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Chen TC, Liang JT. Robotic low anterior resection of rectal cancer with partial resection of urinary bladder and reconstruction - a video vignette. Colorectal Dis 2018; 20:354. [PMID: 29341403 DOI: 10.1111/codi.14017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/12/2017] [Indexed: 02/08/2023]
Affiliation(s)
- T-C Chen
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Hsinchu Branch, Taipei, Taiwan
| | - J-T Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Chan C, Chiu AW, Chen M, Hsu JM, Yang S, Lin WR. A comparative study of laparoscopic and robotic assisted radical prostatectomy performed by a single surgeon. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Alvin LWX, Gee SH, Hong HH, Christopher CWS, Henry HSS, Weber LKO, Hoon TP, Shiong LL. Oncological outcomes following robotic-assisted radical prostatectomy in a multiracial Asian population. J Robot Surg 2015; 9:201-9. [PMID: 26531200 DOI: 10.1007/s11701-015-0516-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/02/2015] [Indexed: 11/26/2022]
Abstract
This study evaluates the oncological outcomes of RARP in a multiracial Asian population from a single institution. All suitable patients from 1st January 2003-30th June 2013 were identified from a prospectively maintained cancer registry. Peri-operative and oncological outcomes were analysed. Significance was defined as p < 0.05. There were n = 725 patients identified with a mean follow-up duration 28 months. The mean operative time, EBL and LOS were 186 min, 215 ml and 3 days, respectively. The pathological stage was pT2 in 68.6% (n = 497/725), pT3 in 31.3% (n = 227/725) and n = 1 patient with pT4 disease. The pathological Gleason scores (GS) were 6 in 27.9% (n = 202/725), GS 7 in 63.6% (n = 461/725) and GS ≥ 8 in 8.0 % (n = 58/725). The node positivity rate was 5.8% (n = 21/360). The positive margin rates were 31.0% (n = 154/497) and 70.9% (n = 161/227) for pT2 and pT3, respectively, and decreasing PSM rates are observed with surgical maturity. The biochemical recurrence rates were 9.7% (n = 48/497) and 34.2% (n = 78/228) for pT2 and pT3/T4, respectively. On multivariate analysis, independent predictors of BCR were pathological T stage and pathological Gleason score. Post-operatively, 78.5% (n = 569/725) of patients had no complications and 17.7% (n = 128/725) had minor (Clavien grade I-II) complications. This series, representing the largest from Southeast Asia, suggests that RARP can be a safe and oncologically feasible treatment for localised prostate cancer in an institution with moderate workload.
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Affiliation(s)
- Low Wei Xiang Alvin
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Sim Hong Gee
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Huang Hong Hong
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Cheng Wai Sam Christopher
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Ho Sien Sun Henry
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Lau Kam On Weber
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Tan Puay Hoon
- Department of Pathology, Singapore General Hospital, Singapore, 169856, Singapore
| | - Lee Lui Shiong
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore.
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Ku JY, Ha HK. Learning curve of robot-assisted laparoscopic radical prostatectomy for a single experienced surgeon: comparison with simultaneous laparoscopic radical prostatectomy. World J Mens Health 2015; 33:30-5. [PMID: 25927060 PMCID: PMC4412005 DOI: 10.5534/wjmh.2015.33.1.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 12/31/2014] [Accepted: 01/10/2015] [Indexed: 11/15/2022] Open
Abstract
Purpose Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. Materials and Methods A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. Results Mean operation time and length of hospital stay for RARP and LRP were 145.5±43.6 minutes and 118.1±39.1 minutes, and 6.4±0.9 days and 6.6±1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). Conclusions Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.
