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1 accredited content Volume 14, Issue 5, September 2015 ISSN EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) No. 5 available at journal homepage: European Urology Your Platinum Journal EUROPEAN UROLOGY SUPPLEMENTS EU-ACME European Association of Urology Programme and abstracts of the 12th Meeting of the EAU Robotic Urology Section (ERUS) September 2015, Bilbao, Spain Oral Presentations Junior ERUS-YAU nominees Poster abstracts (PJY04-PJY08-PJY12) PJY04 Simulation-based robotic surgery training: Validation of the RobotiX mentor simulator Aydin A., Whittaker G., Raison N., Challacombe B., Khan M., Dasgupta P., Ahmed K. King s College London, Dept. of MRC Centre for Transplantation, London, United Kingdom Introduction and objectives: With robot-assisted surgery becoming more common practice in urology, effective training remains a challenge. Simulation has gained wide acceptance as a method of reducing the initial phase of the learning curve. This study aims to assess face, content and construct validity of the RobotiX Mentor virtual reality simulator. It also aims to assess its acceptability as a training tool and feasibility of its use in training. Material and methods: This prospective, observational and comparative study recruited novice (n=20), intermediate (n=11) and expert (n=8) robotic surgeons as participants from institutions across the United Kingdom. Each participant completed nine surgical tasks across two modules on the simulator, followed by a questionnaire to evaluate subjective realism (face validity), task importance (content validity), feasibility, and acceptability. Outcome measures of novice, intermediate and expert groups were compared using Mann-Whitney U-tests to assess construct validity. Results: Construct validity was demonstrated in a total of 17/25 performance evaluation metrics (p<0.001). Experts performed better than intermediates in regard to time taken to complete the first (p=0.023) and second (p=0.043) module, number of cuts >2mm deep (p=0.035), average distance from suture target (p=0.015), and number of suture breakages (p=0.038). Participants determined both the simulator console and psychomotor tasks as highly realistic (mean: 3.8/5) and very important for surgical training (4.4/5), with diathermy pedals (4.5/5) and knot tying task (4.6/5) scoring highest respectively. The simulator was also rated as an acceptable (4.3/5) tool for training and its use highly feasible (4.4/5). Conclusions: The RobotiX Mentor shows potential as a valuable tool for training and assessment of trainees in robotic skills and may reduce the initial learning curve if utilised as an adjunct to operating-room training. Investigation of concurrent and predictive validity is necessary to complete validation and evaluation of learning curves would provide insight into its value for training. PJY08 Single surgeon perioperative and early continence results of initial 52 cases after graduating ERUS Robotic Urology Curriculum Fellowship (Pilot Study II) for robot-assisted radical prostatectomy (RARP) Salwa P., Wagner C., Schuette A., Addali M., Harke N.N., Witt J. St. Antonius-Hospital, Academic Teaching Hospital Affiliated To The University Münster, Dept. of Urology, Pediatric Urology and Urologic Oncology, Gronau, Germany Introduction and objectives: No validated curriculum for robotic surgery exists so far. The ERUS Pilot Study II aimed at validating the ability of a 6 month structured training program to allow a novice surgeon to perform a complete RARP independently and

