Defensive mindset with SP retro partial #1

Richard Link

@RoboDocXMar 11

Vascular control may be even more critical in SP regionalized partial nephrectomy given the limited capacity to manage high-volume bleeding with remote suction. Defensive vascular strategies include:

1. Understanding patient-specific vascular anatomy through high-quality preoperative imaging.

2. Ensuring proximal vascular control, facilitated by retroperitoneal access.

3. Looping vessels to allow rapid return to the hilum, particularly in obese patients.

4. Placing multiple low-pressure bulldogs and maintaining elbow position to avoid inadvertent dislodgement.

5. Using ICG or color Doppler frequently to confirm adequate vascular control before resection.

6. Flashing the artery to assess bleeding during early unclamping.

7. Ensuring adequate venous access should clamping be required in right-sided cases.

8. Maintaining disciplined remote suction technique to prevent clogging, including frequent movement and parking on dry gauze.

9. Early unclamping to allow identification of arterial bleeders inside the bed before closure of the defect.

#SP @IntuitiveSurg #partialnx #DefensiveMindset