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Gabriel PE, Pinar U, Lenfant L, Parra J, Vaessen C, Mozer P, Chartier-Kastler E, Rouprêt M, Seisen T. Perioperative, renal function and oncological outcomes of robot-assisted radical nephroureterectomy for patients with upper tract urothelial carcinoma. World J Urol 2023; 41:3001-3007. [PMID: 37676283 DOI: 10.1007/s00345-023-04590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023] Open
Abstract
PURPOSE To report perioperative, renal function and oncological outcomes of robot-assisted radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC). METHODS This was a retrospective single-arm monocentric study including all consecutive UTUC patients treated with robot-assisted RNU at our institution between 2014 and 2022. Descriptive statistics with median and interquartile range (IQR) for continuous variables and numbers with frequencies for categorical variables were used to report perioperative and renal function outcomes while Kaplan-Meier curves were computed to present extravesical and intravesical recurrence-free survival(RFS) as well as cancer-specific (CSS) and overall survival (OS) with the corresponding 95% confidence intervals(CIs). RESULTS Overall, 70 patients with a median age of 69.6 [63.3-74.9] years were included in our study. With regards to perioperative outcomes, the median operative time was 157 [130-182] min with a median blood loss of 200 [100-300] cc. Intraoperative complications occurred in 4 (5.7%) patients but no conversion to open or laparoscopic surgery was required. Postoperative complications occurred in 9 (12.9%) patients, including 5 (7.1%) with grade ≥ 3 complications according to the Clavien-Dindo classification. The median length of stay was 4 [3-6] days. With regards to renal function outcomes, the median postoperative loss in estimated glomerular filtration rate at discharge was 16 [10.25-26] mL/min/1.73 m2. With regards to oncological outcomes, the 3-year extravesical and intravesical RFS, CSS and OS rates were 73.6 [62.8-86.2]%, 68.1 [54.6-85]%, 82.5 [72-94.4]% and 75.3 [63.4-89.5]%, respectively. CONCLUSION We report favorable perioperative and oncological outcomes with expected decrease in renal function after robot-assisted RNU for patients with UTUC.
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Affiliation(s)
- Pierre-Etienne Gabriel
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Ugo Pinar
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Louis Lenfant
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Jérôme Parra
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Christophe Vaessen
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Pierre Mozer
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Thomas Seisen
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
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Mesnard B, de Vergie S, Chelghaf I, Bouchot O, Perrouin Verbe MA, Karam G, Branchereau J, Rigaud J. Robot-assisted radical nephroureterectomy for upper tract urothelial carcinoma: Peri and postoperative outcomes. Actas Urol Esp 2023; 47:441-449. [PMID: 36966898 DOI: 10.1016/j.acuroe.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION The treatment of urothelial tumours of the upper urinary tract at high risk of specific mortality is based on radical nephroureterectomy (RNU). Robotic-assisted laparoscopic radical nephroureterectomy (RARNU) is still under investigation to definitively establish the safety of this procedure in the management of urothelial tumours of the upper urinary tract. The primary objective is to evaluate the intra- and postoperative safety of RARNU and, subsequently, to evaluate the medium-term oncological results. METHODS Our study is a retrospective, mono-centric study with a collection of RARNUs conducted between 1st January 2015 and 1st October 2021. The RARNUs were performed with the assistance of the Da Vinci Si® robot, then from 2017 the Da Vinci Xi® robot. Whenever possible, the entire procedure was carried out without re-docking. RESULTS Between 1st January 2015 and 1st October 2021, 29 RARNUs were carried out at our centre. Complete surgery without re-docking was possible in 80% of cases with the Da Vinci Xi® robot. One patient required conversion to open surgery due to difficult dissection. 50% of tumours were classified as T3 or T4. The 30-day complication rate was 31%. The median length of hospitalisation was 5 days. The disease-free survival at the mean survival time (27.5 months) was of 75.2%. One patient had a recurrence in the nephrectomy compartment and no patient had a peritoneal or trocar orifice recurrence. CONCLUSION Performing RARNU for the management of tumours of the upper urinary tract appears to meet the criteria of surgical safety and those of oncological safety.
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Affiliation(s)
- B Mesnard
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France.
| | - S de Vergie
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | - I Chelghaf
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | - O Bouchot
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | - M A Perrouin Verbe
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | - G Karam
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | - J Branchereau
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | - J Rigaud
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
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Morizane S, Stein H, Komiya T, Kaneta H, Takenaka A. Retroperitoneal robot-assisted laparoscopic nephroureterectomy using the da Vinci Xi and SP systems: Initial experiences in cadaveric models. Investig Clin Urol 2023; 64:380-387. [PMID: 37417563 DOI: 10.4111/icu.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/16/2023] [Accepted: 04/05/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To investigate the feasibility and optimal port placements of robot-assisted laparoscopic nephroureterectomy (RANU) via the retroperitoneal approach in the lateral decubitus and supine positions using the da Vinci Xi (DVXi) and da Vinci SP (DVSP) systems. MATERIALS AND METHODS We performed lateral decubitus extraperitoneal RANU on the right side and supine extraperitoneal RANU on the left side using the DVXi and DVSP systems without repositioning in two fresh cadavers. In addition, paracaval and pelvic lymphadenectomies were performed simultaneously during both surgical procedures. The operative time of each procedure was calculated, and the technical details associated with these procedures were evaluated. RESULTS Lateral decubitus and supine extraperitoneal RANU using the DVXi and DVSP systems were achieved without repositioning. The surgeon console time ranged from 89 to 178 minutes, and no major technical complications were observed. However, carbon dioxide insufflation into the abdominal cavity was observed owing to a peritoneal breach during the creation of the surgical workspace, particularly in the supine position. Compared with the DVXi system, the DVSP system was more suitable for RANU using the retroperitoneal approach, except for renal handling. CONCLUSIONS The DVXi and DVSP systems are feasible for performing lateral decubitus and supine extraperitoneal RANU without patient repositioning. The lateral decubitus position may be better than the supine position, and the DVSP system is more suitable for retroperitoneal RANU than the DVXi system. Nevertheless, further studies should be performed in clinical settings to validate our results.