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Affiliation(s)
- Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Busan, Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Busan, Korea. ; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Bang SL, Png KS, Yeow YY, Tan GYM, Chong YL. Developing technical expertise in robot-assisted laparoscopic prostatectomy in a moderate-volume center through a proctor-based team approach. J Robot Surg 2014; 8:245-50. [PMID: 27637685 DOI: 10.1007/s11701-014-0460-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
Abstract
Our aim is to report our preliminary experience of a proctor-based team approach in robot-assisted laparoscopic prostatectomy (RALP) for the treatment of localized prostate cancer. Data was collected between December 2008 and February 2012. RALP was performed on 100 consecutive patients with prostate cancer by a team of five urologists proctored by two fellowship-trained surgeons from a single hospital. Clinical and pathological data of these patients were reviewed. The mean age of the patients was 66 years (range 48-76). Clinical stages were 82 % cT1c, 3 % cT1b, 13 % cT2a and 2 % cT3a disease. Preoperative mean prostate-specific antigen level was 11.33 ng/ml (SD 10.47). Mean operative time was 342 min and mean blood loss was 717 ml (SD 988). Mean hospital stay and duration of the indwelling catheter were 3.2 days (SD 1.8) and 12.6 days (SD 8.5), respectively. Pathological staging showed 65 patients with pT2a (65 %) disease and 33 patients with pT3a (33 %) disease. Thirty-five patients (35 %) had positive surgical margins. Eighteen patients underwent adjuvant radiotherapy. Overall postoperative complication rate was 14 %. There were six Clavien grade 1 complications, seven Clavien grade 2 complications and one Clavien grade 3 complication. At mean follow-up of 36 months, 100 % of patients remained free of biochemical recurrence with continence at 70 %. Our proctor-based team approach will continue to improve each surgeon's technical competency. He or she will continue to improve and gradually move on to achieving his or her outcomes learning curve.
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Affiliation(s)
| | | | - Yu Yi Yeow
- Tan Tock Seng Hospital, Singapore, Singapore
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Patel VR, Shah K, Palmer KJ, Thaly R, Coughlin G. Robotic-assisted laparoscopic radical prostatectomy: a report of the current state. Expert Rev Anticancer Ther 2014; 7:1269-78. [PMID: 17892427 DOI: 10.1586/14737140.7.9.1269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cancer of the prostate is the most common malignancy diagnosed in the male genitourinary tract. Although a number of treatment options are available for early prostate cancer, the gold standard of treatment remains retropubic radical prostatectomy. However, robotic-assisted laparoscopic radical prostatectomy (RALP) has become a forerunner in treatment options, yielding comparable medium-term perioperative and functional outcomes. For this our team utilized MEDLINE, searching for publications on perioperative and functional outcomes related to robotic prostatectomy. Robotic-assisted prostatectomy has allowed urologists to enter the realm of minimally invasive surgery by incorporating open surgery maneuvers into a laparoscopic environment. To date, RALP perioperative and functional outcomes are comparable to the gold standard; the collection of long-term data is needed in order to establish its true efficacy.
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Affiliation(s)
- Vipul R Patel
- Center for Robotic & Computer-Assisted Surgery, 410 W. 10th Avenue, 538 Doan Hall, Columbus, Ohio 43210-1228, USA.
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Seo DY, Cho HJ, Cho JM, Kang JY, Yoo TK. Experience with robot-assisted laparoscopic radical prostatectomy at a secondary training hospital: operation time, treatment outcomes, and complications with the accumulation of experience. Korean J Urol 2013; 54:522-6. [PMID: 23956827 PMCID: PMC3742904 DOI: 10.4111/kju.2013.54.8.522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 06/18/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the learning curve and outcomes of robot-assisted laparoscopic radical prostatectomy (RALP) performed by a relatively lower volume surgeon at a secondary training hospital. Materials and Methods The medical records and the surgery video recordings of 100 patients who underwent RALP by a single surgeon between March 2010 and January 2013 were reviewed. The first 10 cases were grouped into period 1, cases 11 to 40 into period 2, cases 41 to 70 into period 3, and cases 71 to 100 into period 4. The interval between the operations, the operative time for each step of the surgery, the total console time, and the operative outcomes were investigated. Results The mean interval between surgeries was 10.6±9.3 days. The console time decreased progressively after the first 10 cases and reached under 3 hours after 75 cases. The time taken to begin dissection of the dorsal vein complex, for the division of the bladder neck, for lateral dissection with neurovascular bundle preservation, and for apex dissection decreased significantly with experience, although the time for vesicourethral anastomosis did not. The margin-positive rate of stage T2 patients was 27.4% (20/73), and the transfusion rate was 50% in period 1 patients and 3.3% in period 4 patients. No major complications occurred. Conclusions It is difficult to shorten the learning curve of surgeons in secondary training hospitals owing to the smaller number of cases and the irregular surgical intervals. Although the operation time was relatively longer, the surgical outcome and complication rates were comparable with those of surgeons at larger hospitals.
