1
|
Pettenuzzo G, Ditonno F, Cannoletta D, Pacini M, Morgantini L, Sauer RC, Torres-Anguiano JR, Montorsi F, Briganti A, Bartoletti R, Veccia A, Bertolo R, Antonelli A, Crivellaro S. Pelvic Lymph Node Dissection: A Comparison Among Extraperitoneal Single-port and Transperitoneal Multiport Radical Prostatectomy-A Single-center Experience. EUR UROL SUPPL 2024; 67:69-76. [PMID: 39229365 PMCID: PMC11369446 DOI: 10.1016/j.euros.2024.07.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 09/05/2024] Open
Abstract
Background and objective The role of pelvic lymph node dissection (PLND) for prostate cancer is still controversial. This study aims to compare the outcomes of PLND between extraperitoneal single-port (SP eRARP) and transperitoneal multiport (MP tRARP) robotic-assisted radical prostatectomy. Methods This was a retrospective analysis from our single-center database for patients who underwent SP eRARP or MP tRARP with PLND between 2015 and 2023. The primary endpoint was to analyze and compare specific data related to PLND between the two populations by the detection of pN+ patients, the total number of lymph nodes removed, and the number of positive lymph nodes removed. The secondary endpoints included comparing major complications, lymphoceles, and biochemical recurrence between the two cohorts of the study. Key findings and limitations A total of 293 patients were included, with 85 (29%) undergoing SP eRARP and 208 (71%) undergoing MP tRARP. SP eRARP showed significant differences in PLND extension from MP tRARP, while MP tRARP yielded more lymph nodes (p < 0.001). There were no differences in pN+ patient detection (p = 0.7) or the number of positive lymph nodes retrieved (p = 0.6). The rates of major complications (p = 0.6), lymphoceles (p = 0.2), and biochemical recurrence (p = 0.9) were similar between the two groups. Additionally, SP eRARP had shorter operative time (p = 0.045), hospital stay (p < 0.001), and less postoperative pain at discharge (p = 0.03). Limitations include a retrospective, single-center analysis. Conclusions and clinical implications Despite the SP approach in RARP resulting in fewer retrieved lymph nodes, outcomes were comparable with the MP approach regarding the detection of patients with positive lymph nodes and the number of positive nodes. Additionally, the SP approach led to lower pain levels and shorter hospital stays. Patient summary With this study, we demonstrate that pelvic lymph node dissection performed via the extraperitoneal approach during robotic-assisted radical prostatectomy with a single-port system provides comparable outcomes with the standard transperitoneal multiport approach in detecting patients with positive lymph nodes and retrieving positive nodes. In addition, it offers significantly reduced pain levels and shorter hospital stays.
Collapse
Affiliation(s)
- Greta Pettenuzzo
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Ditonno
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Department of Urology, Rush University, Chicago, IL, USA
| | - Donato Cannoletta
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Pacini
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
- Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Luca Morgantini
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ruben Calvo Sauer
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Bartoletti
- Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Bertolo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
2
|
Wu Z, Wang Z, Moschovas MC, Bertolo R, Campi R, Rivas JG, Wei Y, Xia D, Xu B, Zhu Q, Teoh JYC, Gandaglia G, Amparore D, Porpiglia F, Patel V, Wang L. Robot-assisted Single-port Radical Prostatectomy with the SHURUI SP and da Vinci SP Platforms: Comparison of the Technology, Intraoperative Performance, and Outcomes. EUR UROL SUPPL 2024; 67:26-37. [PMID: 39113717 PMCID: PMC11304864 DOI: 10.1016/j.euros.2024.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/10/2024] Open
Abstract
Background and objective The purpose-built SHURUI single-port (SP) robotic platform has recently been introduced for several procedures in urology, general surgery, and gynecology. However, comparative evidence on its performance in relation to earlier models such as the da Vinci SP is lacking. Our aim was to compare the step-by-step techniques and 1-yr outcomes for radical prostatectomy (RP) between the SHURUI SP and da Vinci SP robots. Methods Data were retrieved from two prospectively maintained databases. The SHURUI SP robot was used to perform RP in 34 patients in China (September 2021 to August 2022); the da Vinci SP robot was used to perform 100 consecutive RP cases in the USA (June 2019 to October 2020). A comparative analysis was conducted before and after 1:1 propensity score matching for age, body mass index, American Urological Association symptom score, prostate size, prostate-specific antigen (PSA) levels, biopsy grade group, and D'Amico risk group. Intraoperative performance and short-term oncological and continence outcomes were compared between the groups. Biochemical recurrence was defined as two consecutive postoperative PSA levels >0.2 ng/ml. Continence was defined as full recovery of urinary control without the use of pads. The Kaplan-Meier method was used to estimate continence recovery curves, and a log-rank test for trend was used to detect ordered differences in continence recovery between the SHURUI SP and da Vinci SP groups after surgery. Key findings and limitations For the matched SHURUI and da Vinci groups, median age (69 vs 69 yr), median PSA (8.4 vs 7.1 ng/ml), and the proportion of patients with low-risk (33.3% vs 29.6%), intermediate-risk (66.7% vs 63%), and high-risk disease (0% vs 7.4%) were comparable (all p > 0.05). All surgeries were successfully accomplished without conversion. A higher percentage of cases in the SHURUI group involved extraperitoneal access (81.5% vs 0%; p < 0.001) and a pure SP approach (25.9% vs 0%; p = 0.01), while a higher percentage of cases in the da Vinci group had nerve-sparing surgery. The median total operative (215 vs 110 min; p < 0.001) and median console time (162 vs 75 min; p < 0.001) were significantly longer in the SHURUI group. No intraoperative or major postoperative complications were observed in either group. Rates of positive surgical margins (18.5% vs 14.8%; p = 1.0) and extraprostatic extension (14.8% vs 29.6%; p = 0.19) were similar. At median follow-up of 13.5 versus 15.9 mo, none of the patients had experienced biochemical recurrence. At 1 yr after surgery, the continence rate was 96.3% in both groups. Conclusions Despite differences in driving mechanisms between the two SP robotic systems, RP can be performed safely and effectively with the SHURUI RP robot during the initial learning phase, with similar short-term oncological and continence outcomes to those with the da Vinci SP robot. Patient summary We compared two surgical robots (SHURUI SP and da Vinci SP) used to perform robotic surgery to remove the prostate through a single keyhole incision instead of multiple incisions. Our results show comparable technology and similar surgical and short-term cancer control outcomes for the two robots.
Collapse
Affiliation(s)
- Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- European Association of Urology Young Academic Urologists, Arnhem, The Netherlands
| | - Zheng Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Marcio Covas Moschovas
- European Association of Urology Young Academic Urologists, Arnhem, The Netherlands
- Global Robotics Institute, AdventHealth, Celebration, FL, USA
- University of Central Florida, Orlando, FL, USA
| | - Riccardo Bertolo
- European Association of Urology Young Academic Urologists, Arnhem, The Netherlands
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Campi
- European Association of Urology Young Academic Urologists, Arnhem, The Netherlands
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Juan Gómez Rivas
- European Association of Urology Young Academic Urologists, Arnhem, The Netherlands
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Yong Wei
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Dan Xia
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingyi Zhu
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jeremy Yuen-Chun Teoh
- European Association of Urology Young Academic Urologists, Arnhem, The Netherlands
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Giorgio Gandaglia
- European Association of Urology Young Academic Urologists, Arnhem, The Netherlands
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Clinical Oncology, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Amparore
- European Association of Urology Young Academic Urologists, Arnhem, The Netherlands
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Vipul Patel
- Global Robotics Institute, AdventHealth, Celebration, FL, USA
- University of Central Florida, Orlando, FL, USA
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
3
|
Chavali JS, Pedraza AM, Soputro NA, Ramos-Carpinteyro R, Mikesell CD, Kaouk J. Single-Port Extraperitoneal vs. Multiport Transperitoneal Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis. Cancers (Basel) 2024; 16:2994. [PMID: 39272854 PMCID: PMC11393968 DOI: 10.3390/cancers16172994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 09/15/2024] Open
Abstract
(1) Background: Since the introduction of the purpose-built Single Port (SP) robotic platform, there has been an ongoing debate regarding its advantages compared to the established multi-port (MP) system. The goal of this present study is to compare the perioperative, oncological, and functional outcomes of SP Extraperitoneal robotic radical prostatectomy (RARP) versus that of MP Transperitoneal RARP approach at a high-volume tertiary center. (2) Methods: Based on a retrospective review of the prospectively maintained IRB-approved database, 925 patients successfully underwent RARP by a single experienced robotic surgeon. A 4:1 propensity-matched analysis based on the baseline prostate cancer International Society of Urological Pathology (ISUP) Grade Group, clinical stage, and preoperative Prostate Specific Antigen (PSA) was performed, which yielded a cohort of 606 patients-485 in the SP EP and 121 in the MP TP approaches. Of note, the SP EP approach also included the traditional Extraperitoneal (n = 259, 53.4%) and the novel Transvesical (TV) approaches (n = 226, 46.6%). (3) Results: The overall operative time was slightly longer in the SP cohort, with a mean of 198.9 min compared to 181.5 min for the MP group (p < 0.001). There were no intraoperative complications with the MP approach and only one during the SP approach. The SP EP technique demonstrated significant benefits, encompassing reduced intraoperative blood loss (SP 125.1 vs. MP 215.9 mL), shorter length of hospital stay (SP 12.6 vs. MP 31.9 h), reduced opioid use at the time of discharge (SP 14.4% vs. MP 85.1%), and an earlier Foley catheter removal (SP 6 vs. MP 8 days). From an oncological perspective, the rate of positive surgical margins remained comparable across both groups (p = 0.84). Regarding functional outcomes, the mean continence rates and Sexual Health Inventory for Men (SHIM) scores were identical between the two groups at 6 weeks, 3 months, and 6 months respectively. (4) Conclusion: SP EP RARP demonstrates similar performance to MP TP RARP in terms of oncologic and functional outcomes. However, SP EP RARP offers several advantages in reducing the overall hospital stay, decreasing postoperative pain and hence the overall opioid use, as well as shortening the time to catheter removal, all of which translates to reduced morbidity and facilitates the transition to outpatient surgery.