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Affiliation(s)
- Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Hubert Stein
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Takayuki Komiya
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Hiroyuki Kaneta
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Peng L, Mehmud I, Meng C, Tang D, Li K, Gan L, Li J, Yi F, Li Y. Comparison of Perioperative Outcomes and Complications of Laparoscopic and Robotic Nephroureterectomy Approaches in Patients with Upper-Tract Urothelial Carcinoma. Ann Surg Oncol 2023; 30:3805-3816. [PMID: 36879036 DOI: 10.1245/s10434-023-13221-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND For medical institutions without robotic equipment, it remains uncertain whether laparoscopic radical nephroureterectomy (LNU) can achieve results similar to those of robotic surgery for the treatment of upper tract urothelial carcinoma (UTUC). This meta-analysis aimed to compare the efficacy and safety of robot-assisted radical nephroureterectomy (RANU) with that of LNU using a large sample size of patients. METHODS A systematic meta-analysis was performed using data (available to May 2022) acquired from multiple scientific databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, according to the protocols registered with PROSPERO (CRD42021264046), were followed to perform this cumulative analysis. RESULTS Nine high-quality studies were included in this analysis, considering factors such as operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), positive surgical margins (PSM), and complications. Statistical indicators revealed no significant differences between the RANU and LNU groups in terms of OT (weighted mean difference [WMD] 29.41, 95% confidence interval [CI] -1.10 to 59.92; p = 0.22), EBL (WMD -55.30, 95% CI -171.14 to 60.54; p = 0.13), LOS (WMD -0.39, 95% CI -1.03 to 0.25; p = 0.12), PSM (odds ratio [OR] 1.22, 95% CI 0.44-3.36; p = 0.17], or complications (OR 0.91, 95% CI 0.49-1.69; p = 0.13). CONCLUSION The meta-analysis showed that the perioperative and safety indicators of both RANU and LNU were similar and both showed favorable outcomes in UTUC treatment. However, some uncertainties remain in the implementation and selection of lymph nodes for dissection.
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Affiliation(s)
- Lei Peng
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu, China.,Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China.,Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen University, Shenzhen, China.,South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Irfan Mehmud
- Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen University, Shenzhen, China.,South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Dongdong Tang
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu, China.,Department of Urology, The Third Affiliated Hospital of Shenzhen University (Luohu Hospital Group), Shenzhen University, Shenzhen, China.,South China Hospital, Health Science Center, Shenzhen University, Shenzhen, China
| | - Kangsen Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Lijian Gan
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Fulin Yi
- North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, China.
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Sparwasser P, Epple S, Thomas A, Dotzauer R, Boehm K, Brandt MP, Mager R, Borgmann H, Kamal MM, Kurosch M, Höfner T, Haferkamp A, Tsaur I. First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique. World J Urol 2022; 40:1019-1026. [PMID: 35037964 PMCID: PMC8994743 DOI: 10.1007/s00345-021-03920-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/26/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction While various surgical techniques have been reported for open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuff has never been reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique allowing to perform robot-assisted NU by a unique retroperitoneal approach. Methods Between February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed. Results The analysis included five patients [median age: 73 years; BMI: 27.2 kg/m2; Charlson comorbidity index 5]. All five patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classification ≥ 2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postoperative complications exceeding Clavien–Dindo classification ≥ 3a. Median hospital stay was 5.4d without any 30-d readmission. Conclusion We demonstrate safety and feasibility of the first entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03920-1.
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Affiliation(s)
- P Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - S Epple
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Thomas
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Dotzauer
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - K Boehm
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M P Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - H Borgmann
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M M Kamal
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Kurosch
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - T Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - I Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Mourmouris P, Argun OB, Tzelves L, Tuna MB, Gourtzelidou M, Tziotis A, Kural AR, Skolarikos A. Is robotic radical nephroureterectomy a safe alternative to open approach: The first prospective analysis. Arch Ital Urol Androl 2021; 93:408-411. [PMID: 34933526 DOI: 10.4081/aiua.2021.4.408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To test the efficacy and safety profile of robotic radical nephroureterectomy compared to the open approach. METHODS We enrolled 45 consecutive patients who suffered from non-metastatic, upper urinary tract urothelial carcinoma from September 2019 to March 2021 and underwent radical nephroureterectomy. Patients were divided in two groups: group A consisted of 29 patients (open approach) and group B consisted of 16 patients (robotic approach). The factors which were taken into consideration were age, sex, body mass index, tumour size, side and grade, cancer stage, ASA score, operation time, drain removal time, foley time, hospitalization time, estimated blood loss, surgical margins, preoperative and postoperative creatinine, Hct and bladder recurrences. Statistical analysis was performed with the use of SPSS version 26 and p < 0.05 was the cut-off for reaching statistical significance. RESULTS The mean age in group 1 was 67.12 years and in group 2 68.12 years, whereas the mean body mass index (BMI) in group 1 was 26.54 kg/m2 and in group 2 25.20 kg/m2. Operative time was better in group A (124 vs 186 mins p < 0.001) and estimated blood loss were better in group B compared to group A (137 vs 316 ml p < 0.001). Length of stay (LOS) was significantly less in the robotic group (5.75 vs 4.3 days p = 0.003) and the same applied for time required for drain removal (4.5 vs 3.3 days p = 0.006). CONCLUSIONS Robotic radical nephroureterectomy is a safe and efficient alternative to open approach. It provides a favorable perioperative profile in patients suffering from upper urinary tract carcinoma without metastasis.