2 80 ORAL PRESENTATIONS / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) effectively. Here, we report perioperative efficacy and safety results of initial 52 full cases performed by single surgeon after graduating from fellowship. Material and methods: The fellowship was conducted from January to June It consisted of e-learning, bedside assistances, intensive training consisting of lectures on technical and non-technical skills, laboratory training (virtual reality simulation, dry lab, wet lab on dog cadaver and living anaesthetized pigs) and dual-console live surgery followed by a 5-month modular training at host center. After passing the final evaluation (a full case of RARP was evaluated blindly by robotic experts) the trainee was deemed capable of performing a full case of RARP. Here we report the perioperative and early continence results of initial 52 cases performed from July 2014 to April Results: During initial 10 months after graduating from the Pilot Study II, 52 cases of RARP were performed. Mean age was 65.2 years, BMI 27.5 kg/m2, initial PSA 12.9 ng/ml and a prostate volume of 43.7 ml in TRUS, 61% of patients had a prior abdominal or pelvic surgery. A pelvic lymphadenectomy was performed in every case and 3 patients showed positive lymph nodes. The mean console time was minutes. Estimated blood loss was ml. 29 patients (55.8%) had a local confined disease (T2) in the final pathology, with positive surgical margin in 2 cases. 23 patients (44.2%) had a locally advanced prostate cancer (T3 or T4) with a positive margin in three cases (one T3 and two T4 cases). Catheter was removed on the 5 th postoperative day after inconspicuous cystogram in 96.2% of cases. We observed one major (Clavien 4) and 13 minor (Clavien 1 and 2 i.e. urinary retention, skin allergic reaction and uncomplicated urinary infection) complications. Follow-up with validated questionnaires after 3 months was available in 12 patients, with 9 patients using 0 or 1, whereas 3 patients need 2 or more safety pads. Age (years) 65.2 BMI (kg/m 2 ) 27.5 TRUS (ml) 43.7 Prior abdominal/pelvic surgery (%) 61 Mean ipsa-value (ng/ml) 12.9 Average console time (min) Estimated blood loss (ml) Mean catheterization time (days) 5.5 T2 55.8% T3 40.4% T4 3.8% N+ 5.8% Positive surgical margin in all cases (%) 9,6% in T2 cases 6.9% in T3/T4 cases 13.0% PJY12 Multi-institutional development and validation of the RARP score for training and assessment Lovegrove C.E. 1, Novara G 2, Guru K. 3, Mottrie A. 4, Challacombe B. 1, Raza J. 3, Van Der Poel H. 5, Peabody J. 6, Popert R. 6, Dasgupta P. 1, Ahmed K. 1 1 Guy s Hospital, Dept. of Urology, London, United Kingdom, 2 University of Padua, Dept. of Urology, Padua, Italy, 3 Roswell Park Cancer Institute, Dept. of Urology, Buffalo, United States of America, 4 OLV Hospital, Dept. of Urology, Aalst, Belgium, 5 Netherlands Cancer Institute, Dept. of Urology, Amsterdam, The Netherlands, 6 Henry Ford Hosiptal, Dept. of Urology, Detroit, United States of America Introduction and objectives: Robot assisted surgical training and assessment are critical in assuring optimal outcomes. This study aims to: (1) develop and validate a check-list based training and assessment tool (RARP Score); (2) Evaluate learning curve (LC) of the RARP using RARP score. Material and methods: This multi-institutional, observational, prospective study used HFMEA (Healthcare Failure Mode and Effect Analysis) to identify high risk, critical steps of RARP. A, focus group of specialists was consulted to develop and content validate the RARP Score. Following development, 15 trainees performed RARP cases and were assessed by mentors using this tool. Previously, full follow-up results were unavailable for analysis. The full data-set was analysed relative to RARP experience to examine learning curves for each step. A LC plateau above Score 4 was indicative of competence for a given step. Results: 5 surgeons were observed for 42 console hours to map steps of RARP. HFMEA identified 84 failure modes and 46 potential causes with Hazard score 8. Content validation by experts (US, UK, Europe) created the RARP Score of 17 stages and 41 steps (Figure 1). This was acceptable, feasible with educational impact. Conclusions: After graduating from ERUS Robotic Urology Curriculum Fellowship Pilot Study II, a fellow was able to perform 52 RARPs in a safe and efficient manner despite the fact that 44% of the patients had a locally advanced disease. Early continence results are promising, however complete functional recovery could better be assessed after longer (i.e. 12 months after surgery) follow-up. Further limitation of this report is a moderate number of performed cases.