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Affiliation(s)
- Do Young Seo
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW The shift toward robot-assisted laparoscopic radical prostatectomy has reshaped the surgical approach for localized prostate cancer in America and many parts of Europe. Its impact on Asia, however, has been somewhat delayed and less widespread compared with western countries. We reviewed and surveyed the evolving trends in robotic prostatectomy in east Asia and describe how the influence of cancer demography, financial reimbursement models, refinements in robotic technology and robotic surgical training will alter the future direction of the procedure in this region. RECENT FINDINGS There are about 50 systems installed in east Asia. Numerous centers have reported successful implementation of robotic prostatectomy program, with transfusion rate of 7-26.4%. Margin positivity for T2 disease ranges from 9.8 to 24%, whereas continence rates range from 75 to 94% over 3-6 months. Significant increase in number of prostatectomy has been observed in some centers. SUMMARY The outlook for robotic prostatectomy in east Asia remains rosy despite the obstacles in financial reimbursement, patient volume and surgical skill development. Future robotic systems with smaller footprint, leaner instrument arms and lower costs will help to accelerate its integration into more Asian hospitals.
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Lee JW, Jeong WJ, Park SY, Loreazo EIS, Oh CK, Rha KH. Learning curve for robot-assisted laparoscopic radical prostatectomy for pathologic t2 disease. Korean J Urol 2010; 51:30-3. [PMID: 20414407 PMCID: PMC2855468 DOI: 10.4111/kju.2010.51.1.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 09/16/2009] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the learning curve for robot-assisted laparoscopic radical prostatectomy (RALP) for pathologic T2 disease, we examined differences in perioperative outcomes according to time period. Materials and Methods Between July 2005 and June 2008, a total of 307 consecutive patients underwent RALP for prostate cancer and 205 patients had pathologic T2 disease. Patients were grouped into 6-month time periods. We collected and examined the patient's perioperative data including age, body mass index (BMI), prostate-specific antigen (PSA), operation time, estimated blood loss, and positive surgical margin. Results There were no significant differences among the groups in age (p=0.705), BMI (p=0.246), PSA (p=0.425), or prostate volume (p=0.380). Operation time (p<0.001) and estimated blood loss (p<0.001) decreased significantly with time. The positive surgical margin rate also showed a decreasing trend, but this was not significant (p=0.680). Conclusions Operation time and estimated blood loss had a steep learning curve during the early 24 cases and then stabilized. A positive surgical margin rate, however, did not have a significant learning curve, although the positive surgical margin decreased continuously.
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Affiliation(s)
- Jae Won Lee
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
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Murphy DG, Bjartell A, Ficarra V, Graefen M, Haese A, Montironi R, Montorsi F, Moul JW, Novara G, Sauter G, Sulser T, van der Poel H. Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications. Eur Urol 2009; 57:735-46. [PMID: 20036784 DOI: 10.1016/j.eururo.2009.12.021] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 12/10/2009] [Indexed: 11/29/2022]
Abstract
CONTEXT Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. OBJECTIVE The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. EVIDENCE ACQUISITION A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. EVIDENCE SYNTHESIS RALP has the following principal downsides: (1) device failure occurs in 0.2-0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. CONCLUSIONS Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients.
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Affiliation(s)
- Declan G Murphy
- Department of Urological Oncology, The Peter MacCallum Cancer Centre, Melbourne, Australia.