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Affiliation(s)
- Panagiotis Mourmouris
- 2nd Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Omer Burak Argun
- Department of Urology, Acıbadem Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Istanbul.
| | - Lazaros Tzelves
- 2nd Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Mustafa Bilal Tuna
- Department of Urology, Acıbadem Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Istanbul.
| | - Maria Gourtzelidou
- 2nd Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Andreas Tziotis
- 2nd Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Ali Riza Kural
- 2nd Department of Urology, Athens Medical School, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens.
| | - Andreas Skolarikos
- Department of Urology, Acıbadem Mehmet Ali Aydınlar University, Acibadem Maslak Hospital, Istanbul.
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Abstract
First proposed by Kimball and Ferris in 1933 for the treatment of papillary tumors in the upper urinary tract, radical nephroureterectomy (RNU) with bladder cuff excision remains the gold standard for management of high-risk upper tract urothelial carcinoma involving the proximal ureter and/or pelvicaliceal system. Over three decades since the first description of laparoscopic RNU, minimally invasive approaches to RNU have continued to evolve and become increasingly utilized. More recently, robot-assisted RNU (RARNU) has increasingly become a viable approach. Specifically, RARNU affords a reduction in perioperative morbidity and improved convalescence as a minimally invasive approach, all while adhering to traditional open surgical principles and providing surgeons with improved technical ergonomics and streamlined operating room logistics, particularly with the advent of the da Vinci Xi platform. In this study, we describe our approach to transperitoneal RARNU, including indications, operating room setup, step-by-step surgical technique, and perioperative care.
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Affiliation(s)
- Jason P Joseph
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Padraic O'Malley
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Li-Ming Su
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
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8
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Wen CY, Lin JT, Tsai JY, Yu CC. A novel distal ureter management during robot-assisted nephroureterectomy with bladder cuff excision. Asian J Surg 2021; 44:1291. [PMID: 34330591 DOI: 10.1016/j.asjsur.2021.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chen-Yueh Wen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Jeng-Yu Tsai
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Chia-Cheng Yu
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taiwan, ROC; Department of Pharmacy, Tajen University, Taiwan, ROC.
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Ye H, Feng X, Wang Y, Chen R, Zhang C, Zhang W, Guo F, Wang Z, Fang Y, Wu Z, Yang Q, Yang B, Lü C, Wang L. Single-docking robotic-assisted nephroureterectomy and extravesical bladder cuff excision without intraoperative repositioning: The technique and oncological outcomes. Asian J Surg 2020; 43:978-985. [PMID: 31941594 DOI: 10.1016/j.asjsur.2019.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/09/2019] [Accepted: 11/24/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND /Objective: Currently there are few report of oncologic outcomes following robotic-assisted radical nephroureterectomy (RRNU) based on long-term follow-up. To evaluate the therapeutic effect of RRNU for upper tract urothelial carcinoma (UTUC), a technique of single-docking RRNU was described and its oncological outcomes was evaluated. PATIENTS AND METHODS The data of 29 patients underwent RRNU for UTUC of Ta-T3 from July 2013 to June 2016 was analyzed. The data of 131 patients of UTUC underwent laparoscopic radical nephroureterectomy (LRNU) over the same period was analyzed as control. Kaplan-Meier analysis and Cox regression were used for prognosis evaluation. RESULTS The median follow-up time was 40.5 and 40.4 months in RRNU cohort and LRNU cohort. No difference in 5-year intravesical recurrence-free survival (IVRFS) (88.0% vs. 85.5%, p = 0.611) or distant metastasis-free survival (93.1% vs.96.7%, p = 0.323) between RRNU cohort and LRNU cohort. The 5-year retroperitoneal recurrence-free survival and cancer-specific survival (CS) were lower in RRNU cohort than in LRNU cohort (77.3% vs. 87.7%, and 71.2% v.s. 84.7%, respectively). CONCLUSION The single-docking RRNU is an effective treatment for UTUC, avoiding the re-docking of patient-side cart or the intraoperative reposition of patient, and bringing equivalent 5-year IVRFS compared to LRNU. However, the lower 5-year retroperitoneal recurrence-free survival and CS in RRNU cohort warned the concern of higher chance of local tumor spillage during RRNU. The noninferiority of RRNU to LRNU still needed the confirmation of large sample sized, prospective randomized controlled study.
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Affiliation(s)
- Huamao Ye
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Xiang Feng
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Yang Wang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Rui Chen
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Chao Zhang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Wei Zhang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Fei Guo
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Zeyu Wang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Yu Fang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Zhenjie Wu
- Department of Urology, Shanghai Changzheng Hospital, The Second Military Medical University, PR China.
| | - Qing Yang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Bo Yang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Chen Lü
- Department of Urology, Shanghai East Hospital Affiliated to Shanghai Tongji University, PR China; Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China.
| | - Linhui Wang
- Department of Urology, Shanghai Changzheng Hospital, The Second Military Medical University, PR China.