3 ORAL PRESENTATIONS / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) trainees were assessed for 8 months. They participated in 426 RARP cases (Range 4-79) and, all 17 procedural steps were attempted. Of reported data, the majority of cases were T stage 2 (40.3%), N stage 0 (59.9%) and Intermediate D Amico risk (36.1%). Learning curves derived demonstrated several findings. Of note were plateaus for Anterior Bladder Neck Transection (16 cases), Posterior Bladder Neck Transection (18 cases- Figure 2.), Posterior Dissection (9 cases), Dissection of Prostatic Pedicle and Seminal Vesicles (15 cases) and Anastomosis (17 cases). For the rest of the steps the LC did not plateau for the data collection period (e.g. Expose Prostatic Apex and Endopelvic Fascia; 31 cases, Stitching and Division of Dorsal Venous Plexus; 32 cases). vas deferens. The ureter is dissected distal to the vas and tented up with a tape. After that left ureter was clipped and sutured with a 3-0 vicryl suture in watertight fashion. Tailoring for the dilated distal rest ureter is performed. The bladder is elevated with suture through the abdominal wall. A 4 cm detrusorotomy is performed. Mucosa is cut for anastomosis. 6 F nelaton catheter is placed through urethra and bladder inside the left tailored ureter. Ureterovesical anastomosis is made with a 4-0 monocryl suture. Detrusorraphy is performed by a 3-0 barbed suture. The parietal peritoneum closed. Foley catheter, nelaton catheter and drain are left at the end of the procedure. Results: Console time for the operation was 82 minutes for our unilateral case. No perioperative complications were seen. Perioperative blood loss was minimal and postoperative pain was none. 11-month result of this patient is satisfactory. He has normal urine flow through left ureterovesical junction. Conclusions: RALUR is a technically feasible approach for VUR, UVS and the other ureteral pathologies. With this video presentation we tried to explain the technique of tailoring and RALUR and wanted to recommend usage of barbed suture for detrusorraphy. We think to accept this technique as an alternative of open repair it is needed larger case series of tailoring and RALUR according to the literature. VJY04 Tips and tricks in robotic prostatectomy: Appropriate endoscope selection to bail you out of challenging cases Fuentes Pastor J., Sridhar A., Goldstraw M., Lamb B.W., Cathcart P., Senthil N., Kelly J., Timothy B. University College London Hospital (UCLH), Dept. of Urology, London, United Kingdom Conclusions: RARP score based on HFMEA methodology identified critical hazardous steps specific to RARP and was used to assess and evaluate surgeons while performing RARP. The learning curves derived demonstrate the experience necessary to reach competence in essential technical skills required to protect patient safety. Junior ERUS-YAU nominees Video abstracts (VJY01-VJY04-VJY06) VJY01 Robot assisted laparoscopic left ureteral reimplantation for uretero-vesical stricture Yalcin S., Kibar Y. Gülhane Military Medical Academy, Dept. of Urology, Ankara, Turkey Introduction and objectives: Extravesical robot-assisted laparo scopic ureteral reimplantation (RALUR) for ureterovesical strictures (UVS) is an alternative to the gold standard open repair. With this video presentation we want to share our initial experience for a 5 year old boy patient who is the youngest patient received this intervention in Turkey. Material and methods: We have performed 8 RALUR procedure for adult and pediatric patients in our clinic. This patient explained in the video was a 5-year-old boy who has had recurrent infections due to this condution. When the patient applied to our clinic he had already grade 4 left ureterohydronephrosis. We performed left sided RALUR procedure for this patient. Technique: The DaVinci SI system was used via a transperitoneal approach. We used a 4 port configuration for the procedure. Modified Trendelenburg (approximately 10o) position was used. Following docking, the ureter is identified closed to the Introduction and objectives: The 3- dimensional endoscopic view is central to robot assisted laparoscopic surgery. Visualization of critical strictures ateach step of the procedure is essential for precise dissection and in turn favourable outcomes. The 0 0 scope does not always provide complete visualization of anatomy. This video demonstrates the use of the 30 0 angled lens for improved visualization in challenging scenarios. Material and methods: We expose in the video how the use of different positions of the 30º angle scope (30º up/30º down) can be helpful during different steps of robotic radical prostatectomy: Bladder neck dissection, dissection of the seminal vesicles and bladder neck reconstruction. Results: We show in the video how the use of 30º down scope is useful in the bladder neck dissection providing better view, also in the dissection of the seminal vesicles and in the bladder neck reconstruction. On the other hand the use of 30º up scope might be helpful in the dissection of the puboprostatic ligaments and the dorsal vein complex in patients with prominent pubic bone. Conclusions: Use of the 30º angle scope is helpful during challenging cases. Identifying when to use one or the other will help to achieve better result during the surgery. VJY06 Laparoscopic robot-assisted heminephrectomy in a patient with left duplex collector system and ectopic uretrocele to vagina Morales Higelmo G., Gutierrez Garcia M.A., Estebanez Zarranz J., Belloso Loidi J., Cano Restrepo C., Peralta Durango J.M., Rubio Calaveras V., Sanz Jaka J.P. Donostia Universitary Hospital, Dept. of Urology, San Sebastian, Spain Introduction and objectives: Robot-assisted laparoscopy indications in Urology are increasing. Among thus indications, not only oncological diseases but also benign ones may have an important place.