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Is the transition from open to robotic prostatectomy fair to your patients? A single-surgeon comparison with 2-year follow-up. J Robot Surg 2009; 3:201-7. [DOI: 10.1007/s11701-009-0162-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 10/18/2009] [Indexed: 11/26/2022]
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Watts R, Botti M, Beale E, Crowe H, Costello AJ. Patient outcomes in the acute recovery phase following robotic-assisted prostate surgery: A prospective study. Int J Nurs Stud 2009; 46:442-9. [PMID: 17825304 DOI: 10.1016/j.ijnurstu.2007.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 03/20/2007] [Accepted: 07/04/2007] [Indexed: 01/03/2023]
Abstract
BACKGROUND Robotic-assisted minimally invasive urologic surgery was developed to minimise surgical trauma resulting in quicker recovery. It has many potential benefits for patients with localised prostate cancer over traditional surgical techniques without taking a risk with the oncological result. OBJECTIVES To report the specific surgical outcomes for the first Australian cohort of patients with localised prostate cancer that had undergone robotic-assisted radical prostatectomy (RARP) surgery. The outcomes represent the acute (in-hospital) recovery phase and include pain, length of stay (LOS), urinary catheter management and wound management. METHODS Prospective descriptive survey of 214 consecutive patients admitted to a large metropolitan private hospital in Melbourne, Australia between December 2003 and June 2005. Patients had undergone RARP surgery for localised prostate cancer. Data were collected from the medical records and through interview at the time of discharge. Descriptive statistics were used to describe the frequency and proportion of outcomes. Patient characteristics were tabulated using cross tabulation frequency distribution and measures of central tendency. RESULTS The findings from this study are highly encouraging when compared to outcomes associated with traditional surgical techniques. Transurethral catheter duration (median 7 days (IQ range 2)) and LOS (median 3 days (IQ range 2)) were considerably reduced. While operation time (median 3.30 h (IQ range 1.07)) was marginally reduced we would expect a further reduction as the surgical team becomes more skilled. CONCLUSION The findings from this study contribute to building a comprehensive picture of patient outcomes in the acute (in-hospital) recovery phase for a cohort of Australian patients who have undergone RARP surgery for localised prostate cancer. As such, these findings will provide valuable information with which to plan care for patients' who undergo robotic-assisted surgery.
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Affiliation(s)
- Rosemary Watts
- Centre for Clinical Nursing Research, Epworth Hospital/Deakin University, 89 Bridge Road, Melbourne, Vic. 3121, Australia.
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Ko YH, Ban JH, Kang SH, Park HS, Lee JG, Yoon DK, Kim JJ, Cheon J, Patel VR. Does robot-assisted laparoscopic radical prostatectomy enable to obtain adequate oncological and functional outcomes during the learning curve? From the Korean experience. Asian J Androl 2009; 11:167-75. [PMID: 19151734 DOI: 10.1038/aja.2008.52] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy (RALRP) during the learning curve, in terms of surgical, oncological and functional outcomes, we conducted a prospective survey on RALRP. From July 2007, a single surgeon performed 63 robotic prostatectomies using the same operative technique. Perioperative data, including pathological and early functional results of the patient, were collected prospectively and analyzed. Along with the accumulation of the cases, the total operative time, setup time, console time and blood loss were significantly decreased. No major complication was present in any patient. Transfusion was needed in six patients; all of them were within the initial 15 cases. The positive surgical margin rate was 9.8% (5/51) in pT2 disease. The most frequent location of positive margin in this stage was the lateral aspect (60%), but in pT3 disease multiple margins were the most frequent (41.7%). Overall, 53 (84.1%) patients had totally continent status and the median time to continence was 6.56 weeks. Among 17 patients who maintained preoperative sexual activity (Sexual Health Inventory for Men > or = 17), stage below pT2, followed up for > 6 months with minimally one side of neurovascular bundle preservation procedure, 12 (70.6%) were capable of intercourse postoperatively, and the mean time for sexual intercourse after operation was 5.7 months. In this series, robotic prostatectomy was a feasible and reproducible technique, with a short learning curve and low perioperative complication rate. Even during the initial phase of the learning curve, satisfactory results were obtained with regard to functional and oncological outcome.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, MIS & Robotic Urologic Surgery Center, Korea University School of Medicine, Seoul 136705, Korea