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Campi R, Cotte J, Sessa F, Seisen T, Tellini R, Amparore D, Mormile N, Gobert A, Mari A, Porpiglia F, Serni S, Minervini A, Rouprêt M. Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience. World J Urol 2019; 37:2303-11. [PMID: 31062121 DOI: 10.1007/s00345-019-02790-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report a multi-institutional experience on robotic radical nephroureterectomy (RNU) and segmental ureterectomy (SU) for upper tract urothelial carcinoma (UTUC). METHODS Data were prospectively collected from patients with non-metastatic UTUC undergoing robotic SU or RNU at three referral centers between 2015 and 2018. Transperitoneal, single-docking robotic RNU followed established principles. Bladder cuff excision (BCE) was performed with robotic or open approach. Techniques for SU included: ureteral resection and primary uretero-ureterostomy; partial pyelectomy and modified pyeloplasty; ureteral resection with BCE and direct- or psoas hitch-ureteroneocystostomy. We retrospectively evaluated the technical feasibility, and peri-operative and oncologic outcomes after robotic RNU/SU. RESULTS 81 patients were included. No case required conversion to open surgery. Early major (Clavien-Dindo grade > 2) complications were reported in six (7.4%) patients (two after SU, four after RNU). Three patients experienced late major complications (one after SU, two after RNU). Median ΔeGFR at 3 months was - 1 ml/min/1.73 m2 after SU and - 15 ml/min/1.73 m2 after RNU. Positive surgical margins were recorded in five patients (one after SU, four after RNU). Median follow-up was 21 months and 22 months in the SU and RNU groups, respectively. Three (20%) patients had ipsilateral upper tract recurrence after SU, while five (7.5%) developed metastases after RNU. No case of port-site metastases or peritoneal carcinomatosis was reported. At last follow-up, 67 (82.7%) patients were alive without evidence of disease. CONCLUSION Robotic SU and RNU are technically feasible and achieved promising peri-operative and oncologic outcomes in selected patients with non-metastatic UTUC.
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Tamhankar AS, Patil SR, Ahluwalia P, Gautam G. Current Status of Lymphadenectomy During Radical Nephroureterectomy for Upper Tract Urothelial Cancer-Yes, No or Maybe? Indian J Surg Oncol 2018; 9:418-426. [PMID: 30288011 DOI: 10.1007/s13193-018-0807-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/26/2018] [Indexed: 01/30/2023] Open
Abstract
While pelvic lymphadenectomy during radical cystectomy for bladder cancer is a well-established standard of care, the same does not hold true for upper tract urothelial carcinoma (UTUC). Indeed, a template-based lymphadenectomy is rarely, if ever, performed in conjunction with radical nephroureterectomy at most centres across the globe. While multiple studies have explored the staging and therapeutic role of lymphadenectomy in cases of UTUC, there remain large gaps in our understanding of the indications, extent and safety of this procedure as an adjunct to nephroureterectomy. This article elucidates the current knowledge on outcomes, benefits and complications of template-based lymphadenectomy during radical nephroureterectomy for UTUC. We also explore the current evidence-based guidelines on this controversial topic.
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Affiliation(s)
- Ashwin Sunil Tamhankar
- Section of Urologic Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Saurabh Ramesh Patil
- Section of Urologic Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Puneet Ahluwalia
- Section of Urologic Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Gagan Gautam
- Section of Urologic Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India
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Abstract
Upper tract urothelial carcinoma is a rare malignancy that has an abundance of surgical treatment options, including open, laparoscopic, robotic, and endoscopic approaches. As advances in technology allow for shorter, less morbid operations, the variation in care of this uncommon disease has raised concerns about compromising oncologic principles. Many institutions have described their experience with promising results; however, there is a paucity of high-quality data that supports the use of robotic surgery as a new gold standard. This article describes how to perform the operation using a single-dock method and reviews contemporary literature on perioperative and oncologic outcomes.
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Affiliation(s)
- Benjamin L Taylor
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, 525 East 68th Street, Star Pavilion, New York, NY 10065, USA
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, 525 East 68th Street, Star Pavilion, New York, NY 10065, USA.