4 82 ORAL PRESENTATIONS / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) We present the case of 44 years-old woman with a left duplex collector system and ectopic ureterocele to vagina, assessed at outpatient clinic due to persistent lumbar pain, dyspareunia and multiple UTIs, to whom we offered robot-assisted laparoscopy to correct the defect. Material and methods: In this 7 minute video we describe the case and the surgery, for which we use the S model Da Vinci robot we have since 2008, using its fourth arm in several movements during the surgery. We first setted up a ureteral catheter in the healthy left ureter. After identifying the upper pole ureter and liberate it we performed the heminephrectomy. Later we released the splitted ureter until we achieved vagina. A main surgeon and an assistant worked with the four arms of the robot, with the essential help of two trained nurses. Results: The patient of the case presented in the video undergoes really a satisfactory recovery after surgery, with minimal bleeding and no complications. Discharge took place only 4 days after the intervention, with completely functional recovery. Conclusions: According to our experience robot-assisted laparoscopy is a good alternative for well selected patients with benign urological disease, such as duplex collector system, who need surgical treatment, with less invasive approach and fast recovery. ERUS Poster abstracts (PE13-PE18-PE31) PE13 Complications after totally intracorporeal robot-assisted radical cystectomy: Results from the ERUS scientific working group Hosseini A. 1, Collins J.W. 1, Koupparis A. 2, Rowe E. 2, Perry M. 3, Issa R. 3, Adding C. 1, Nyberg T. 4, Schumacher M.C. 5, Wijburg C. 6, Canda A.E. 7, Balbay M.D. 8, Decaestecker K. 9, Schwentner C. 10, Stenzl A. 10, Edeling S. 11, Pokupić S. 11, Guru K. 12, Mottrie A. 13, Wiklund N.P. 1 1 Karolinska, Dept. of Urology, Stockholm, Sweden, 2 Bristol Urological Institute, Dept. of Urology, Bristol, United Kingdom, 3 St Georges, Dept. of Urology, London, United Kingdom, 4 Karolinska, Dept. of Clinical Cancer Edpidemiology, Stockholm, Sweden, 5 Hirslanden Klinik, Dept. of Urology, Aarau, Switzerland, 6 Rijnstate, Dept. of Urology, Arnham, The Netherlands, 7 Ankara Ataturk Hospital, Dept. of Urology, Ankara, Turkey, 8 Memorial Sisli Hospital, Dept. of Urology, Istanbul, Turkey, 9 Ghent University, Dept. of Urology, Ghent, Belgium, 10 University of Tuebingen, Dept. of Urology, Tuebingen, Germany, 11 Da Vinci Zentrum, Dept. of Urology, Hanover, Germany, 12 Roswell Park Cancer Institute, Dept. of Urology, Buffalo, United States of America, 13 O.L.V. Hospital, Dept. of Urology, Aalst, Belgium Introduction and objectives: Radical cystectomy is associated with high complications rates irrespective of surgical approach. Worldwide most centers performing robot-assisted radical cystectomy (RARC) perform an extracorporeal urinary diversion, despite potential advantages of a completely minimally invasive technique. We describe complication outcomes after totally intracorporeal RARC from a multi-institutional database using a standardized and validated reporting methodology. Material and methods: Using the ERUS Scientific Working Group (ESWG) database, we identified 621 patients who underwent totally intracorporeal RARC with at least 90d of follow-up. Complications were analyzed and graded according to the Clavien-Dindo Classification system and were further stratified by organ system. Secondary outcomes included identification of preoperative and intraoperative variables associated with the complications. Logistic regression models were used to define predictors of complications and readmission, using backward selection (p<0.05). Results: Overall 55% (n=343) of patients experienced a complication within 90 days of their operation, 49% (n=306) and 17% (n=103) within 30d and 30-90d of surgery respectively. 