Collapse
Affiliation(s)
- Jaya S Chavali
- Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH 44195, USA
| | - Adriana M Pedraza
- Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH 44195, USA
| | - Nicolas A Soputro
- Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH 44195, USA
| | - Roxana Ramos-Carpinteyro
- Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH 44195, USA
| | - Carter D Mikesell
- Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH 44195, USA
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH 44195, USA
| |
Collapse
|
4
|
Soputro NA, Ramos-Carpinteyro R, Chavali JS, Pedraza AM, Mikesell CD, Kaouk J. Predictors for selection of outpatient single-port robot-assisted laparoscopic radical prostatectomy. BJU Int 2024. [PMID: 39051533 DOI: 10.1111/bju.16483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To evaluate the different perioperative variables that may serve as important clinical predictors when selecting patients for outpatient single-port robot-assisted radical prostatectomy (SP-RARP). PATIENTS AND METHODS A retrospective review was performed on the Institutional Review Board-approved, prospectively maintained database to identify 485 consecutive patients who underwent SP-RARP between 2018 and 2023. A comparison analysis was performed on patients who were managed as outpatients vs inpatients following their respective SP-RARP. A separate analysis was performed after excluding patients with pre-planned admissions to identify the risk factors for unplanned admissions. RESULTS All procedures were successfully completed without any conversion or additional ports. After excluding patients with pre-planned admissions, outpatient SP-RARP was successfully achieved in 86.6% with a median (interquartile range) length of stay of 4.6 (3.8-6.1) hours. Our multivariate regression analysis identified cardiac comorbidity and preoperative International Prostate Symptom Score (IPSS) as predictors of outpatient SP-RARP. In addition, the absence of cardiac comorbidity, previous abdominal surgery, and lower postoperative pain score were protective against the risk of unplanned admission. Furthermore, both inpatient and outpatient encounters had comparable 90-day rates of postoperative complication (P = 0.136) and hospital re-admission (P = 0.942). CONCLUSION Outpatient management models could be successfully achieved in most patients who underwent SP-RARP (86.6%) while maintaining similarly low perioperative morbidity profile. Nevertheless, appropriate patient selection based on the baseline clinicodemographic characteristics remains essential to ensure the safety and ongoing success of outpatient SP-RARP.
Collapse
Affiliation(s)
- Nicolas A Soputro
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | | | - Jaya S Chavali
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Adriana M Pedraza
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Carter D Mikesell
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Jihad Kaouk
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| |
Collapse
|
5
|
Soputro NA, Chavali JS, Ferguson EL, Ramos-Carpinteyro R, Calvo RS, Nguyen J, Moschovas MC, Wilder S, Okhawere K, De La Rosa RS, Saini I, Peabody J, Badani KK, Rogers C, Joseph J, Nix J, Patel V, Stifelman M, Ahmed M, Crivellaro S, Kim M, Kaouk JH. Complications of single-port robot-assisted radical prostatectomy: multi-institutional analysis from the Single-Port Advanced Research Consortium (SPARC). BJU Int 2024; 134:54-62. [PMID: 37971182 DOI: 10.1111/bju.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To evaluate the perioperative complications of single-port robot-assisted radical prostatectomy (SP-RARP). PATIENTS AND METHODS A retrospective review was performed on the prospectively maintained, Institutional Review Board-approved, multi-institutional Single-Port Advanced Research Consortium (SPARC) database. A total of 1103 patients were identified who underwent three different approaches of SP-RARP between 2019 and 2022 using the purpose-built SP robotic platform. In addition to baseline clinical, perioperative outcomes, this study comprehensively analysed for any evidence of intraoperative complication, as well as postoperative complication and readmission within 90 days of the respective surgery. RESULTS Of the 244, 712, and 147 patients who underwent transperitoneal, extraperitoneal, and transvesical SP-RARP, respectively, intraoperative complications were noted in five patients (0.4%), all of which occurred during the transperitoneal approach. Two patients had bowel serosal tears, two had posterior button-holing of the bladder necessitating repair, and one patient had an obturator nerve injury. Postoperative complications were noted in 143 patients (13%) with major complications (Clavien-Dindo Grade ≥III) only identified in 3.7% of the total cohort. The most common complications were lymphocele (3.9%), acute urinary retention (2%), and urinary tract infection (1.9%). The 90-day re-admission rate was 3.9%. CONCLUSION The SP-RARP is a safe and effective procedure with low complication and readmission rates regardless of the approach. These results are comparable to current multi-port RARP literature.
Collapse
Affiliation(s)
- Nicolas A Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaya Sai Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Indu Saini
- Mount Sinai Hospital, New York City, NY, USA
| | | | | | | | - Jean Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Nix
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vipul Patel
- Advent Health Medical Group Urology, Celebration, FL, USA
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack, NJ, USA
- Hackensack Meridien School of Medicine, Hackensack, NJ, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ, USA
- Hackensack Meridien School of Medicine, Hackensack, NJ, USA
| | | | - Moses Kim
- Orange County Urology Associates, Laguna Hills, CA, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
6
|
Pedraza AM, Ferguson EL, Ramos-Carpinteyro R, Mikesell C, Chavali JS, Soputro N, Almassi N, Weight C, Gorgun E, Kaouk J. Managing prostate cancer after proctocolectomy and ileal pouch-anal anastomosis: feasibility and outcomes of single-port transvesical robot-assisted radical prostatectomy. World J Urol 2024; 42:368. [PMID: 38832957 DOI: 10.1007/s00345-024-05051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Patients with proctocolectomy and ileal pouch-anal anastomosis (PC-IPAA) face unique challenges in managing prostate cancer due to their hostile abdomens and heightened small bowel mucosa radiosensitivity. In such cases, external beam radiation therapy (EBRT) is contraindicated, and while brachytherapy provides a safer option, its oncologic effectiveness is limited. The Single-Port Transvesical Robot-Assisted Radical Prostatectomy (SP TV-RARP) offers promise by avoiding the peritoneal cavity. Our study aims to evaluate its feasibility and outcomes in patients with PC-IPAA. METHODS A retrospective evaluation was done on patients with PC-IPAA who had undergone SP TV-RARP from June 2020 to June 2023 at a high-volume center. Outcomes and clinicopathologic variables were analyzed. RESULTS Eighteen patients underwent SP TV-RARP without experiencing any complications. The median hospital stay was 5.7 h, with 89% of cases discharged without opioids. Foley catheters were removed in an average of 5.5 days. Immediate urinary continence was seen in 39% of the patients, rising to 76 and 86% at 6- and 12-month follow-ups. Half of the cohort had non-organ confined disease on final pathology. Two patients with ISUP GG3 and GG4 exhibited detectable PSA post-surgery and required systemic therapy; both had SVI, multifocal ECE, and large cribriform pattern. Positive surgical margins were found in 44% of cases, mostly Gleason pattern 3, unifocal, and limited. After 11.1 months of follow-up, no pouch failure or additional BCR cases were found. CONCLUSION Patients with PC-IPAA often exhibit aggressive prostate cancer features and may derive the greatest benefit from surgical interventions, particularly given that radiation therapy is contraindicated. SP TV-RARP is a safe option for this group, reducing the risk of bowel complications and promoting faster recovery.
Collapse
Affiliation(s)
- Adriana M Pedraza
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Roxana Ramos-Carpinteyro
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Carter Mikesell
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Jaya S Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Nicolas Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Nima Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Colorectal Surgery, DDSI, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA.
| |
Collapse
|
7
|
Ko YH, Jang JY, Kim YU, Kim SW. Faster both in operative time and functional recovery by the extraperitoneal daVinci SP-based robot-assisted radical prostatectomy: a propensity score matching analysis compared to transperitoneal multiport counterpart. J Robot Surg 2024; 18:205. [PMID: 38714543 DOI: 10.1007/s11701-024-01950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/14/2024] [Indexed: 05/10/2024]
Abstract
We aim to investigate the peri-operative outcomes after extraperitoneal single-port based robot-assisted radical prostatectomy (eSP-RARP) utilizing the da Vinci SP system compared to conventional transperitoneal multi-port counterparts (tMP-RARP), in an era when pelvic lymph node dissection (PNLD) was omitted for the node-negative case. With exclusion criteria of volume + 50 g, suspicious rectal invasion, and node-positive disease given relatively weak grasping power and limited range of motion from the current SP system, 50 consecutive patients (Since December 2021) with localized prostate cancer underwent eSP-RARP by a single urologist maintaining identical surgical technique for 100 consecutive tMP-RARP cases (Since December 2020). Given initial selection criteria, each group was matched to a 1:1 ratio based on the risk-stratification parameters and the prostate volume. The operative time, which was maintained in each group during the study period, was significantly faster in eSP-RARP groups than in tMP-RARP (149.2 vs. 163.2 min, p = 0.025), while the weight of the removed specimen (27.1 vs. 29.0 g, p = 0.420) and margin positivity (14.7% vs. 11.7% in pT2, p = 0.812) were similar. The gas-out (1.5 vs. 1.88 days, p = 0.003) and solid diet dates (2.26 vs. 3.22 days, p < 0.001) were faster in the eSP-RARP group. The single-pad continence dates (30.5 vs. 51.9 days, p = 0.145) and zero-pad continence dates (105.5 vs. 146.2 days, p = 0.210) were identical. 90-day single-pad continence rate was 92% vs. 82% (p = 0.142, 52% vs. 56% in zero-pad continence). Based on these, daVinci SP-based RARP restored bowel function faster with shorter operative time through an extraperitoneal approach than the conventional transperitoneal multi-port counterpart while maintaining similar incontinence outcomes in cases without a routine PNLD.