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Morelli L, Palmeri M, Simoncini T, Cela V, Perutelli A, Selli C, Buccianti P, Francesca F, Cecchi M, Zirafa C, Bastiani L, Cuschieri A, Melfi F. A prospective, single-arm study on the use of the da Vinci® Table Motion with the Trumpf TS7000dV operating table. Surg Endosc 2018; 32:4165-4172. [PMID: 29603010 DOI: 10.1007/s00464-018-6161-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 03/21/2018] [Indexed: 02/08/2023]
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Tamhankar AS, Patil SR, Ahluwalia P, Gautam G. Robot-assisted radical nephroureterectomy with extended template lymphadenectomy for upper tract urothelial carcinoma: An outcome analysis. Indian J Urol 2018; 34:212-218. [PMID: 30034133 PMCID: PMC6034406 DOI: 10.4103/iju.iju_30_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Robot-assisted radical nephroureterectomy (RANU) with extended template lymphadenectomy (E-LND) is the leading treatment option for nonmetastatic upper tract urothelial carcinoma. Due to the rarity of this disease, there is a lack of consensus regarding the best approach and the extent of lymphadenectomy. We report our technique and its initial outcomes from the retrospective evaluation of a prospectively maintained database of 11 consecutive cases of RANU + E-LND. To the best of our knowledge, our series represents the first published experience of this procedure from India. Materials and Methods RANU was performed in 11 patients (including two patients with simultaneous radical cystectomy) with the da Vinci Xi system. Pelvic and upper ureteric tumors were operated without re-docking or repositioning, using the port hopping feature. For the lower ureteric tumors, the patient was repositioned and the robot was re-docked to ensure completeness of pelvic lymphadenectomy. E-LND was performed in all the patients as per the templates described in previous studies. Results Median age was 67.5 years (range 52-71). Median console time and blood loss were 170 min (range 156-270) and 150 cc (range 25-500), respectively. Median hospital stay was 3 days (range 2-8). One patient developed paralytic ileus in the postoperative period (Clavien Dindo Grade 1). None had a positive surgical margin and the median lymph node yield was 22.5 (range 7-47). Median follow-up was 9 months during which one patient developed metastatic systemic recurrence. All other patients were disease free at the last follow-up. Conclusions A robotic approach to radical nephroureterectomy with E-LND is feasible and safe and does not appear to compromise the short-term oncological outcomes as defined by lymph node yields and margin positivity. At the same time, it offers the benefits of minimal invasion and results in swifter patient recovery from this extensive surgery.
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Affiliation(s)
| | | | - Puneet Ahluwalia
- Department of Uro-oncology, Max Institute of Cancer Care, New Delhi, India
| | - Gagan Gautam
- Department of Uro-oncology, Max Institute of Cancer Care, New Delhi, India
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Abstract
As a result of ergonomics, optimal magnification of the operative field, surgeon dexterity, and precision of surgical manipulation, robotic technology has been shown to overcome many difficulties associated with pure laparoscopy. With the recent expansion of robot-assisted surgery in the field of urology and following the success of robot-assisted prostatectomy and robot-assisted partial nephrectomy, robot-assisted surgery is being applied to treat many other genitourinary diseases, such as bladder cancer and ureteropelvic junction obstruction. The aim of the present review is to discuss the role of robotic surgery in urology and summarize recent developments in the field of urologic robotic surgery.
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Affiliation(s)
- Masashi Honda
- Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Shuichi Morizane
- Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Katsuya Hikita
- Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Atsushi Takenaka
- Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan
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Wu W, Hung S, Yii S, Tsai C, Chung S. Robot-assisted laparoscopic nephroureterectomy for upper tract urothelial carcinoma (UT-UC). Urological Science 2017; 28:63-65. [DOI: 10.1016/j.urols.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Developments in pediatric robotic surgery have increased the feasibility of minimally invasive surgery for complex urinary tract reconstruction. Ureteroureterostomy is a commonly employed strategy for the management of a duplicated ureteral system with either upper pole obstruction or lower pole vesicoureteral reflux, and this approach minimizes the risk to a healthy ureter as might be seen in a common sheath ureteral reimplant and avoids complex dissection around the renal hilum as with a heminephrectomy. The robotic platform enables optimum instrument manipulation for an end-to-side ureteral anastomosis as well as excellent visualization deep into the pelvis for excision of the distal ureteral stump. In this study, the indications and preoperative evaluation for pediatric robotic ureteroureterostomy (RUU) were described and intraoperative considerations for a successful repair were highlighted. In order to assess the outcomes, a PubMed search was performed to find the articles focusing on RUU in the pediatric population. The institutional experience of the authors was also reviewed. As with an open procedure, both minimizing dissection on the recipient ureter and ensuring a tension-free, watertight anastomosis are key principles to minimize complications. Although port placement is similar to that in robotic pyeloplasty, small adjustments may need to be made to ensure access to the pelvis. An assistant port and/or traction sutures is often used to aid in the dissection and anastomosis. RUU was first described in 2008, and several reports have demonstrated positive short-term results. However, median follow-up times are limited with most series reporting outcomes <1 year postoperatively. A future study is required to establish the long-term efficacy of this procedure and define the optimum patient population for a robotic approach.
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Affiliation(s)
- Jonathan S Ellison
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
| | - Thomas S Lendvay
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
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Alvarez-Maestro M, Rivas JG, Gregorio SAY, Guerin CDC, Gómez ÁT, Ledo JC. Current role of lymphadenectomy in the upper tract urothelial carcinoma. Cent European J Urol 2016; 69:384-390. [PMID: 28127455 PMCID: PMC5260448 DOI: 10.5173/ceju.2016.834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/17/2022] Open
Abstract
Introduction Lymphadenectomy (LND) has recently attracted considerable interest from urological surgeons, as extended lymphadenectomy might have a role in accurate staging or improving patient survival in those patients with urological malignancies. Upper tract urothelial carcinoma (UTUC) is a relatively rare neoplasm, accounting for about 5% of all urothelial cancers. Up to 30% of patients with muscle-invasive UTUC have metastasis in the regional lymph nodes (LNs), which represents a well-established poor prognostic factor. Material and methods A medline search was conducted to identify original articles and review articles addressing the role of lymphadenectomy LND in UTUC. Keywords included lymphadenectomy, lymph node excision, nephroureterectomy, and upper tract urothelial carcinoma. Results LND instead of lymphadenectomy has recently attracted considerable interest from urological surgeons and might have a potential role in improving the oncological outcome in patients with urothelial carcinoma. LND ideally improves disease staging; thereby, we need to find the way to identify the patients who could really benefit from adjuvant systemic theraphy. Template-based LND with Radical Nephroureterectomy (RNU) for high risk disease is gaining support based on accumulating retrospective data and supports its utility as a potentially therapeutic maneuver. RNU is still the gold standard treatment for UTUC, but minimal invasive procedures such as laparoscopic RNU and Robot Assisted Nephroureterectomy (RANU) are becoming more employed in recent years and should be used by expert hands. Conclusions Therapeutic benefits of LND and nodal status on disease free survival (DFS) and Cancer Free Survival (CSS) remains controversial. Although most of the data comes from retrospective studies, we encourage performing well designed, prospective, and multicentre studies to clarify this in the coming years.
