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Volume 12
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10.3390/jcm12020427
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Article

Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies

by
Aref S. Sayegh
1,
Luis G. Medina
1,
Anibal La Riva
1,
Laura C. Perez
1,
Jaime Poncel
1,
Edward Forsyth
1,
Giovanni E. Cacciamani
1,
Ben Challacombe
2,
Michael Stifelman
3,
Inderbir Gill
1 and
Rene Sotelo
1,*
1
The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
2
Department of Urology, Guy’s and St Thomas NHS Foundation Trust, London SE1 9RT, UK
3
Department of Urology, Hackensack Meridian School of Medicine, Hackensack, NJ 07601, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2023, 12(2), 427; https://doi.org/10.3390/jcm12020427
Submission received: 19 December 2022 / Revised: 30 December 2022 / Accepted: 3 January 2023 / Published: 5 January 2023
(This article belongs to the Section General Surgery)
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Abstract

Injury to the superior mesenteric artery (SMA) is a rare, underreported, and potentially devastating complication. This study aims to propose a systematic workup to describe how to prevent and manage SMA injury in a standardized stepwise manner. Three different instances of intraoperative injury to the SMA are described in an accompanying video. All three occurred when the SMA was misidentified as the left renal artery during left robotic radical nephrectomy. In the first case, the SMA was mistakenly identified as the renal artery, but after further dissection, the real renal artery was identified and SMA injury was prevented. In the second case, the SMA was clipped and the real left renal artery was subsequently identified, requiring clip removal. In the third case, the SMA was clipped and completely transected, requiring prompt repair by vascular surgery with a successful outcome. This study aims to propose a systematic workup to describe how to prevent and manage SMA injury in a standardized stepwise manner. The proper anatomic recognition of the SMA may prevent its injury. Intraoperative SMA injury should be promptly identified and repaired to avoid its devastating consequences.
Keywords: superior mesenteric artery injury; radical nephrectomy; intraoperative complications; robotics; management superior mesenteric artery injury; radical nephrectomy; intraoperative complications; robotics; management

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MDPI and ACS Style

Sayegh, A.S.; Medina, L.G.; La Riva, A.; Perez, L.C.; Poncel, J.; Forsyth, E.; Cacciamani, G.E.; Challacombe, B.; Stifelman, M.; Gill, I.; et al. Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies. J. Clin. Med. 2023, 12, 427. https://doi.org/10.3390/jcm12020427

AMA Style

Sayegh AS, Medina LG, La Riva A, Perez LC, Poncel J, Forsyth E, Cacciamani GE, Challacombe B, Stifelman M, Gill I, et al. Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies. Journal of Clinical Medicine. 2023; 12(2):427. https://doi.org/10.3390/jcm12020427

Chicago/Turabian Style

Sayegh, Aref S., Luis G. Medina, Anibal La Riva, Laura C. Perez, Jaime Poncel, Edward Forsyth, Giovanni E. Cacciamani, Ben Challacombe, Michael Stifelman, Inderbir Gill, and et al. 2023. "Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies" Journal of Clinical Medicine 12, no. 2: 427. https://doi.org/10.3390/jcm12020427

APA Style

Sayegh, A. S., Medina, L. G., La Riva, A., Perez, L. C., Poncel, J., Forsyth, E., Cacciamani, G. E., Challacombe, B., Stifelman, M., Gill, I., & Sotelo, R. (2023). Superior Mesenteric Artery Injury during Robotic Radical Nephrectomy: Scenarios and Management Strategies. Journal of Clinical Medicine, 12(2), 427. https://doi.org/10.3390/jcm12020427

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