Collapse
Affiliation(s)
- Young Hwii Ko
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.
| | - Jae Youn Jang
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Yeong Uk Kim
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Sang Won Kim
- College of Medicine, Medical Research Center, Yeungnam University, Daegu, Korea
| |
Collapse
|
8
|
Fan S, Chen Z, Zhou F, Lv Q, Wang D, Ren S, Tian X. Comparison of perioperative and functional outcomes of single-incision versus standard multi-incision robot-assisted laparoscopic radical prostatectomy: a prospective, controlled, nonrandomized trial. J Robot Surg 2024; 18:195. [PMID: 38700764 PMCID: PMC11068665 DOI: 10.1007/s11701-024-01962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
To compare perioperative and functional outcomes between improved (port-free) single-site robot-assisted laparoscopic radical prostatectomy (pf-ssRARP) and standard multi-port robot-assisted radical prostatectomy (MPRARP). A total of 372 consecutive patients underwent RARAP using the da Vinci Si® robotic surgical system. Group I (n = 210) included patients undergoing pf-ssRARP and Group II (n = 162) included patients undergoing MPRARP. Demographics and perioperative data including postoperative recovery outcomes were recorded and compared between the two groups. Overall mean operative time was significantly shorter with the pf-ssRARP compared to the MPRARP (p < 0.05). The length of hospitalization after the pf-ssRARP was shorter (p < 0.05). In Group I, the positive surgical margin rate was 15.2%; while in Group II, the positive margin rate was 33.3% (p < 0.05). The rate of instant urinary continence was significantly higher in Group I than in Group II (p < 0.05). The percentage of urinary continence was higher in the pf-ssRARP than in the MPRARP, at 6 months post-surgery (p < 0.05) and 9 months post-surgery (p < 0.05). There was no significant difference in the proportion of erectile function in the pf-ssRARP and MPRARP groups at the time of reaching the endpoint of this study (p > 0.05). The two groups were comparable in terms of total hospitalization costs (p < 0.05). The improved (port-free) single-site robot-assisted laparoscopic radical prostatectomy is a practical and easy technique to implement in clinical practice. Extraperitoneal implementation of the modified technique requires only a small incision, no special PORT, no additional auxiliary foramen creation, increased postoperative aesthetics and reduced hospitalization costs, and a high percentage of early postoperative urinary control recovery.
Collapse
Affiliation(s)
- Shida Fan
- Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Zhengjun Chen
- Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fang Zhou
- Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Lv
- Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dong Wang
- Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shangqing Ren
- Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuemei Tian
- Centre for Surgical Anaesthesia, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
9
|
Lama DJ, Thomas K, Vernez SL, Okunowo O, Lau CS, Yuh BE. Minimally invasive cytoreductive radical prostatectomy, exploring the safety and feasibility of a single-port or multi-port robotic platform. BMC Urol 2024; 24:72. [PMID: 38532371 PMCID: PMC10964602 DOI: 10.1186/s12894-024-01463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Consolidative resection or cytoreductive radical prostatectomy (CRP) may benefit men with non-organ confined prostate cancer. We report the safety, feasibility, and outcomes of robot-assisted laparoscopic CRP using a single-port (SP) or multi-port (MP) platform. METHODS We reviewed consecutive men with clinical node positive or metastatic castrate-sensitive prostate cancer who underwent IRB-approved CRP and extended pelvic lymph node dissection using the da Vinci SP or MP Surgical Systems (Intuitive Surgical, Sunnyvale, CA) from 2015-2022. Perioperative data and Clavien-Dindo 90-day complications were recorded. RESULTS Twenty-four men with a median age of 61 (IQR 56-69) years and prostate-specific antigen of 32.1 (IQR 21.9-62.3) ng/mL were included. Clinical N1, M1, or N1 + M1 disease were detected in 8 (33%), 9 (38%), 7 (29%) patients, respectively. There was no difference in positive margins, 41% vs. 29% (P = 0.67), lymph node yield, 21 (IQR 14-28) vs. 20 (IQR 13.5-21) nodes (P = 0.31), or estimated blood loss, 150 mL (IQR 100-200) vs. 50 mL (IQR 50-125) (P = 0.06), between the MP and SP cohorts, respectively. Hospital length of stay was significantly shorter for the SP group, same-day discharge (IQR 0-0), compared to MP, 1-day (IQR 1-1), P < 0.001. One grade III bowel obstruction and lymphocele occurred in the MP cohort. No major complications occurred in the SP cohort. CONCLUSION Robot-assisted laparoscopic CRP is safe and feasible for select men with advanced castrate-sensitive prostate cancer.
Collapse
Affiliation(s)
- Daniel J Lama
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Kyle Thomas
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Simone L Vernez
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Oluwatimilehin Okunowo
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Clayton S Lau
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Bertram E Yuh
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| |
Collapse
|
10
|
Ferguson EL, Ramos-Carpinteyro R, Soputro N, Chavali JS, Geskin A, Kaouk JH. Single-Port Robotic Radical Prostatectomy Using Transvesical and Transperineal Access in Patients with a Hostile Abdomen. J Endourol 2024; 38:150-158. [PMID: 38069569 DOI: 10.1089/end.2023.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Introduction: Prostate cancer diagnosis and treatment is challenging in surgically complex patients. Radical prostatectomy can be performed without peritoneal entry using novel single-port (SP) transperineal (TP) and transvesical (TV) approaches. We sought to examine the outcomes of radical prostatectomy using novel TP and TV approaches in patients with extensive prior abdominal surgeries. Materials and Methods: From 2019 to 2023, 51 patients with extensive prior abdominal surgeries were identified who underwent TP (18) and SP TV (33) robotic radical prostatectomy. Indications included history of various surgeries with open laparotomy, including J-pouch reconstruction (22, 43%), active stoma (14, 27%), and open bowel resection (9, 18%). In all patients, 12/51 (24%) had a history of incisional hernia repair with mesh. A retrospective analysis was performed. Results: All cases were completed without open conversion, bowel injuries, or blood transfusions. Length of stay was 5.6 hours for TV and 22 hours for TP. No opioids were prescribed in 91% of TV vs 56% of TP. One intraoperative complication (ureteral injury) occurred in a patient undergoing the TP approach. Postoperative complications were noted in 14/51 (27%), including 10/18 (56%) TP vs 4/33 (12%) TV. High-grade complications (Clavien 3) occurred in three patients (6%, all TP). Pathologic staging showed pT3 in 26/51 (17 TV vs 9 TP), while the remainder were pT2. Biochemical recurrences were noted in four patients (8%, three TV and one TP). Immediate continence was noted in 30% of TV patients. Long-term continence after 12 months was 92% in TV and 67% in TP. Conclusions: In patients with extensive prior abdominal surgeries, radical prostatectomy is feasible using a TP or TV approach. No bowel injuries or open conversion were observed. The SP TV approach offers advantages of shorter hospital stay, shorter catheter duration, less opioid use, fewer complications, and improved continence recovery.
Collapse
Affiliation(s)
- Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Nicolas Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaya Sai Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Albert Geskin
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
11
|
Franco A, Ditonno F, Manfredi C, Pellegrino AA, Licari LC, Bologna E, Feng C, Antonelli A, De Sio M, De Nunzio C, Porpiglia F, Cherullo EE, Kaouk J, Crivellaro S, Autorino R. Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00787-2. [PMID: 38263281 DOI: 10.1038/s41391-024-00787-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Aim of our study was to review the current evidence on single port robot-assisted radical prostatectomy (SP-RARP) and SP robot-assisted simple prostatectomy (SP-RASP) procedures. METHODS A comprehensive bibliographic search on multiple databases was conducted in July 2023. Studies were included if they assessed patients with non-metastatic prostate cancer or candidate for benign prostatic hyperplasia surgery (P) who underwent SP-RARP or SP-RASP, respectively, (I), compared or not with other surgical techniques (C), evaluating perioperative, oncological, or functional outcomes (O). Prospective and retrospective original articles were included (S). A meta-analysis of comparative studies between SP-RARP and MP-RARP was performed. RESULTS A total of 21 studies investigating 1400 patients were included in our systematic review, 18 were related to SP-RARP while 3 to SP-RASP. Only 8 comparative studies were eligible for meta-analysis. Mean follow-up was 8.1 (±5.8) months. Similar outcomes were observed for SP-RARP and MP-RARP in terms of operative time, catheterization time, pain score, complications rate, continence and potency rates, positive surgical margin, and biochemical recurrence. Length of hospital stay was shorter in the SP group after sensitivity analysis (WMD -0.58, 95% IC -1.17 to -0.9, p < 0.05). Subgroup analysis by extraperitoneal approach did not show any statistical difference, except for a lower positive margins rate in the SP extraperitoneal technique compared to MP-RARP. Overall, SP-RASP exhibited shorter hospital stay and lower rate of de novo urinary incontinence when compared to other techniques, while no differences were reported in terms of postoperative International Prostate Symptom Score, post void residual and maximum flow. CONCLUSIONS Overall comparable oncological, functional, and perioperative outcomes can be achieved with SP platform. Subgroup analysis by different approaches did not reveal significant variations in outcomes. However, the retrospective nature of the studies, the limited follow-up, and the relatively small sample size of selected Centers may impact these results.
Collapse
Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | | | - Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carol Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | | | - Marco De Sio
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Jihad Kaouk
- Department of Urology, Glickman Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | |
Collapse
|
12
|
Mian AH, Tollefson MK, Shah P, Sharma V, Mian A, Thompson RH, Boorjian SA, Frank I, Khanna A. Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy. J Clin Med 2024; 13:359. [PMID: 38256493 PMCID: PMC10815957 DOI: 10.3390/jcm13020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.