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Affiliation(s)
| | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Lai GS, Yang CK, Ou YC, Hung SW, Wang J. Robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma without intraoperative reposition or redocking. Urological Science 2016. [DOI: 10.1016/j.urols.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Lin VC, Chen CH, Chiu AW. Laparoscopic nephroureterectomy for upper tract urothelial carcinoma - Update. Asian J Urol 2016; 3:115-9. [PMID: 29264177 DOI: 10.1016/j.ajur.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/08/2016] [Accepted: 05/12/2016] [Indexed: 12/13/2022] Open
Abstract
Upper urinary tract urothelial carcinomas (UTUCs) are uncommon and account for only 5%-10% of urothelial carcinomas. Pyelocaliceal tumors are about twice as common as ureteral tumors. Sixty percent of UTUCs are invasive at diagnosis. Radical nephroureterectomy, including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs, because of the high potential for recurrence, multifocality, and progression. Since first laparoscopic nephroureterectomy (LNU) was introduced by Clayman et al. in 1991 and improvement of laparoscopic technique and equipment, LNU has been reported to be equivalent to conventional open method. We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects, peri-operative and oncological outcomes. Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs. Indications tend to increase as operator skills increase. Indications for laparoscopic or open nephroureterectomy are in principle the same. The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.
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Abstract
This paper examines the current role of robot-assisted renal surgery as complex and partial nephrectomies, including vena cava thrombus, combined nephroureterectomies, living donor nephrectomy, autotransplantation, and difficult anatomy as in patients with obesity or adhesions. Indications for robot-assisted renal surgery are comparable to those of conventional laparoscopic approaches. A reduction in the learning curve leads to a stabilization of the procedure and further increases the number of minimally invasive procedures performed. A Medline literature search for publications on the field of robotic kidney surgery has been performed using the MeSH terms: robotic surgical procedures and kidney. Future directions include progress in robotic technology and instrumentation with further miniaturization of robotic procedures as laparoendoscopic single-site interventions and progress in image-guided robotic surgery.
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Affiliation(s)
- Manuela Hiess
- Department of Urology, Medical University of Vienna, Vienna, Austria,
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria,
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Kondo T, Takagi T, Tanabe K. Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract. World J Clin Oncol 2015; 6:237-51. [PMID: 26677437 PMCID: PMC4675909 DOI: 10.5306/wjco.v6.i6.237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/14/2015] [Accepted: 10/01/2015] [Indexed: 02/06/2023] Open
Abstract
Lymphadenectomy for urothelial carcinoma of the upper urinary tract has attracted the attention of physicians. The mapping study of lymphatic spread has shown that a relatively wide area should comprise the regional nodes for tumors of the right renal pelvis or the right upper two-thirds of the ureter. A prospective study showed that an anatomical template-based lymphadenectomy significantly improved patient survival in tumors of the renal pelvis. This benefit was more evident for patients with pT2 stage tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy, which is likely to be associated with improved patient survival. The removal of lymph node micrometastases is assumed to be the reason for therapeutic benefit following lymphadenectomy. The number of resected lymph nodes can be used to assess the quality of lymphadenectomy, but not to determine the extent of lymphadenectomy. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease, even though the current recommendation grades are still low. The present limitation of lymphadenectomy is the lack of standardization of the extent of lymphadenectomy and the randomized trials. Further studies are warranted to collect the evidence to support lymphadenectomy.
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Melquist JJ, Redrow G, Delacroix S, Park A, Faria EE, Karam JA, Matin SF. Comparison of Single-docking Robotic-assisted and Traditional Laparoscopy for Retroperitoneal Lymph Node Dissection During Nephroureterectomy With Bladder Cuff Excision for Upper-tract Urothelial Carcinoma. Urology 2015; 87:216-23. [PMID: 26494291 DOI: 10.1016/j.urology.2015.07.070] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/07/2015] [Accepted: 07/27/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the results of traditional laparoscopy and a simple, single-docking robotic approach for retroperitoneal lymph node dissection (RPLND), nephroureterectomy, and bladder cuff excision. MATERIALS AND METHODS We evaluated 63 and 37 consecutive patients who underwent laparoscopic and robotic nephrouretectomy with RPLND, respectively, for upper-tract urothelial carcinoma (UTUC). RESULTS Our robotic approach was associated with improved lymph node procurement (21.0 nodes [interquartile range 16.0-30.0]) when compared with laparoscopy (11.0 nodes [interquartile range 5.5-21.0]) (P < .0001). Major blood loss as defined by requiring a blood transfusion was less for the robotic group than for the laparoscopic cohort (8% vs 30%) (P = .012). In contrast, the robotic group had longer operative times (5.1 vs 3.9 hours) (P = .0001) and longer hospital stays (5.0 vs 4.0 days) (P = .0002). CONCLUSION Our single-docking robotic technique for concomitant RPLND during nephrouretectomy is associated with improved lymph node yield.