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Robot-Assisted Laparoscopic Prostatectomy: A Single-Institutions Learning Curve. Urology 2009; 73:127-33. [DOI: 10.1016/j.urology.2008.08.482] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Revised: 08/08/2008] [Accepted: 08/18/2008] [Indexed: 11/19/2022]
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Affiliation(s)
- Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan. J Robot Surg 2008; 2:85-8. [PMID: 27637506 DOI: 10.1007/s11701-008-0087-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 04/20/2008] [Indexed: 10/22/2022]
Abstract
Recently, we have introduced robotic-assisted laparoscopic radical prostatectomy (RALP) in Japan. This article describes the details of a training program to shorten the learning curve in the absence of an urologist with expertise in robotic surgery. Five months after a 2-day training course of robotic surgery, RALP was first performed in Japan, and a total of 15 cases were performed in the subsequent 4 months. Our training program consisted of: (1) image training using surgical operation videos, (2) dry lab training using a sham pelvic cavity model, and (3) intraoperative mentoring. The operative procedure was divided into five consecutive stages, and time required to complete each stage was recorded. Robotic radical prostatectomy was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-h operation had been imposed by the ethics committee. The mean console time and the mean intraoperative blood loss (including urine) reduced from 264.2 min and 459.4 ml, respectively, in the first 11 cases, to 151 min and 133.3 ml, respectively, in the last three cases. With direct intraoperative guidance by the mentor during cases 13 and 14, the operation time was reduced at all five stages of the operative procedure. Our training program proved remarkably effective in reducing the learning curve of RALP in Japan, where there is no person with expertise in robotic surgery.
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Artibani W, Fracalanza S, Cavalleri S, Iafrate M, Aragona M, Novara G, Gardiman M, Ficarra V. Learning Curve and Preliminary Experience with da Vinci-Assisted Laparoscopic Radical Prostatectomy. Urol Int 2008; 80:237-44. [DOI: 10.1159/000127333] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 03/19/2007] [Indexed: 11/19/2022]
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Buse S, Gilfrich C, Hohenfellner M. [Robotic surgery in urology]. Urologe A 2007; 46:1239-42. [PMID: 17665163 DOI: 10.1007/s00120-007-1487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S Buse
- Urologische Klinik, Ruprecht-Karls-Universität, Im Neuenheimer Feld 110, 69121 Heidelberg.
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Mavrich Villavicencio H, Esquena S, Palou Redorta J, Gómez Ruíz JJ. Prostatectomía radical robótica: revisión de nuestra curva de aprendizaje. Actas Urol Esp 2007; 31:587-92. [PMID: 17896554 DOI: 10.1016/s0210-4806(07)73694-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We present the first cases of our robotic radical prostatectomy with Da Vinci (RRPdaV) that corresponds to the learning curve (LC) of the surgeon that has initiated with this technique. METHODS We reviewed the first 20 patients that underwent RRPdaV, performed by an expert surgeon, without previous laparoscopic training, but with a wide experience in retropubic and perineal prostatectomy (HV). We analyzed: Surgical time, blood loss, conversion rate, intra and postoperative complications, hospital stay and days of bladder catheterization. Also: rates and location of surgical margins, as well as functional outcomes with an average follow up of 10 months. RESULTS Mean operating time was 140 minutes (100-211) and blood loss 180 mL (80-360), and none required a blood transfusion. There were no intraoperative complications and neither any conversion to open surgery. The only postoperative outstanding fact was mean hospital stay were 3,35 days. (3-5). We had 6 cases of positive surgical margins (30%). The most frequent location was postero-lateral. Eighteen out of 20 patients (90%) were early totally continent, 2 (10%) required the use of one pad during the first six months due slight stress incontinence that stopped spontaneously. From 20 cases, two of them (10%) had preoperative erectile dysfunction; 12 out of the remaining 18 (66.6%) preserved potency at review and 6 (33.4%) had postoperative erectile dysfunction. CONCLUSIONS It has been demonstrated that robotic surgery for radical prostatectomy is clearly an advantage technique (easy maneuver although it is a minimally invasive technique, comfortable and ergonomic position for the surgeon, 3D visualization and short learning curve). The RRPDAv learning curve is significantly shorter if the surgeon has a wide previous surgical experience in open and/or laparoscopic surgery.