Collapse
Affiliation(s)
- Abrar H. Mian
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ahmed Mian
- Urology Associates of Green Bay, Green Bay, WI 54301, USA
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Abhinav Khanna
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
13
|
Roy SS, Sathe AA, Watson MJ, Singh A. Comparison of robotic-assisted laparoscopic radical prostatectomy: SP versus XI, a single surgeon experience. J Robot Surg 2023; 17:2817-2821. [PMID: 37736871 DOI: 10.1007/s11701-023-01720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
Currently, there is a paucity of data regarding Single Port (SP) robotic-assisted laparoscopic prostatectomy (RALP). Our objective was to compare our single-institution single-surgeon SP RALP experience to our XI RALP experience with regard to patient selection, perioperative data, and outcomes. Patients who underwent prostatectomy at our institution between August 2019 and April 2021 were selected for analysis. All patients had biopsy confirmed prostate cancer. All surgeries were performed by one urologist at our institution to limit inter-surgeon variability. Demographic and clinical information were extracted from the medical record in standardized fashion. All documented classifications were graded using the Clavien-Dindo classification system. Patients with previous prostate cancer therapies were excluded. Categorical variables were compared using Chi-square or Fisher's exact test where appropriate. Continuous variables were compared using t tests or Wilcoxon rank sum tests where appropriate. Complete records were available for 208 patients. Of the total patient population 127 (61.1%) underwent SP prostatectomy compared to 81 (38.9%) underwent XI prostatectomy. There was no significant difference between the two cohorts in terms of mean age (65 vs. 66 years; p = 0.60), BMI (29.2 vs. 30.1; p = 0.22), preop ASA score ≥ 3 (68.5% vs. 64.2%; p = 0.52), or preop PSA (7.1 vs. 7.4, p = 0.94). There no difference in procedure time for SP prostatectomy (170 vs. 168 min, p = 0.035), estimated blood loss (100 vs. 100 mL; p = 0.14), or average length of stay (1 vs. 1 days; p = 0.22). There was a significant difference in Gleason grade group between the two cohorts with patients undergoing XI RALRP more likely to have higher stage disease (p = 0.025) and a trend towards higher D'Amico risk scores in the XI group (p = 0.053). There was no difference in rate of positive surgical margins (29.9% vs. 29.6%; p = 0.96). There was no difference in the distribution of complications between the two groups (p = 0.99) with 89% of patients having no complication. There was no difference in the number of lymph nodes removed by modality (p = 0.94). To date, this study represents one of the largest cohorts of patients who underwent SP RALP. Importantly, it is among the first studies comparing perioperative variables between the SP and XI platforms. As surgeons become more facile with the SP system there appear to minimal differences in patient factors, perioperative results, or outcomes between the platforms. These findings provide evidence that surgeons who are competent on the XI platform can confidently perform SP RALPs through a single incision without compromising outcomes.
Collapse
Affiliation(s)
- Samit Sunny Roy
- University of Tennessee College of Medicine - Chattanooga, Chattanooga, TN, USA.
| | - Aditya A Sathe
- University of Tennessee College of Medicine - Chattanooga, Chattanooga, TN, USA
| | - Matthew J Watson
- University of Tennessee College of Medicine - Chattanooga, Chattanooga, TN, USA
| | - Amar Singh
- University of Tennessee College of Medicine - Chattanooga, Chattanooga, TN, USA
| |
Collapse
|
14
|
Franco A, Ditonno F, Manfredi C, Johnson AD, Mamgain A, Feldman-Schultz O, Feng CL, Pellegrino AA, Mir MC, Porpiglia F, Crivellaro S, De Nunzio C, Chow AK, Autorino R. Robot-assisted Surgery in the Field of Urology: The Most Pioneering Approaches 2015-2023. Res Rep Urol 2023; 15:453-470. [PMID: 37842031 PMCID: PMC10575039 DOI: 10.2147/rru.s386025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Robot-assisted surgery has emerged as a transformative technology, revolutionizing surgical approaches and techniques that decades ago could barely be imagined. The field of urology has taken charge in pioneering a new era of minimally invasive surgery with the ascent of robotic systems which offer enhanced visualization, precision, dexterity, and enabling surgeons to perform intricate maneuvers with improved accuracy. This has led to improved surgical outcomes, including reduced blood loss, lower complication rates, and faster patient recovery. The aim of our review is to present an evidence-based critical analysis on the most pioneering robotic urologic approaches described over the last eight years (2015-2023).
Collapse
Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, “Luigi Vanvitelli” University, Naples, Italy
| | | | | | | | - Carol L Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | | | | |
Collapse
|
15
|
Soputro NA, Ferguson EL, Ramos-Carpinteyro R, Chavali JS, Kaouk J. The Transition Toward Opioid-sparing Outpatient Radical Prostatectomy: A Single Institution Experience With Three Contemporary Robotic Approaches. Urology 2023; 180:140-150. [PMID: 37454769 DOI: 10.1016/j.urology.2023.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To evaluate for differences in the perioperative and early postoperative outcomes between three different contemporary approaches of robotic radical prostatectomy (RARP), namely Single-Port (SP) Transvesical (TV), SP Extraperitoneal (EP), and Multi-Port (MP) Transperitoneal (TP). METHODS Retrospective review was performed on 865 consecutive patients with localized prostate cancer who underwent SP-TV, SP-EP, and MP-TP RARP. SP-TV and SP-EP RARP were performed using the purpose-built SP robotic platform. All procedures were performed by a single, experienced robotic surgeon. Demographics, perioperative, and early postoperative data were collected from the prospectively-maintained database. Statistical analysis was performed with descriptive statistics as presented. RESULTS All SP cases were completed without any need for conversion or additional ports. When compared with MP-TP RARP, both SP-EP and SP-TV RARP were associated with significantly reduced length of stay (median, SP-TV 5.07 vs SP-EP 5.1 vs MP-TP 26.6 hours, P = <.05) and with most patients being discharged within 24 hours (SP-TV 92.3% vs SP-EP 84.6% vs MP-TP 30.4%, P = <.05). Postoperative analgesia requirements were significantly reduced following SP-TV RARP with 95% did not require opioid analgesia after discharge, as opposed to 77.6% and 12.1% of patients in the SP-EP and MP-TP RARP cohorts, respectively (P = <.05). Additionally, SP-TV RARP demonstrated the added benefit of a shorter Foley catheter duration of 4 days with an earlier return of urinary continence. CONCLUSION The localization of RARP, as facilitated by the SP robotic platform, provided the opportunity for enhanced postoperative recovery resulting in decreased length of admission and postoperative pain, which allowed for increasing adoption of opioid-sparing outpatient prostatectomy.
Collapse
Affiliation(s)
- Nicolas A Soputro
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ethan L Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Jaya S Chavali
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
16
|
Soputro NA, Ferguson EL, Ramos-Carpinteyro R, Sauer Calvo R, Nguyen J, Moschovas MC, Wilder S, Chavali JS, Okhawere KE, De La Rosa RS, Saini I, Peabody J, Badani KK, Rogers C, Joseph J, Patel V, Stifelman M, Ahmed M, Crivellaro S, Kim M, Nix J, Kaouk J. Low Risk of Postoperative Hernia Following Single-port Robot-assisted Radical Prostatectomy: A Report From the Single-port Advanced Research Consortium (SPARC). Urology 2023; 180:151-159. [PMID: 37454768 DOI: 10.1016/j.urology.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To evaluate the risk of postoperative hernia following different approaches of single-port robot-assisted radical prostatectomy (SP-RARP). METHODS A retrospective review was performed on patients who underwent SP-RARP between February 2019 and December 2022. Demographic and clinical information was collected from the multi-institutional, prospectively-maintained Single-Port Advanced Research Consortium (SPARC) database. Data were analyzed using IBM Statistical Packaging for Social Sciences (SPSS) version 29.0 with descriptive statistics as presented. RESULTS A total of 1103 patients were identified, consisting of 244 (22.1%), 712 (64.6%), and 147 (13.3%) cases performed via transperitoneal, extraperitoneal (EP), and transvesical (TV) approaches, respectively. During a median follow-up time of 11 months (interquartile range 5.7-17.1 months), only two cases of incisional hernia were reported. Both cases occurred following transperitoneal SP-RARP with one patient requiring surgical repair. There remains no evidence of postoperative hernia following EP and TV SP-RARP at the completion of our review. CONCLUSION SP-RARP was associated with low risk for postoperative hernia. The risk was lower following TV and EP SP-RARP where the peritoneum is preserved.
Collapse
Affiliation(s)
- Nicolas A Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | | - Jaya S Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | | | | - Jean Joseph
- University of Rochester Medical Center, Rochester, NY
| | - Vipul Patel
- AdventHealth Medical Group Urology, Celebration, FL
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack, NJ; Hackensack Meridian School of Medicine, Nutley, NJ
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ; Hackensack Meridian School of Medicine, Nutley, NJ
| | | | - Moses Kim
- Orange County Urology Associates, Laguna Hills, CA
| | - Jeffrey Nix
- University of Alabama at Birmingham, Birmingham, AL
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
17
|
Ramos-Carpinteyro R, Ferguson EL, Chavali JS, Geskin A, Soputro N, Kaouk J. Single-port Transvesical Robot-assisted Radical Prostatectomy: The Surgical Learning Curve of the First 100 Cases. Urology 2023; 178:76-82. [PMID: 37302759 DOI: 10.1016/j.urology.2023.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/15/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine the number of cases required to reach plateau performance. METHODS We performed a single-surgeon review of the first 100 consecutive procedures. All procedures were performed using the da Vinci single-port robotic system between November 2020 and March 2022. Time was used as the measure of the learning curve (LC). Relevant surgical steps were considered separately for detailed analysis. Data were collected retrospectively and analyzed through the cumulative sum method and moving average graphing. A comparative analysis was done between subgroups of 20 consecutive cases for perioperative outcomes. RESULTS All cases were completed successfully, without extra ports or conversion. The LC for prostate excision showed initial exponential improvement and reached plateau at case 28. Vesicourethral anastomosis time gradually shortened over time, with a clear inflection point at case 10. Total operative time rapidly improved and plateaued early to 213.0 minutes. Robot-docking and undocking, achieving hemostasis, wound closure, and intraoperative idle times were consistent throughout the series. Estimated blood loss decreased significantly after the first 20 cases (from median of 135.0-88.0 mL, P = .03). CONCLUSION In our early experience, the LC for single-port transvesical robot-assisted radical prostatectomy suggests that performance improved after 10-30 cases in the hands of an experienced robotic surgeon.
