vascular fixation, which is a very different scenario from post-chemotherapy salvage surgery, where fibrosis and adherence to major vessels often make the dissection more challenging and technically demanding.This finding further supported the decision to treat the patient upfront. In selected cases like this one, robotic retroperitoneal lymph node dissection can provide excellent exposure, precise dissection, and a minimally invasive route to complete resection. The absence of prior chemotherapy likely contributed to a cleaner surgical plane and facilitated a safer operation.In conclusion, this case highlights the value of an upfront robotic strategy in a young patient with a teratoma-predominant metastatic germ cell tumor and negative markers after orchiectomy. The surgical findings confirmed the expected behavior of teratoma as a chemotherapy-resistant component and reinforced the importance of individualized treatment planning. Robotic surgery offered an effective and elegant solution in this setting, with a favorable intraoperative course and no complications.

Isabelle Yukari Maruoka Nunes

Linfadenectomia Vídeo-Endoscópica Inguinal (VEIL) com Preservação da Veia Safena e de suas Colaterais

Caso clínico: Paciente do sexo masculino com diagnóstico de carcinoma epidermoide de pênis e indicação de linfadenectomia inguinal por doença linfonodal de risco intermediário/alto. Foi submetido à linfadenectomia inguinal vídeo-endoscópica (VEIL) com preservação da veia safena magna e de suas colaterais, técnica empregada com o objetivo de manter a radicalidade oncológica e reduzir a morbidade pós-operatória, especialmente edema de membro inferior, complicações linfáticas e alterações de cicatrização. O procedimento foi realizado sem intercorrências, com adequada identificação e preservação das estruturas vasculares de interesse.

Carlos Alberto Toledo Martínez

Cirurgia de Próstata Avançada: Técnica HoLEP Guiada por Realidade Aumentada

"Neste vídeo, exploramos a vanguarda da urologia: a integração da Realidade Aumentada (RA) na cirurgia HoLEP (Enucleação da Próstata com Laser Holmium). Descubra como o uso dessa tecnologia imersiva está revolucionando o tratamento da Hiperplasia Prostática Benigna (HPB), oferecendo uma precisão cirúrgica sem precedentes e maior segurança."

RENAN GIFFONI RODRIGUES

Cistectomia Radical Videolaparoscópica Feminina

Cistectomia Radical Videolaparoscópica Feminina com neobexiga a Bricker

fernando marsicano

Robot-assisted laparoscopic radical prostatectomy clipless, transvesical approach, step by step.

Case description: Robot-assisted laparoscopic radical prostatectomy performed using a clipless, transvesical approach. The procedure is presented in a step-by-step manner, highlighting key surgical landmarks, technical nuances, and strategies for anatomical preservation to optimize functional outcomes.

Carlos Alberto Toledo Martínez

Diverticulectomia Robótica com abordagem inicial endoscópica.

Colocação de fio-guia no interior do divertículo para distensão do mesmo e identificação exata do divertículo no acesso robótico. Vantagem: manter bexiga vazia durante procedimento proporcionando melhor visualização e mobilização no intra-operatório. Caso: paciente com Câncer de Próstata de Risco Intermediário Favorável e sintomas de armazenamento + ITU de repetição devido divertículo vesical a esquerda. Console: Wesley Magnabosco. Auxílio: Isabelle Maruoka.

Isabelle Yukari Maruoka Nunes

Confecção de neocolo vesical laparoscópico

Paciente portador de próstata volumosa, aderida a planos profundos e com realização de RTU prévia. Tentado realização de anastomose vesicouretral padrão, porém sem sucesso devido a distância entre colo vesical e uretra. Optado por cerclagem de colo vesical nativo e confecção de novo colo vesical laparoscópico

ronaldo carvalho neiva

Coloplastia em PTR Videolaparoscópica pós RTU de próstata

Câncer de Próstata de Alto Risco, cT3b, próstata 110g, em uso de bloqueio hormonal. Antecedente de RTU de próstata. Vídeo focado na reconstrução do colo vesical para esses casos.

Isabelle Yukari Maruoka Nunes

Tratamento minimamente invasivo do feocromocitoma e tumores renais em rim único na Síndrome de Von Hippel–Lindau Tipo 2B

Paciente do sexo feminino, 48 anos, submetida previamente a nefrectomia esquerda laparoscópica por tumor renal volumoso. Oito meses após o procedimento inicial, no seguimento clínico, identificaram-se três lesões suspeitas: uma em glândula adrenal e duas no rim único. Após discussão multidisciplinar, indicou-se nefrectomia parcial laparoscópica das lesões renais associada à adrenalectomia direita, diante da suspeita clínica de feocromocitoma e neoplasia renal. O exame histopatológico confirmou carcinoma de células claras nas lesões renais e feocromocitoma na glândula adrenal, permitindo a classificação do caso como Síndrome de Von Hippel–Lindau Tipo 2B.

Carlos Alberto Toledo Martínez

Prostatectomia Radical Robótica Pós HT Neoadjuvante

Paciente com próstata de 180g, T4, submetido a HT neoadjuvante. Foi operado com próstata de 125g e com abordagem lateral de colo vesical

Isabelle Yukari Maruoka Nunes