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Ficarra V, Cavalleri S, Novara G, Aragona M, Artibani W. Evidence from Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review. Eur Urol 2007; 51:45-55; discussion 56. [PMID: 16854519 DOI: 10.1016/j.eururo.2006.06.017] [Citation(s) in RCA: 309] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 06/12/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review the literature available on robot-assisted laparoscopic radical prostatectomy (RALP). METHODS A literature search was performed using EMBASE, MEDLINE, and Web Science databases through a "free text" protocol, including the following terms: robotic radical prostatectomy, da Vinci, and radical prostatectomy. Three of the authors separately reviewed the records to select the papers relevant for the topic of the review, with any discrepancies solved by open discussion. The selected articles were recorded in an electronic database and analysed by version 13.0 SPSS software. RESULTS We identified 71 manuscripts. Eleven papers focused on surgical technique, and 35 manuscripts reported clinical, pathologic, and/or follow-up data. Seven studies included clinical data concerning surgical series with fewer than 10 patients, whereas the remaining 26 series reported larger surgical series of RALP. RALP turned out to be a feasible procedure, with limited blood loss, favourable complication rates, and short hospital stays. Positive surgical margin rates decreased with the surgeon's experience and technique improving, reaching percentages similar to those of retropubic and laparoscopic series. The available oncologic data are only preliminary. Especially interesting are the data on postoperative continence rates, whereas results on potency, although promising, are based only on a limited number of patients and have to be considered as incomplete and premature. CONCLUSION Literature showed that RALP had a short learning curve and interesting postoperative results, especially with regard to continence recovery. The available data on recovery of erectile function and oncologic follow-up are still incomplete.
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Sim HG, Yip SKH, Lau WKO, Tan YH, Wong MYC, Cheng CWS. Team-based approach reduces learning curve in robot-assisted laparoscopic radical prostatectomy. Int J Urol 2006; 13:560-4. [PMID: 16771713 DOI: 10.1111/j.1442-2042.2006.01354.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM We assessed the team approach in reducing the learning curve during our 2-year experience transiting from open to robot-assisted laparoscopic radical prostatectomy (rLRP). METHODS A team of three urologists progressed through assistant phase to console phase to obtain competency in robotic prostatectomy. One hundred patients underwent rLRP by this team using the da Vinci robotic surgical system from 1 February 2003 to 15 May 2005. RESULTS The immediate perioperative outcome was divided into three corresponding time frames and the results demonstrated gradual improvement in outcome parameters. The mean set-up time and dissection time were 24+/-14 min and 182+/-52 min, respectively. The mean perioperative blood loss was 272+/-240 mL, and 7% of patients (n=7) required blood transfusion. The mean duration of bladder catheterization was 8.4+/-4.1 days, and mean hospital stay was 2.9+/-1.6 days. There was no perioperative mortality or conversion to open radical prostatectomy. Major complications (4%) included urethrovesical leak requiring re-operation, postoperative cerebrovascular accident, and transient ureteric obstruction. Minor complications (7%) included minor urethrovesical leak, bladder neck stenosis, and urinary tract infection. Mean follow up was 6.6+/-5.0 months. Pathological assessment showed pT2 disease in 55% and pT3 in 45% of specimens. CONCLUSIONS A team-based approach to robot-assisted LRP helped to reduce the learning curve of the procedure for individual surgeons and continued to show significantly lower perioperative blood loss, transfusion requirements and postoperative pain compared to open radical retropubic prostatectomy.