Collapse
Affiliation(s)
| | - Ethan L Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jaya S Chavali
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Albert Geskin
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Nicolas Soputro
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
18
|
Ren S, Zheng Y, Hu X, Bao Y, Wang D, Chang Y. Recent advances in single-site/incision robotic-assisted radical prostatectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1341-1350. [PMID: 36935223 DOI: 10.1016/j.ejso.2023.03.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Single-site robotic-assisted radical prostatectomy (ssRARP) has been successfully applied to treat prostate cancer. This review aims to describe the recent advances of surgical approaches, working accesses and novel robotic platforms in ssRARP. MATERIAL AND METHODS A systematic literature search was performed by searching the PubMed, EMBASE, Web of Science and Scopus databases in December 2022 to identify all literature related to ssRARP. RESULTS A total of 48 relevant studies were found worldwide from 2008 to 2023. Since the introduction of ssRARP, various modifications of this technique in surgical approaches, working accesses and novel robotic platforms have been developed. The application of ssRARP using the da Vinci SP platform has shown great superiority with encouraging clinical outcomes. DISCUSSION There has been a potential shift toward ssRARP using the da Vinci SP platform due to its potential advantages in terms of lower blood loss, minimal postoperative pain, better cosmetic outcome and rapid recovery. More convincing evidence, further technical improvement and higher cost-effectiveness are needed for its widespread acceptance.
Collapse
Affiliation(s)
- Shangqing Ren
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Yang Zheng
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610051, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Dong Wang
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.
| | - Yifan Chang
- Department of Urology, Changhai Hospital, Shanghai, 200433, China.
| |
Collapse
|
19
|
Wang R, Bai H, Xia G, Zhou J, Dai Y, Xue Y. Identification of milling status based on vibration signals using artificial intelligence in robot-assisted cervical laminectomy. Eur J Med Res 2023; 28:203. [PMID: 37381061 DOI: 10.1186/s40001-023-01154-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/03/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND With advances in science and technology, the application of artificial intelligence in medicine has significantly progressed. The purpose of this study is to explore whether the k-nearest neighbors (KNN) machine learning method can identify three milling states based on vibration signals: cancellous bone (CCB), ventral cortical bone (VCB), and penetration (PT) in robot-assisted cervical laminectomy. METHODS Cervical laminectomies were performed on the cervical segments of eight pigs using a robot. First, the bilateral dorsal cortical bone and part of the CCB were milled with a 5 mm blade and then the bilateral laminae were milled to penetration with a 2 mm blade. During the milling process using the 2 mm blade, the vibration signals were collected by the acceleration sensor, and the harmonic components were extracted using fast Fourier transform. The feature vectors were constructed with vibration signal amplitudes of 0.5, 1.0, and 1.5 kHz and the KNN was then trained by the features vector to predict the milling states. RESULTS The amplitudes of the vibration signals between VCB and PT were statistically different at 0.5, 1.0, and 1.5 kHz (P < 0.05), and the amplitudes of the vibration signals between CCB and VCB were significantly different at 0.5 and 1.5 kHz (P < 0.05). The KNN recognition success rates for the CCB, VCB, and PT were 92%, 98%, and 100%, respectively. A total of 6% and 2% of the CCB cases were identified as VCB and PT, respectively; 2% of VCB cases were identified as PT. CONCLUSIONS The KNN can distinguish different milling states of a high-speed bur in robot-assisted cervical laminectomy based on vibration signals. This method is feasible for improving the safety of posterior cervical decompression surgery.
Collapse
Affiliation(s)
- Rui Wang
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - He Bai
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Guangming Xia
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, College of Artificial Intelligence, Nankai University, 94 Weijin Road, Nankai District, Tianjin, 300071, China
| | - Jiaming Zhou
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yu Dai
- Tianjin Key Laboratory of Intelligent Robotics, Institute of Robotics and Automatic Information System, College of Artificial Intelligence, Nankai University, 94 Weijin Road, Nankai District, Tianjin, 300071, China.
| | - Yuan Xue
- Key Laboratory of Spine and Spinal Cord, Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
| |
Collapse
|
20
|
Abstract
Objective: The da Vinci single-port (SP) platform represents the latest innovation in minimally invasive urologic surgery, and the adoption of this technology by urologists is increasing. In this article, we briefly describe the evolution of minimally invasive and single-site surgery, and offer a comprehensive review of the current literature on the SP platform. Materials and Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until August 15, 2022. The published literature to date within SP robotic surgery in urology will be discussed. Evidence Synthesis: There are relatively few high-quality studies on the SP system, but there are multiple case series describing unique indications and surgical approaches with the SP robot, demonstrating safety and feasibility in the hands of experienced robotic surgeons. There also are an increasing number of prospective, larger cohort studies comparing outcomes between SP and multiport (MP) approaches that show benefits of the SP system regarding improved cosmesis, postoperative pain control, and decreased length of stay. Conclusions: Multiple prospective studies have shown benefits regarding cost and pain control for SP platform procedures compared to the traditional MP robotic approach. While its high cost and learning curve represent barriers to adoption, the SP platform represents a critical development in minimally invasive surgery. As this technology is further implemented at more institutions, long-term, high-quality data should accrue that will demonstrate its true value.
Collapse
Affiliation(s)
- Tuan Thanh Nguyen
- Department of Urology, University of California Irvine, Orange, California, USA
- University of Medicine and Pharmacy at Ho Chi Minh City, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Jacob Basilius
- Department of Urology, University of California Irvine, Orange, California, USA
| | - Sohrab Naushad Ali
- Department of Urology, University of California Irvine, Orange, California, USA
| | - Ryan W Dobbs
- Department of Urology, Cook County Health & Hospitals System, Chicago, Illinois, USA
| | - David I Lee
- Department of Urology, University of California Irvine, Orange, California, USA
| |
Collapse
|
21
|
Franco A, Pellegrino AA, De Nunzio C, Salkowski M, Jackson JC, Zukowski LB, Checcucci E, Vourganti S, Chow AK, Porpiglia F, Kaouk J, Crivellaro S, Autorino R. Single-Port Robot-Assisted Radical Prostatectomy: Where Do We Stand? Curr Oncol 2023; 30:4301-4310. [PMID: 37185441 PMCID: PMC10136812 DOI: 10.3390/curroncol30040328] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
In 2018, the da Vinci Single Port (SP) robotic system was approved by the US Food and Drug Administration for urologic procedures. Available studies for the application of SP to prostate cancer surgery are limited. The aim of our study is to summarize the current evidence on the techniques and outcomes of SP robot-assisted radical prostatectomy (SP-RARLP) procedures. A narrative review of the literature was performed in January 2023. Preliminary results suggest that SP-RALP is safe and feasible, and it can offer comparable outcomes to the standard multiport RALP. Extraperitoneal and transvesical SP-RALP appear to be the two most promising approaches, as they offer decreased invasiveness, potentially shorter length of stay, and better pain control. Long-term, high-quality data are missing and further validation with prospective studies across different sites is required.
Collapse
Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | | | - Jamal C Jackson
- Department of Urology, Rush University, Chicago, IL 60612, USA
| | | | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy
| | | | | | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | |
Collapse
|
22
|
Lv Z, Chen G, Li Y, Li J, Hu A, Yu X. Perioperative results of single-port vs multi-port robotic-assisted radical prostatectomy via peritoneal approach: a meta-analysis. J Robot Surg 2023:10.1007/s11701-023-01589-9. [PMID: 37052809 DOI: 10.1007/s11701-023-01589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023]
Abstract
To compare the perioperative outcomes of single-port robotic-assisted radical prostatectomy (SP-RARP) and multiport robotic-assisted radical prostatectomy (MP-RARP) via transperitoneal approach, we conducted a comprehensive database search of eligible studies up to October 2022 and compared their results. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and a leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of six articles were included, involving 926 patients, among which 256 underwent SP-RARP and 670 underwent MP-RARP. Comparing the two, SP-RARP was associated with shorter hospitalization time (- 0.5 days; 95% CI - 1.02, - 0.06, p < 0.05) and less intraoperative blood loss (- 29.88 ml; 95% CI - 45.66, - 14.10, p < 0.05). However, there were no significant differences in any complications, operative time, positive surgical margins, or short-term follow-up outcomes (continence and potency at 3 months). These findings provide reference data for the selection of surgical methods in performing transperitoneal RP and support further research on the broad applicability of the SP platform.
Collapse
Affiliation(s)
- Zongying Lv
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Guiyuan Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yugen Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Junyang Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Anneng Hu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaodong Yu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
| |
Collapse
|
23
|
Bang S, Shin D, Moon HW, Cho HJ, Ha US, Lee JY, Hong SH. Comparison of transperitoneal and retroperitoneal partial nephrectomy with single port robot. J Endourol 2023; 37:551-556. [PMID: 36800901 DOI: 10.1089/end.2022.0730] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
PURPOSE To investigate the efficacy and safety of single port robotic transperitoneal (TP) and retroperitoneal (RP) partial nephrectomy. MATERIALS AND METHODS From September 2021 to June 2022, 30 sequential cases of partial nephrectomy performed after a single port (SP) robot was introduced to our hospital were retrospectively analyzed. All patients were diagnosed with T1 renal cell carcinoma and operated by a single expert in conventional robot with a da Vinci SP platform. RESULTS A total of 30 patients underwent SP robotic partial nephrectomy, including 16 (53.33%) by TP and 14 (47.67%) by RP. Body mass index was slightly higher in the TP group (25.37 vs. 23.53, p-value = 0.040). Other demographic characteristics were not significantly different between the two groups. There was no statistically significant difference in ischemic time (727.41 ± 561.18 sec for TP and 698.56 ± 299.23 sec for RP, p-value = 0.812) or console time (67.97 ± 24.06 min for TP and 69.71 ± 28.66 min for RP, p-value = 0.724). There was no statistically significant difference in perioperative or pathological outcome either. Renal function calculated from DTPA was 103.33 ml/min/1.73m2 for TP and 101.33 ml/min/1.73m2 for RP (p-value = 0.214) postoperatively. It was 90.36 ml/min/1.73m2 for TP and 87.74 ml/min/1.73m2 for RP (p-value = 0.592) at 90 days after surgery. CONCLUSION SP robot partial nephrectomy can be performed effectively and safely regardless of the approach. Both TP and RP approaches offer similar perioperative and postoperative outcomes for T1 RCC.