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Affiliation(s)
- Jonathan J Melquist
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grant Redrow
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scott Delacroix
- Department of Urology, Louisiana State University, New Orleans, LA
| | - Andrew Park
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eliney E Faria
- Department of Urology, Barretos Cancer Hospital, Barretos, Brazil
| | - Jose A Karam
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surena F Matin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
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Hu CY, Yang CK, Huang CY, Ou YC, Hung SF, Chung SD, Pu YS. Robot-Assisted Laparoscopic Nephroureterectomy versus Hand-Assisted Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: A Matched Comparison Study. Biomed Res Int 2015; 2015:918486. [PMID: 26539538 DOI: 10.1155/2015/918486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/17/2015] [Accepted: 08/02/2015] [Indexed: 12/20/2022]
Abstract
Objectives. To investigate the perioperative and oncological outcomes of hand-assisted laparoscopic nephroureterectomy (HANU) and robotic-assisted nephroureterectomy (RANU). Methods. Patients who underwent RANU were matched by sex, age (±5 years), and tumor location to those who underwent HANU; 18 matched pairs were included. Results. Each group consisted of five men and 13 women. The mean age was 70.4 years in RANU group and 69.6 years in HANU group (p = 0.646). Each group contained 10 patients with tumor location in the renal pelvis, five in the ureter, and three in both sites. The median follow-up time was 6.1 months for the RANU group and 47.8 months for the HANU group. The demographic and pathological data did not differ significantly. The RANU group had significantly less blood loss (p < 0.001), resumed oral intake earlier (p = 0.043), and had shorter hospital stays (p = 0.014) but higher pain scores associated with their wounds (p = 0.043). The oncological outcomes were comparable with those of the HANU group. Conclusions. Our results show that the RANU and HANU groups have comparable operative, early postoperative, and functional outcomes. A longer follow-up period would be needed for final comparison of oncological outcome.
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Gelpi-Hammerschmidt F, Tinay I, Allard CB, Su LM, Preston MA, Trinh QD, Kibel AS, Wang Y, Chung BI, Chang SL. The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population Based Analysis. J Urol 2016; 195:399-405. [PMID: 26321407 DOI: 10.1016/j.juro.2015.08.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE We evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis after extirpative renal surgery. MATERIALS AND METHODS We conducted a population based, retrospective cohort study of patients who underwent extirpative renal surgery with a diagnosis of a renal mass or renal cell carcinoma in the United States between 2004 and 2013. Regression analysis was performed to evaluate 90-day mortality (Clavien grade V), nonfatal major complications (Clavien grade III-IV), hospital readmission rates, direct costs and length of stay. RESULTS The final weighted cohort included 310,880 open, 174,283 laparoscopic and 69,880 robotic extirpative renal surgery cases during the 10-year study period, with 745 (0.001%) experiencing postoperative rhabdomyolysis. The presence of postoperative rhabdomyolysis led to a significantly higher incidence of 90-day nonfatal major complications (34.7% vs 7.3%, p <0.05) and higher 90-day mortality (4.4% vs 1.02%, p <0.05). Length of stay was twice as long for patients with postoperative rhabdomyolysis (incidence risk ratio 1.83, 95% CI 1.56-2.15, p <0.001). The robotic approach was associated with a higher likelihood of postoperative rhabdomyolysis (vs laparoscopic approach, OR 2.43, p <0.05). Adjusted 90-day median direct hospital costs were USD 7,515 higher for patients with postoperative rhabdomyolysis (p <0.001). Our model revealed that the combination of obesity and prolonged surgery (more than 5 hours) was associated with a higher likelihood of postoperative rhabdomyolysis developing. CONCLUSIONS Our study confirms that postoperative rhabdomyolysis is an uncommon complication among patients undergoing extirpative renal surgery, but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities, obesity, prolonged surgery (more than 5 hours) and a robotic approach appear to place patients at higher risk for postoperative rhabdomyolysis.
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Abstract
OBJECTIVE To report registry data obtained by the British Association of Urological Surgeons (BAUS) for nephroureterectomy (NU) surgery in the UK performed between 1 January and 31 December 2012. SUBJECTS/PATIENTS AND METHODS Registry data entered by each individual surgeon's team (self-reported) on all 6042 nephrectomy surgeries reported to BAUS during 2012 were analysed to identify all NU surgery. Parameters for analysis included demographics, indication, type of surgery, histopathology and complications (Clavien system) of surgery. Data did not include tumour location or multiplicity, preoperative diagnostic evaluation or details of minimally invasive surgery (MIS) undertaken. Before analysis for this report a central process of 'data-cleansing' was undertaken by a BAUS group to address any discrepancy between the listed surgery and the preoperative indication. RESULTS In all, 863 NU surgeries were included, performed by 220 consultant surgeons in 119 centres, and the median (range) number of NU per surgeon and unit was 3 (1-20) and 6 (1-29), respectively. The most common age group was 71-80 years (40%), most were male (64%), and haematuria was the most common presentation (74%). The dominant pathology was upper tract urothelial cancer (89%, 735), with final stage ≥pT2 in 47% (367), and the grade was 1, 2 or 3 in 6% (38), 36% (228) and 58% (362) respectively. Operative technique included MIS in 85% (720) and total reported operative complication rate (any Clavien) was 15% (128), of which Clavien ≥3 was reported in 4% (36), and perioperative death was reported in nine patients (1%). Advantages in favour of MIS included reduced hospital stay (median 5 vs 8 days), reduced major blood loss (3% vs 14%) and reduced transfusion requirement (6% vs 24%). In all, 76 cases (8%) were excluded from analysis based on benign pathology leading to reassignment to the 'simple nephrectomy' category. CONCLUSIONS NU is currently a low-volume operation (median 3 cases/year) within the remit of the nephrectomy surgeon, but is a safe procedure with a relatively low complication rate. Most NU surgery in the UK is now performed with laparoscopic assistance, with advantages including reduced major blood loss, reduced transfusion requirement and shorter hospital stay.