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Affiliation(s)
- Hong Gee Sim
- Singapore General Hospital, Department of Urology, Singapore
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Abstract
INTRODUCTION Robotic technology has been safely integrated into thoracic and abdominopelvic surgery, and the early experience has been very promising with very rare complications related to robotic device failure. Recently, several reports have documented the technical feasibility of transoral robotic surgery (TORS) with the daVinci Surgical System. Proposed pharyngeal and laryngeal applications include radical tonsillectomy, base-of-tongue resection, supraglottic laryngectomy, and phonomicrosurgery. The safety of transoral placement of the robotic endoscope and instruments has not been established. Potential risks specific to the transoral use of the surgical robot include facial skin laceration, tooth injury, mucosal laceration, mandible fracture, cervical spine fracture, and ocular injury. We hypothesize that these particular risks of transoral surgery are similar with robotic assistance compared with conventional transoral surgery. METHODS To test this hypothesis, we attempted to intentionally injure a human cadaver with the daVinci Surgical System by impaling the facial skin and pharyngeal and laryngeal mucosa with the robotic instruments and endoscope. We also attempted to extract or fracture teeth and fracture the cadaver's mandible and cervical spine by applying maximal pressure and torque with the robotic arms. Experiments were documented with still and video photography. RESULTS Impaling the cadaver's skin and mucosa resulted in only superficial lacerations. Tooth, mandible, and cervical spine fracture could not be achieved. CONCLUSIONS Initial experiments performing TORS on a human cadaver with the daVinci Surgical System demonstrate a safety profile similar to conventional transoral surgery. Additionally, we discuss several strategies to increase patient safety in TORS.
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Affiliation(s)
- Neil G Hockstein
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Sim HG, Yip SKH, Cheng CWS. Equipment and technology in surgical robotics. World J Urol 2006; 24:128-35. [PMID: 16538515 DOI: 10.1007/s00345-006-0070-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 03/06/2006] [Indexed: 01/12/2023] Open
Abstract
Contemporary medical robotic systems used in urologic surgery usually consist of a computer and a mechanical device to carry out the designated task with an image acquisition module. These systems are typically from one of the two categories: offline or online robots. Offline robots, also known as fixed path robots, are completely automated with pre-programmed motion planning based on pre-operative imaging studies where precise movements within set confines are carried out. Online robotic systems rely on continuous input from the surgeons and change their movements and actions according to the input in real time. This class of robots is further divided into endoscopic manipulators and master-slave robotic systems. Current robotic surgical systems have resulted in a paradigm shift in the minimally invasive approach to complex laparoscopic urological procedures. Future developments will focus on refining haptic feedback, system miniaturization and improved augmented reality and telesurgical capabilities.
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Affiliation(s)
- Hong Gee Sim
- Department of Urology, Singapore General Hospital, Outram Road, 168609, Singapore, Singapore.
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Mayer EK, Winkler MH, Aggarwal R, Karim O, Ogden C, Hrouda D, Darzi AW, Vale JA. Robotic prostatectomy: the first UK experience. Int J Med Robot 2006; 2:321-8. [PMID: 17520650 DOI: 10.1002/rcs.113] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND We describe a teamwork approach to setting up the UK's first clinical programme for robotically assisted laparoscopic radical prostatectomy. METHODS On 22 November 2004 the Imperial Robotic Urological Surgery Group performed their first robotically assisted prostatectomy. Robotically assisted prostatectomy lends itself to division into eight definable stages. A team of four consultant urological surgeons utilized a structured rotating system, using these stages, for time at the console and tableside assisting. Fluidity of surgery was maintained by a surgeon acting as the tableside assistant for the stage prior to moving to the console. Data was collected prospectively for the first 50 cases and parameters associated with the learning curve compared to other reported series. RESULTS Median operative time of 369.5 mins, median blood loss of 700 ml, with 12% of patients requiring a blood transfusion. Four patients required conversion to an open procedure; one resulting from equipment failure and three due to failure of progression. Four patients had an anastomotic leak with resulting ileus and two patients sustained rectal injuries, which were repaired intraoperatively using the robot. Median hospital stay was 4 days with a 22% positive surgical margin rate. CONCLUSION Parameters indicative of the learning curve are comparable to existing published initial series of other robotic centres. The use of teamwork has enabled us to provide safe and time-efficient training for four surgeons simultaneously. The structured approach used in this setting demonstrates that urological surgeons of varying laparoscopic experience can acquire the skills necessary to competently perform laparoscopic radical prostatectomy.
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Affiliation(s)
- E K Mayer
- Imperial Robotic Urological Surgery Group, Department of Urology, St Mary's Hospital, London, UK
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