Collapse
Affiliation(s)
- Seokhwan Bang
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Dongho Shin
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Hyong Woo Moon
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea
| |
Collapse
|
24
|
Abou Zeinab M, Beksac AT, Ferguson E, Kaviani A, Moschovas MC, Joseph J, Kim M, Crivellaro S, Nix J, Patel V, Kaouk J. Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched Study. Urology 2023; 171:140-145. [PMID: 36244472 DOI: 10.1016/j.urology.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/21/2022] [Accepted: 10/02/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the perioperative and early postoperative outcomes between single-port (SP) extraperitoneal radical prostatectomy (EPRP) and SP transperitoneal radical prostatectomy (TPRP), in a multi-institutional setting. METHODS We identified all patients who underwent SP robot-assisted radical prostatectomy at 6 different institutes. Data of 650 patients were collected and divided into 2 groups based on the surgical approach: SP EPRP or SP TPRP. A Propensity-score matched-pair analysis for body mass index (BMI), prostate size, and National Comprehensive Cancer Network risk was performed with a 1:1 ratio. Analysis of perioperative and postoperative outcomes was performed using Wilcoxon signed-rank test and chi-square and Fisher's exact tests. RESULTS After matching, 238 patients were included in each arm. The median follow-up period was 7 and 6 months for EPRP and TPRP groups, respectively. The total operative time was longer in the EPRP group (206 vs 155 minutes, P < .001). The EPRP group had a shorter length of hospitalization and same-day discharge rate compared to the TPRP approach (P < .001). There was no difference in the overall intraoperative or postoperative complications rate between the 2 groups, nor positive surgical margin rates. CONCLUSION The SP extraperitoneal approach is associated with a shorter hospital stay and higher rate of same-day discharge, with no difference in the surgical margin, or complication rates.
Collapse
Affiliation(s)
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ethan Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Aaron Kaviani
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Simone Crivellaro
- University of Illinois Hospital & Health Sciences System, Chicago, IL
| | - Jeffrey Nix
- University of Alabama Birmingham, Birmingham, AL
| | | | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
25
|
Zhang H, Ning Z, Jia G, Zhang G, Wang J, Liu H, Tao B, Wang C. Modified hood technique for single-port robot-assisted radical prostatectomy contributes to early recovery of continence. Front Surg 2023; 10:1132303. [PMID: 37206347 PMCID: PMC10189123 DOI: 10.3389/fsurg.2023.1132303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/19/2023] [Indexed: 05/21/2023] Open
Abstract
Background and purpose Urinary incontinence is one of the common side effects of robot-assisted radical prostatectomy (RARP). Here, we described the modified Hood technique for single-port RARP (sp-RARP) and assessed the interest of this new technique for early continence recovery. Methods We retrospectively reviewed 24 patients who underwent sp-RARP modified hood technique from June 2021 to December 2021. The pre-and intraoperative variables, postoperative functional and oncological outcomes of patients were collected and analyzed. The continence rates were estimated at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal. Continence was defined as wearing no pad over a 24 h period. Results Mean time of operation and estimated blood loss were 183 min and 170 ml, respectively. The postoperative continence rates at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal were 41.7%, 54.2%, 75.0%, 91.7% and 95.8%, respectively. There were two patients who detected positive surgical margins and no patients observed complications requiring further treatment. Conclusion The modified hood technique is a safe and feasible method that provides better outcomes in terms of early return of continence, without increasing estimated blood loss and compromising oncologic outcomes.
Collapse
Affiliation(s)
- Haoxun Zhang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zikuan Ning
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guang Jia
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guoling Zhang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiuliang Wang
- Department of Operating Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hua Liu
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Chunyang Wang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
- Correspondence: Chunyang Wang
| |
Collapse
|
26
|
Kim KH, Ahn HK, Kim M, Yoon H. Technique and perioperative outcomes of single-port robotic surgery using the da Vinci SP platform in urology. Asian J Surg 2023; 46:472-477. [PMID: 35691801 DOI: 10.1016/j.asjsur.2022.05.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe surgical technique for single port robotic surgery using the da Vinci SP system and report the perioperative outcomes. PATIENTS AND METHODS Between Jan 2019 and Jan 2021, single-port robotic urologic surgeries were performed in 120 patients by a single surgeon. Clinicopathologic data and perioperative outcomes were collected. All surgical procedures were performed with a transperitoneal approach through an umbilical single port. Additional assistant port was used in complex procedures for malignant disease. Surgeries were carried out using both above and below camera position for effective retraction. For reconstructive surgery using intestine, an extra-intracorporeal hybrid method was used. Surgical procedures involving both kidney and pelvis were performed without change of patient position or trocar placement. RESULTS Mean age was 62.7 years and 102 patients were male. For oncologic indication, 105 patients underwent surgeries including 66 radical prostatectomy, 25 partial nephrectomy, six radical nephrectomies, five nephroureterectomy and three radical cystectomy with urinary diversion. Fifteen cases with benign indication included four ureterolithotomy, seven uretero/pyeloplasty, three ureteroneocystostomy, and one ileal ureter reconstruction. All surgeries were performed successfully without conversion to other surgical approach. Clavien-Dindo grade III complication occurred in two patients. CONCLUSIONS The da Vinci SP system provides a new robotic surgical platform for single port surgery while maintaining the major features of robotic surgery similar to multi-port surgery. Various single port urologic surgeries can be safely performed with this platform.
Collapse
Affiliation(s)
- Kwang Hyun Kim
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, South Korea.
| | - Hyun Kyu Ahn
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Myong Kim
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Hana Yoon
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| |
Collapse
|
27
|
Shiang AL, Palka JK, Balasubramanian S, Figenshau RS, Smith ZL, Kim EH. Comparison of single-port and multi-port Retzius-sparing robot-assisted laparoscopic prostatectomy. J Robot Surg 2022; 17:835-840. [PMID: 36316538 PMCID: PMC9628306 DOI: 10.1007/s11701-022-01464-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
Dissemination of robotic surgical technology for robot-assisted laparoscopic prostatectomy (RALP) has yielded advancements including the Retzius-sparing (RS) approach and the single-port (SP) platform. The safety and feasibility of each individual advancement have been evaluated, yet there is a lack of literature comparing SP RS-RALP to conventional multi-port (MP) RS-RALP. All patients who underwent RS-RALP at our institution between January 2019 and February 2021 were retrospectively reviewed. Data regarding baseline patient and tumor characteristics, operative characteristics, and surgical outcomes were collected and analyzed using the Fisher's exact test and two-tailed unpaired t tests. 62 patients were evaluated: 31 received SP RS-RALP and 31 received MP RS-RALP. Differences in patient age, BMI, and initial PSA were not observed. Lower median lymph node yield (SP: 4 vs MP: 12, p < 0.01), lower estimated blood loss (SP: 111.2 vs. MP 157.8 mL, p < 0.01), shorter operative time (SP: 207.7 vs. MP: 255.9 min, p < 0.01) and decreased length of stay (SP: 0.39 vs. MP: 1.23 days, p < 0.01) were observed in the SP RS-RALP cohort. No differences in positive surgical margins, complications, or biochemical recurrence rates were observed. SP RS-RALP is non-inferior to MP RS-RALP in terms of both perioperative and early oncologic outcomes. Despite the small sample size, the SP platform is a safe and feasible option for RS-RALP and confers potential benefits in the form of shorter operative time and reduced length of stay.
Collapse
Affiliation(s)
- Alexander L. Shiang
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Joshua K. Palka
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Shiva Balasubramanian
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108 USA
| | - R. Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Zachary L. Smith
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| |
Collapse
|
28
|
Hou W, Wang B, Zhou L, Li L, Li C, Yuan P, Ouyang W, Yao H, Huang J, Yao K, Wang L. Single-site multiport vs. conventional multiport robot-assisted radical prostatectomy: A propensity score matching comparative study. Front Surg 2022; 9:960605. [PMID: 36248365 PMCID: PMC9554244 DOI: 10.3389/fsurg.2022.960605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveRobot-assisted radical prostatectomy (RARP) is a dynamically evolving technique with its new evolution of single-site RARP. Here we sought to describe our extraperitoneal technique, named the single-site multiport RARP (ssmpRARP) using the da Vinci Si® platform and compare it with the transperitoneal conventional multiport RARP (cmpRARP).Materials and MethodsData were retrospectively collected for patients who underwent RARP for localized prostate cancer from June 2020 to January 2022 in a single center. Propensity score matching was performed based on age, prostate size, body mass index, neoadjuvant hormonal therapy usage, prostate-specific antigen levels, and clinical T stage. The differences between the matched two groups were investigated.ResultsOf the patients, 20 underwent ssmpRARP and 42 underwent cmpRARP during the period. After matching, 18 patients from each group were selected. Median follow-up was 7.8 months (2–12 months) for the ssmpRARP group, and 15.0 months (3–26 months) for cmpRARP. The demographic features between the two groups were comparable. The median total operative time, estimated blood loss, pathologic data, early follow-up outcomes, and hospitalization stays and costs were similar between the two groups. The ssmpRARP group tended to return to their bowel activities earlier (44.78 ± 10.83 h vs. 54.89 ± 12.97 h, p = 0.016). There were no significant differences in complication rates.ConclusionsWe demonstrated the feasibility and safety of performing extraperitoneal ssmpRARP using the da Vinci Si® robotic platform. Our technique showed comparable short-term outcomes with the transperitoneal cmpRARP. Prospective trials and long-term follow-up are necessary to confirm these results.