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Affiliation(s)
- Stephen S Connolly
- Department of Surgical Oncology, Addenbrooke's Hospital, Cambridge University, Cambridge, UK
| | - Mark A Rochester
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
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Rieken M, Schubert T, Xylinas E, Kluth L, Rouprêt M, Trinh QD, Lee R, Al Hussein Al Awamlh B, Fajkovic H, Novara G, Margulis V, Lotan Y, Martinez-Salamanca J, Matsumoto K, Seitz C, Remzi M, Karakiewicz P, Scherr D, Briganti A, Bachmann A, Shariat S. Association of perioperative blood transfusion with oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur J Surg Oncol 2014; 40:1693-9. [DOI: 10.1016/j.ejso.2014.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/16/2014] [Accepted: 03/20/2014] [Indexed: 12/24/2022] Open
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Trudeau V, Gandaglia G, Shiffmann J, Popa I, Shariat SF, Montorsi F, Perrotte P, Trinh QD, Karakiewicz PI, Sun M. Robot-assisted versus laparoscopic nephroureterectomy for upper-tract urothelial cancer: A population-based assessment of costs and perioperative outcomes. Can Urol Assoc J 2014; 8:E695-701. [PMID: 25408809 DOI: 10.5489/cuaj.2051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large population-based cohort of patients with upper-tract urothelial carcinoma (UTUC). METHODS Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures. RESULTS Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade. CONCLUSIONS Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU.
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Affiliation(s)
- Vincent Trudeau
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
| | - Giorgio Gandaglia
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; ; Department of Urology, Vita-Salute, San Raffaele University Milan, Italy
| | - Jonas Shiffmann
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; ; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ioana Popa
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
| | | | - Francesco Montorsi
- Department of Urology, Vita-Salute, San Raffaele University Milan, Italy
| | - Paul Perrotte
- Department of Urology, University of Montreal Health Centre, Montreal, QC
| | - Quoc-Dien Trinh
- Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC; ; Department of Urology, University of Montreal Health Centre, Montreal, QC
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
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Abstract
Robot-assisted laparoscopic surgery is increasingly used in urologic oncologic surgery. Robotic nephroureterectomy is still a relatively new technique. As upper tract urothelial carcinoma is a rare disease, intermediate- and long-term outcome data are scarce. However, robotic nephroureterectomy does seem to offer advantages to open and laparoscopic counterparts, with comparable short-term oncologic and functional outcomes. Here the authors review the robotic surgical management of upper tract urothelial carcinoma, with a review of the steps and tips on making this approach more widely adoptable.
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Affiliation(s)
- Susan Marshall
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA.
| | - Michael Stifelman
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA
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30
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Yang CK, Chung SD, Hung SF, Wu WC, Ou YC, Huang CY, Pu YS. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: the Taiwan Robot Urological Surgery Team (TRUST) experience. World J Surg Oncol 2014; 12:219. [PMID: 25031072 PMCID: PMC4118608 DOI: 10.1186/1477-7819-12-219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 07/04/2014] [Indexed: 12/16/2022] Open
Abstract
Background To report Taiwan’s experience in robot-assisted laparoscopic nephroureterectomy (RANU) for upper tract urothelial carcinoma (UTUC). Methods Twenty patients with a diagnosis of renal pelvic or ureteral urothelial carcinoma underwent RANU at three medical centers. We performed RANU by re-docking the robot after the nephrectomy with or without repositioning for excision of the distal ureter and bladder cuff. Results From November 2010 to July 2013, a total of 20 patients with a mean age of 70.1 +/- 9.9 years (range 43 to 92 years) and mean body mass index (BMI) of 22.9 +/-3.8 kg/m2 underwent RANU for renal pelvic or ureteral urothelial carcinoma. Mean operative time was 251.6 +/- 126.7 minutes (range 110 to 540 minutes), estimated blood loss was 50.0 +/- 42.9 mL (range 10 to 200 mL), and mean length of hospital stay was 6.7 +/- 2.4 days (range 4 to 12 days). Pathology data revealed 19 high and one low-grade urothelial carcinoma and staged Ta for three, T1 for five, T2 for five and T3 for seven. With a mean follow-up of 14.7 months (range 2 to 34 months), three intravesical recurrences developed in the bladder, and four of them also developed metastatic disease. Conclusions The TRUST early experience showed that RANU is a safe and feasible minimally invasive procedure for UTUC.
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Affiliation(s)
| | | | | | | | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Taichung 40705, Taiwan.
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31
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Autorino R, Zargar H, Kaouk JH. Robotic-assisted laparoscopic surgery: recent advances in urology. Fertil Steril 2014; 102:939-49. [PMID: 24993800 DOI: 10.1016/j.fertnstert.2014.05.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/08/2014] [Accepted: 05/21/2014] [Indexed: 12/11/2022]
Abstract
The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology.
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Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
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