32% of patients (n=197) experienced low grade complications (Clavien grade 1-2) and 23.5% (n=146) experienced high grade complications (Clavien grade 3). Thirty and 90-d mortality was 0.6% and 1.9%, respectively. Overall 30d readmission rate was 25%. Complications were classified according to body system effected and were then tabulated. Infectious, gastrointestinal and genitourinary complications were most common (41%, 19%, and 15%, respectively). On multi-variable analysis of 0-90d complications we found neobladder diversion and ASA grade to be predictors of any grade complications. As a multi-institutional database, disparities in patient selection, operating standards and postoperative management are potential limitations of this study. Conclusions: Surgical morbidity after totally intracorporeal RARC is significant when reported using standardized reporting methods. The majority of complications are low grade. Neobladder diversion and increased ASA grade increase the risk of any grade complication. Accurate reporting of complications is necessary to clarify optimum approaches to radical cystectomy and to guide patient counselling. PE18 Comparative effectiveness of robot assisted vs. open radical prostatectomy in intermediate and high-risk patients Gandaglia G., Suardi N., Fossati N., Cucchiara V., Dell Oglio P., Moschini M., Larcher A., Gaboardi F., Gallina A., Montorsi F., Briganti A. University Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy Introduction and objectives: Evidence is scarce regarding the comparison of perioperative, functional, and oncologic outcomes between open (ORP) and robot-assisted radical prostatectomy (RARP) in intermediate and high-risk Prostate cancer (PCa). We hypothesized that technical advantages associated with minimally invasive surgery might lead to superior outcomes. Material and methods: Overall, 1,975 patients with intermediate and high-risk PCa according to D Amico criteria treated between 2008 and 2014 were identified. Erectile function (EF) recovery was defined as an International Index of Erectile Function EF domain (IIEF-EF) 22. Urinary continence (UC) was defined as being completely pad free over a 24-hour period. Multivariable logistic and Cox regression models were used to test the impact of RARP on perioperative and functional outcomes after accounting for confounders. Multivariable Cox regression analyses the impact of RARP on the risk of BCR (defined as two consecutive PSA 0.2ng/ml) in patients with high-risk disease (n=607). To decrease the effect of unmeasured confounders, these analyses were repeated in a propensity score matched cohort. Results: Mean age was 64.8 years. Median follow up was 27 months. Overall, 1,162 (58.8%) and 813 (41.2%) patients were treated with ORP and RARP, respectively. Patients treated with RARP had lower median blood loss (250 vs. 800 ml, P<0.001), transfusions (4.6 vs. 14.8%, P<0.001), and length of stay (6 vs. 8 days, P<0.001). No differences were observed with regards to Clavien III-V complications (5.1 vs. 6.2%, P=0.2). In logistic regression analyses, RARP was associated with lower odds of transfusions and prolonged length of stay (P<0.001). Patients treated with RARP had higher 3-year UC (81.1 vs. 68.8%; P<0.001) and EF (66.3 vs. 49.5%; P=0.01) recovery rates. In multi-variable analyses, RARP was associated with higher probability of UC (P<0.001) and EF (P=0.02) recovery. When evaluating high-risk

5 ORAL PRESENTATIONS / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) patients, no differences were observed between ORP and RARP with regards to 3-year BCR-free survival rates (P=0.6). This was confirmed in multi-variable regression analyses and after propensity score matching (all P>0.05). Conclusions: RARP is associated with better perioperative and functional outcomes in intermediate and high-risk PCa. Short-term oncologic outcomes are comparable between ORP and RARP. The potential benefits of RARP should be taken into account provided a need for longer cancer control assessments. PE31 Evolution from laparoscopic to robotic nephron sparing surgery a high volume laparoscopic center experience on achieving TRIFECTA outcomes Sivaraman A., Carneiro A., Sanchez-Salas R., Barret E., Prapotnich D., Rozet F., Galiano M., Mombet A., Cathala N., Cathelineau X. Institute Mutualiste Montsouris, Dept. of Urology, Paris, France Introduction and objectives: Our primary objective was to evaluate the TRIFECTA - renal functional outcomes, margin status and complications of nephron sparing surgery after the introduction of robotic partial nephrectomy (RPN) program and compare with our conventional laparoscopic (LPN) partial nephrectomy outcomes. Material and methods: A prospectively maintained database of partial nephrectomy (PN) at our institution from 2001 to 2014 was reviewed and we identified 347 patients (LPN= 303, RPN=44). RPN program was started in our institution 10 years after the start of LPN program. Patients were chronologically divided into Group 1 first 151 LPN, Group 2 remaining 152 LPN and Group 3 all RPN patients. Trifecta outcomes were defined as warm ischemia time (WIT) 25min, no positive surgical margin and complications Clavien 2. Renal functional outcomes were defined