Collapse
Affiliation(s)
- Weibin Hou
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Bingzhi Wang
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Lei Zhou
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Lan Li
- Department of Urology, Ningxiang Hospital Affiliated to Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Chao Li
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Peng Yuan
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Ouyang
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Hanyu Yao
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Jin Huang
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Kun Yao
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Long Wang Kun Yao
| | - Long Wang
- Department of Urology, the Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Long Wang Kun Yao
| |
Collapse
|
29
|
Single-port transvesical robotic radical prostatectomy: Description of technique. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
30
|
Moschovas MC, Brady I, Noel J, Zeinab MA, Kaviani A, Kaouk J, Crivellaro S, Joseph J, Mottrie A, Patel V. Contemporary techniques of da Vinci SP radical prostatectomy: multicentric collaboration and expert opinion. Int Braz J Urol 2022; 48:696-705. [PMID: 35363459 PMCID: PMC9306371 DOI: 10.1590/s1677-5538.ibju.2022.99.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The da Vinci SP robot consists of an innovative single port trocar that houses a flexible camera and three biarticulated arms, which minimizes the number of incisions to assess the surgical site, allowing a less invasive procedure. However, due to its recent release in the market, the current literature reporting SP-RARP is still restricted to a few centers. In this scenario, after performing a literature search with all available techniques of SP-RARP, our objective is to report a multicentric opinion of referral centers on different techniques to approach SP-RARP. Results The SP literature is provided by only a few centers due to the limited number of this new console in the market. Five different approaches are available: transperitoneal, extraperitoneal, Retzius-Sparing, transperineal and transvesical. None of the current studies describe long-term functional or oncological outcomes. However, all approaches had satisfactory operative performance with minimum complication rates. Conclusions Several techniques of SP-RARP have been reported in the literature. We performed a multicentric collaboration describing and illustrating the most challenging steps of this surgery. We believe that the details provided in this article are useful teaching material for new centers willing to adopt the SP technology.
Collapse
Affiliation(s)
- Marcio Covas Moschovas
- AdventHealth Global Robotics Institute (GRI), Celebration, USA.,University of Central Florida (UCF), Orlando, USA
| | - Isabella Brady
- AdventHealth Global Robotics Institute (GRI), Celebration, USA
| | - Jonathan Noel
- AdventHealth Global Robotics Institute (GRI), Celebration, USA
| | | | - Aaron Kaviani
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, USA
| | | | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute (GRI), Celebration, USA.,University of Central Florida (UCF), Orlando, USA
| |
Collapse
|
31
|
Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis. World J Urol 2022; 40:2001-2008. [PMID: 35718816 DOI: 10.1007/s00345-022-04056-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To compare our initial perioperative and postoperative outcomes of the single-port (SP) transvesical radical prostatectomy (TVRP) approach with the single-port extraperitoneal radical prostatectomy (ERP) approach. MATERIALS AND METHODS Initial consecutive seventy-eight patients underwent SP TVRP between December 2020 and October 2021. Patients with extensive previous abdominal surgeries, or low- to intermediate-risk prostate cancer were selected. Data of consecutive 169 patients treated with SP ERP between February 2019 and November 2020, were used for comparison. Optimal matched-paired analysis of PSA value, biopsy Gleason score, and prostate volume was performed. Preoperative, perioperative, and early functional outcomes were included in the analysis. The median follow-up was 7 months and 9 months for TVRP and ERP groups respectively. RESULTS The median total operative time was longer in the TVRP compared to the ERP group (p = .002). There were no differences in intraoperative complications or surgical margin status. TVRP group had less rate of grade 3a Clavien-Dindo complications (p = .026). The Foley catheter duration was 3 (3, 4) days in the TVRP group compared to 7 (7, 8) days in the ERP group (p < .001). There was a consistently improved continence rate in the TVRP group at 6 weeks (72% TVRP, 48% ERP, p = .004), 3 months (97% TVRP, 81% ERP, p = .008), and 6 months postoperatively (100% TVRP, 93% ERP, p = .047). There was no difference in biochemical recurrence at 6 months of follow-up. CONCLUSION In our initial series, TVRP allows for a faster continence recovery, without other functional or oncological compromises.
Collapse
|
32
|
Tsubouchi K, Gunge N, Tominaga K, Matsuzaki H, Fujikawa A, Emoto T, Miyazaki T, Okabe Y, Nakamura N, Kataoka M, Ogawa S, Akaihata H, Sato Y, Hata J, Matsuoka H, Kojima Y, Haga N. Efficacy of the opened legs position for protecting against postoperative rhabdomyolysis after robot-assisted radical prostatectomy: A propensity score-matched analysis of perioperative outcomes. Int J Urol 2022; 29:1132-1138. [PMID: 35606052 DOI: 10.1111/iju.14935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/27/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of the present study was to clarify the relationships of intraoperative surgical position with the incidence of postoperative rhabdomyolysis and with postoperative renal function to safely perform robot-assisted radical prostatectomy. METHODS The participants in the present study were 276 consecutive patients who underwent robot-assisted radical prostatectomy at our institutions between 2013 and 2020; 130 cases were performed in the opened legs position and 146 cases in the lithotomy position with a steep 23°-25° head-down position. Rhabdomyolysis was defined as creatine kinase values greater than 1000 IU/L. Propensity score matching including age, body mass index, the presence of comorbidities, preoperative creatine kinase, preoperative estimated glomerular filtration rate, and prostate-specific antigen was performed, resulting in a matched cohort of 146 patients (opened legs position group n = 73; lithotomy position group n = 73). RESULTS After propensity score matching, creatine kinase values on the first day after surgery were significantly lower in the opened legs position group than in the lithotomy position group (opened legs position group: lithotomy position group = 246.9 ± 114.9 IU/L: 558.2 ± 114.9 IU/L, P = 0.034). There were significantly fewer patients diagnosed with postoperative rhabdomyolysis in the opened legs position group (opened legs position group: lithotomy position group = 0% (0/73): 9.6% (7/73), P < 0.001). In addition, fluid replacement volume was significantly less in the opened legs position group (opened legs position group: lithotomy position group = 5747 ± 180 mL: 6349 ± 0176 mL, P = 0.018). CONCLUSIONS To prevent rhabdomyolysis after surgery, robot-assisted radical prostatectomy should be performed in the opened legs position.
Collapse
Affiliation(s)
- Kazuna Tsubouchi
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Naotaka Gunge
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kosuke Tominaga
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Aiko Fujikawa
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Taiki Emoto
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takeshi Miyazaki
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yu Okabe
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Nobuyuki Nakamura
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidenori Akaihata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junya Hata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirofumi Matsuoka
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nobuhiro Haga
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| |
Collapse
|
33
|
Beksac AT, Zeinab MA, Ferguson E, Kaviani A, Kaouk J. Single-Port Extraperitoneal Robot Assisted Radical Prostatectomy – Description of Technique. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
34
|
Harrison R, Stifelman M, Billah M, Zaifman J, Lulla T, Rosa RSDL, Koster H, Lovallo G, Ahmed M. Propensity-Score Matched Analysis Between Extraperitoneal Single Port and Intraperitoneal Multiport Radical Prostatectomy: A Single-Institutional Experience. Urology 2022; 165:198-205. [PMID: 35427674 DOI: 10.1016/j.urology.2022.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare the perioperative results and intermediate-term functional outcomes of single port and multiport robotic-assisted laparoscopic prostatectomy by using a propensity-score analysis. MATERIALS AND METHODS We evaluated all patients who underwent robotic prostatectomy by three urologic surgeons at our institution between January 2019 and October 2020. Demographic, intraoperative, and postoperative data were collected and assessed. Patients were matched based on body mass index, Gleason group, and prostate volume using the optimal matching method. RESULTS Overall, 98 and 165 patients underwent single port and multiport robotic prostatectomy, respectively. Following propensity-score matching, 98 multiport cases were matched 1:1 to single port cases. The median operative time was lower for multiport (111.5 vs 147.0 minutes, p=0.0000). Single port had a lower median estimated blood loss (50.0 vs 75.0 mL, p=0.0006), pain score on postoperative day 0 (1.0 vs 2.0, p=0.0004), opioid use at postoperative day 1 (0.0 [IQR 0.0-5.0] vs 0.0 MME [IQR 0.0-7.5], p=0.0058), cumulative opioid use (2.0 vs 7.0 MME, p=0.0008), and lymph node yield (4.0 vs 7.0 nodes, p=0.0051). Single port had a greater percentage of men regain full erectile function by 6 months (23.8% vs 4.8%, p=0.002). CONCLUSIONS The single port robotic system is a safe option for localized prostate cancer treatment, offering superior pain control and comparable perioperative results and intermediate-term functional outcomes compared to the multiport robotic approach.
Collapse
Affiliation(s)
- Robert Harrison
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA.
| | - Michael Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Mubashir Billah
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jay Zaifman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Tina Lulla
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Helaine Koster
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Gregory Lovallo
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| |
Collapse
|
35
|
Chang Y, Xu W, Xiao Y, Wang Y, Yan S, Ren S. Super-veil nerve-sparing extraperitoneal pure single-port robotic-assisted radical prostatectomy on da Vinci Si robotic system. World J Urol 2022; 40:1413-1418. [PMID: 35325307 DOI: 10.1007/s00345-022-03976-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/25/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the safety profile and short-term outcome of super-veil nerve-sparing extraperitoneal single-port robotic-assisted radical prostatectomy (espRARP) on da Vinci Si platform. METHODS From December 2018 to March 2021, 106 consecutive patients with treatment-naive prostate cancer were prospectively included. espRARP was performed on da Vinci Si surgical platform. Operative time, estimated blood loss, Clavien-Dindo complication classification, continence, potency recovery, quality-of-life scores, and postoperative prostate-specific antigen (PSA) were documented. RESULTS Patients aged 52-79 years (mean ± SD, 64.8 ± 6.15 yrs), with a median PSA of 9.2 ng/ml (IQR: 6.70, 16.83) and median prostate volume of 31.9 ml (IQR: 30.01, 38.54). 95.28% (101/106) were clinically localized. All patients underwent espRARP successfully with no open conversions. Operative time was 94.2 ± 30.26 min with an estimated blood loss of 68.5 ml (range, 50-120 ml). No Grade III complications or above were documented. Positive surgical margin was 17.9% (19/106). Median pain score at discharge was 0 (IQR: 0, 1.75) without use of opioid narcotics. Postoperative length of stay was 3 days (IQR: 1, 3), in which 28 patients were discharged within 24 h. Instant, 1-, 3-, and 6 month continence recovery was 18.9, 45.3, 79.2, 93.4, and 96.4%, respectively. Of the 43 patients who received nerve-sparing procedures, 13 (30.23%) resumed potency 6 months postoperatively. 12 month biochemical recurrence-free survival was 92.77% (77/83). CONCLUSIONS Extraperitoneal single-port robotic-assisted radical prostatectomy is a safe and feasible technique. Combined with super-veil nerve-sparing procedures, it may provide satisfactory outcome in short-term functional recovery.
