#280 Robotic Repair of Renal Arterio-Venous Malformation-Dr. Sanjoy Sureka

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Abstract: Introduction:

Arteriovenous malformations (AVMs) are fast flow malformations, characterized by the presence of arteriovenous shunting. They are classified into various types based on the number of feeding vessels and size. Options for treating small AVMs are non-operative or conservative therapy. Intervention in the form of embolization are good and minimally invasive options but risk of recurrence is high.

Materials and Methods: A thirty years healthy female presented with the chief complaints of right flank pain of 5 years duration (intermittent). On CT angiography a 5.7 x 3.6 cm cystic lesion was seen in the interpolar region in right kidney with enhancement in arterial phase and there was communication of this lesion with both renal artery and renal vein. Preoperative angiography revealed a sac arising from the anterior division of right renal artery.

Results: With the patient in right flank up position and paramedian docking of ports the procedure was performed with Da Vinci Xi. A 4.5 cm AVM was seen arising from anterior division of main renal artery. Vascular control was taken at the main trunk of renal artery and anterior division of renal artery. The sac was excised and ostium repaired with goretex.

Conclusions: Surgical treatment is most likely to cure a large AVM especially in symptomatic female of child bearing age. Minimally invasive treatment in the form of robotic surgery and ligation of feeding vessels, helps in decreasing the morbidity. The option of bench surgery and preparation for auto-transplant may facilitate successful treatment in complex and large AVMs.

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