as achieving 80% of the baseline creatinine clearance at 3 months following surgery. Results: The patient demographics were similar between the groups (Table 1). The tumor complexity mean tumor size and % of endophytic tumor significantly increased from G1 to G3. We achieved lower WIT and complications Clavien 2 in significantly higher patients from G1 to G3 and the trend continued even with transition to RPN. The rate of complication Clavien 3-4 trend to decrease in the group 2 and group 3 (p=0.06). Our positive surgical margin were consistently low throughout the transition. Renal functional outcomes always showed a significant positive trend and with RPN we achieved improved recovery of renal function (44% vs 57% vs 79%. p < 0.05) and fewer new onset stage 3 5 CKD (21.6% vs 9.6% vs 22.6%. p < 0.05) even with more complex cases. We improved our overall Trifecta rates significantly from G1 to G2 and then achieved it in 81.8% of patients in RPN (48% vs 75,6% vs 81% (p<0.01). Conclusions: With the introduction of robotic assistance in nephron sparing surgery in our institution, the tumor complexity increased and the trifecta outcomes continue to improve than our conventional LPN in fewer cases. Table 1. Baseline clinical and tumor characteristics. Group 1 Group 2 Group 3 p value (n=151) (n=152) (n=44) (all Groups) Sex 0.48 Male (%) Female (%) Age, years (mean/sd) 58.9 (12) 60.17(11) 59(13) 0.63 BMI, kg/m 2 (mean/sd) 24.9(3.8) 25.6(4.5) 25.1(3.7) 0.42 Solitary kidney (%) Tumor side 0.61 Right (%) Left(%) No Clamping (%) Tumor size (mean/sd) 27.33(12) 31.5(18) 34.8(11.5) Tumor location 0.85 Upper pole Inter-polar Lower Pole Exophitic tumor* (%) # Baseline e-gfr (mean/sd) 74.8(64) 100(108) 89(33) # * More than 50% Exophitic # - p<0.05 G1vsG2 - p<0.05 G1vsG3 - p<0.05 G2vsG3 Table 2. Perioperative outcomes. Group 1 Group 2 Group 3 p value Variables (n=151) (n=152) (n=44) (all Groups) WIT, min (mean/sd) 20.9(14.5) 15(11) 14(8.7) <0.001 # Surgical time, min 138(53) 130(42) 118(39) (mean/sd) Estimative of blood loss, 289(410) 287(294) 255(297) 0.85 ml (mean/sd) Perioperative complication (%) Clavien Grade 3 or more complications (%) Conversion (%) Days in the hospital 5.5(3.2) 6.5(3.8) 5.5(1.4) 0,019# (mean/sd) Negative surgical margin (%) Trifecta (%) # # p<0.05 G1 vs G2 p<0.05 G1 vs G3 p<0.05 G2 vs G3 ERUS Video abstracts (VE05-VE12-VE24) VE05 Robotic assisted extended pelvic lymph node dissection (eplnd) in bladder cancer. Technique step-by-step Pini G., Suardi N., Broglia L., Bellinzoni P., Grosso A., Gadda G., Capogrosso P., Gaboardi F. San Raffaele Hospital, Ville Turro, Dept. of Urology, Milan, Italy Introduction and objectives: The standard treatment of muscle invasive bladder cancer is radical cystectomy and bilateral pelvic lymph node dissection. Lymph node positivity is one of the most important indicators of poor prognosis and accounts 15-30% of five-year overall survival. Nodal metastasis above a limited or standard template is not uncommon. There is increasing evidence that extended LND improves survival and the accuracy of cancer staging. However, the ideal proximal limit of LND is still controversial. In this video, we present the common extended pelvic lymph node dissection (eplnd) performed in our center whenever performing a robotic radical cystectomy. Material and methods: After inducing the peritoneum in a blind blade less technique 3 8-mm robotic ports are inserted. Further 2 trocars (12- and 5-mm) for assistant are introduced under vision. Common robotic instruments adopted in this phase are

6 84 ORAL PRESENTATIONS / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) monopolar curved scissors (right arm); bipolar PK or Maryland (left arm) and prograsp forceps (3rd arm). Si HD davinci robotic system is used. Results: Robotic eplnd is performed before radical cystectomy. The limit of dissection are: proximally the ureter cross over the common iliac artery; laterally the genitofemural-nerve and psoas muscle; caudally Cloquet s node; medially peritoneal sheet, umbilical artery and lateral edge of the bladder. Lymphnode are removed en-block following a split and roll technique. Conclusions: E-PLND can be safely performed robotically during radical cystectomy in the management of bladder cancer. The robot assistance is particularly well suited with superior visibility and ergonomics for the management of complex procedures where a precise dissection is needed. The Endowrist technology, and the Clutch function, will overcome the difficulties encountered in a pure laparoscopic approach. VE12 Robot assisted laparoscopic kidney transplantation following vaginal insertion with a living donor graft: Surgical technique Doumerc N. 1, Roumiguie M. 1, Sallusto F. 1, Beauval J.B. 1, Game X. 1, Thoulouzan M. 1, Souile M. 1, Rostaing L. 2, Rischmann P. 1 1 CHU Rangueil, Dept. of Urology, Toulouse, France, 2 CHU Rangueil, Dept. of Nephrology, Toulouse, France Introduction and objectives: Robot assisted laparosopic kidney transplantation technique with vaginal approach was recently reported by a single indian tertiary centre. We here describe a modified technique which allowed transplantation with a totally robotic approach in less than 200 min. Material and methods: Case: 50 years old female receiving a living donor transplant for end stage kidney chronic disease. We used a 4-arm Si HD Da Vinci Intuitive Surgical device with standard port placement. Here following steps were performed in sequential order: Transperitoneal dissection of the external vessels, uterine mobilization with transparietal stitchi to allow full visualization of the posterior vaginal wall used for graft insertion through a Alexis (Applied corporation) retractor, vagina one layer running suture, continuous monitoring of the kidney surface temperature, vascular anastomosis, retroperitonealization of the kidney, Lich-Gregoir technique ureterocystostomy anastomosis with double-j stent. Results: The operative time was 200 min, vascular anastomosis time was 55 min and. No per and post-operative complications were observed. Patient was discharged 10 days postoperatively with normal doppler ultrasound of the renal vessels and a normal kidney function. Conclusions: We here show that trained console surgeons can make use of the principles of robotic surgery in kidney transplantation to reduce the impact of open renal transplantation (aesthetic, pain, lymphocele, eventration and wound infections) in selected female patients. VE24 Common pitfalls and surgical errors in robotic assisted radical prostatectomy: Lessons learned after 7000 cases Dutto L. 1, Wagner C. 2, Witt J. 2 1 University College London Nhs Foundation Trust, Dept. of Urology, London, United Kingdom, 2 Prostatazentrum Nordwest, St. Antonius-Hospital, Dept. of Urology, Gronau, Germany Introduction and objectives: Robotic assisted radical prostatectomy (RARP) is a complex procedure with a steep learning curve [1,2,3,4]. Numerous publications and surgical videos have described the most serious and significant complications that may occur during this procedure. There are however a series of less serious surgical errors that are often committed when performing RARP. These mistakes which may or may not lead to complications have not often been described. Nonetheless they could play a role for operative times, complications and for the standardization of oncological and functional results within an institution s learning curve. Our institution is a high volume center for radical prostatectomies (>7000 RARP/year) and a high volume training center for RARP, with 2 fellows trained per year and 14 surgeons trained so far. We would like to share our experience on a series of mistakes that are commonly made during the acquisition of this complex technique. Aim of the Study: To describe the most common surgical and technical mistakes that may occur during RARP. Material and methods: Complications and surgical errors were retrospectively collected from our institution s patient- and video database. The video footage was edited and the surgical errors were presented in a modular fashion that reflects the various steps of RARP. In addition, we analyzed how such mistakes are generated and attempted to summarize how these mistakes may be avoided by establishing a list of surgical bullet points for each step. Results: RARP is difficult to master. We attempted to establish a list of surgical principles to keep in mind during RARP. We think that these principles may result to be useful for less experienced, as well as for veteran surgeons who are approaching RARP. References 1. Novara G et Al.. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol Sep;62(3): Murphy DG et Al. Downsides of robot-assisted laparoscopic radical prostatectomy: Limitations and complications. Eur Urol May;57(5): Ficarra V et Al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: A systematic review and cumulative analysis of comparative studies. Eur Urol May;55(5): Thompson JE et Al. Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: A prospective single-surgeon study of 1552 consecutive cases. Eur Urol Mar;65(3):521-31