Collapse
Affiliation(s)
- Yifan Chang
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Weidong Xu
- Department of Urology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China
| | - Yutian Xiao
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Ye Wang
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Shi Yan
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Shancheng Ren
- Department of Urology, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China.
- Department of Urology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
| |
Collapse
|
36
|
Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Torres-Martinez M, Alanis-Garza C, Estrada-Mendizabal RJ, Gonzalez-Bonilla EA, Flores-Villalba E, Olvera-Posada D. Single-port versus multiport robotic-assisted radical prostatectomy: A systematic review and meta-analysis on the da Vinci SP platform. Prostate 2022; 82:405-414. [PMID: 34985775 DOI: 10.1002/pros.24296] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/14/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
CONTEXT Prostate cancer is the most common cancer in men; robotic prostatectomy has cemented itself as part of the standard of care. Since its approval by the Food and Drug Administration in 2018, the SP console's application has been increasingly studied and compared with the multiport (MP) robotic approach. METHODS Following PRISMA guidelines and PROSPERO registration CRD42021228744, a systematic review was performed in April 2021 on single-port robotic-assisted radical prostatectomies (SP-RARPs) compared to MP. Outcomes of interest were operative time, bleeding, complications, analgesic use, and postoperative continence, and erectile function. Data were analyzed with Review Manager 5.3. RESULTS Seven studies were included, of which six studies met the inclusion criteria for quantitative synthesis, totalling 1068 patients, out of which 324 underwent SP-RARP and 744 underwent MP-RARP. No differences were found in baseline characteristics such as age, body mass index, prostatic-specific antigen, or stage. No differences in blood loss-15.77 mL [-42.44, 10.89], p = 0.25, operative time 3.93 min [-4.12, 11.98], p = 0.34, or positive surgical margins, with an odds ratio (OR) of 0.78 [0.55, 1.10], p = 0.15-were found. Length of stay was significantly shorter in SP -0.94 days [-1.56, -0.33], p = 0.003, with no differences in complication rates, with an OR of 1.29 [0.78, 2.14], p = 0.32, continence rates, with an OR of 1.29 [0.90, 1.83], p = 0.16, erectile function, with an OR of 0.86 [0.52, 1.40], p = 0.54, or biochemical recurrence. Qualitative evidence suggests decreased opioid consumption. CONCLUSION SP-RARPs are feasible alternatives to the traditional MP with possible benefits in pain management and length of stay. Future high-quality studies are needed to confirm these findings.
Collapse
Affiliation(s)
| | | | | | - Cordelia Alanis-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| | | | | | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| | - Daniel Olvera-Posada
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| |
Collapse
|
37
|
Ni K, Xue D, Li G. Transperineal single-port robot-assisted radical prostatectomy with Si da Vinci surgical system: initial experience and description of technique. Transl Cancer Res 2022; 10:4694-4701. [PMID: 35116324 PMCID: PMC8799017 DOI: 10.21037/tcr-21-898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/22/2021] [Indexed: 11/06/2022]
Abstract
Background Single-port robotic-assisted radical laparoscopic prostatectomy has emerged as a novel robotic-assisted radical laparoscopic prostatectomy in recent years, arousing wide attention. However, single-port robotic-assisted radical laparoscopic prostatectomy using Si da Vinci surgical system has been rarely reported, especially via the transperineal approach. Methods We retrospectively collected 9 cases of prostate cancer patients who underwent transperineal single-port robot-assisted radical prostatectomy (t-spPARP) using Si da Vinci surgical system in our center from May 2020 to June 2020. The operation time, estimated blood loss (EBL), complications, changes in prostate-specific antigen (PSA) 3 months after surgery, and urinary continence recovery 6 months after surgery were analyzed. Results No perioperative complications were recorded. The median [interquartile range (IQR)] operation time was 350 [150] min and the median [IQR] EBL was 300 [100] mL. PSA levels were less than 0.01 ng/mL at 3 months postoperatively in all cases (undetectable in 8 cases). All the 9 patients recovered their urinary continence 6 months after surgery and merely two patients required pads during the day. Conclusions t-spRARP was verified as a safe and feasible surgical alternative to treat patients with localized prostate cancer, especially for those whose prostate is small-volume or who had abdominal surgery history.
Collapse
Affiliation(s)
- Kangxin Ni
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dingwei Xue
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
38
|
Wei Y, Ji Q, Zuo W, Wang S, Wang X, Zhu Q. Efficacy and safety of single port robotic radical prostatectomy and multiport robotic radical prostatectomy: a systematic review and meta-analysis. Transl Androl Urol 2022; 10:4402-4411. [PMID: 35070822 PMCID: PMC8749066 DOI: 10.21037/tau-21-850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study is to compare the clinical efficacy and safety of single port (SP) robot radical prostatectomy and multiport (MP) robot radical prostatectomy. Methods Using the China National Knowledge database, EMBASE, Cochrane library, PubMed, and other databases to obtain relevant research, SP robot radical prostatectomy and MP robot radical prostatectomy were comprehensively evaluated. The software used to evaluate the impact of the results in the selected articles was Review Manager 5.2. Deviation analysis, forest plot analysis, and sensitivity analysis were carried out for the collected data. Results A total of 7 related studies that met the criteria were finally included. The data showed that the operation time of MP in the control group was significantly longer than that in the SP group [mean difference (MD) =−13.29; 95% confidence interval (CI): (−17.35, −9.23); P<0.00001; I2=50%]. The duration of intensive care unit (ICU) stay for SP surgery was shorter than that for MP surgery [MD =−18.30; 95% CI: (−29.17, −7.42); P=0.0010; I2=94%]. The blood loss of SP surgery was less than that of MP surgery [MD =−15.54; 95% CI: (−28.37, −2.71); the total effective rate was 0.02; I2=0%]. There was no significant difference in the incidence of postoperative complications between SP and MP surgery [risk ratio (RR) =0.95; 95% CI: (0.55, 1.63); P=0.85; I2=0%]. At the same time, the sensitivity analysis and funnel plot showed that this study was robust and publication bias was limited. Discussion Our results show that SP robotic radical prostatectomy is superior to MP robotic radical prostatectomy in terms of efficacy and safety. SP robot radical prostatectomy is worthy of wide promotion.
Collapse
Affiliation(s)
- Yong Wei
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qianying Ji
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenren Zuo
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shiyan Wang
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinyi Wang
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Qingyi Zhu
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
39
|
Koukourikis P, Alqahtani AA, Han WK, Rha KH. Pure single‐port retzius‐sparing robot‐assisted radical prostatectomy with the da Vinci SP: Initial experience and technique description. BJUI COMPASS 2022; 3:251-256. [PMID: 35492224 PMCID: PMC9045582 DOI: 10.1002/bco2.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/28/2021] [Indexed: 01/30/2023] Open
Affiliation(s)
- Periklis Koukourikis
- Department of Urology, Urological Science Institute Yonsei University College of Medicine Seoul South Korea
- Second Department of Urology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Ali Abdullah Alqahtani
- Department of Urology, Urological Science Institute Yonsei University College of Medicine Seoul South Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute Yonsei University College of Medicine Seoul South Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute Yonsei University College of Medicine Seoul South Korea
| |
Collapse
|
40
|
Zhao CC, Shakir NA, Zhao LC. Robotic Bladder Flap Posterior Urethroplasty for Recalcitrant Bladder Neck Contracture and Vesicourethral Anastomotic Stenosis. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
41
|
Bassett J, Salibian S, Crivellaro S. Single-port, Retzius-sparing robotic-assisted radical prostatectomy: feasibility and early outcomes. J Endourol 2021; 36:620-625. [PMID: 34931527 DOI: 10.1089/end.2021.0542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Determine safety and feasibility of single-port, Retzius-sparing robot-assisted radical prostatectomy (SP-rsRARP) using the da Vinci® SP (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform in men with adenocarcinoma of the prostate. PATEINTS AND METHODS Twenty-eight consecutive men with prostate cancer underwent SP-rsRARP by one of two surgeons (J.B., S.C.). Data for peri-operative, pathologic, and functional outcomes were collected prospectively and retrospectively analyzed. RESULTS Mean (SD) follow-up was 6 (3) months. Mean age was 65.3 years old with an average body mass index of 25.2 kg/m2. Mean preoperative PSA was 10.2 ng/mL. Average prostate weight was 42 grams. Three patients (11%) had prior radiation to the prostate. There were no intraoperative complications or conversions of technique. Lymphadenectomy was performed in twenty-four (86%) patients and nerve-sparing in fourteen (46%). Mean operative time (skin to skin) was 234 minutes with an average estimated blood loss of 148 mL. Length of hospital stay averaged 23 hours. Seventeen (61%) of the patients did not require opioids for post-operative pain. Two Clavien Grade IIIa complications occurred (lymphocele aspiration, dilation of bladder neck contracture). Pathological grade group was group 1 (0%), grade 2 (57%), group 3 (29%) and group 4-5 (14%). Pathologic stage was T2 (15/28, 54%) and T3a,b (13/28, 46%). Five patients (18%) had a positive surgical margin, four (80%) of whom had T3 disease. One patient (4%) had a detectable PSA in follow-up and opted for adjuvant radiation. Twenty-three patients (82%) were continent at foley removal. Post-operative mean SHIM scores in those who underwent nerve-sparing was 18 at 3-months follow-up. CONCLUSIONS SP-rsRARP appears safe and feasible. Early continence rates are promising. Full characterization of outcomes require longer follow-up and larger cohort validation.
Collapse
Affiliation(s)
- Jeffrey Bassett
- Hoag Memorial Presbyterian Hospital, 6011, Hoag Urologic Oncology, 1525 Superior Ave, Suite 210, Newport Beach, Newport Beach, California, United States, 92663;
| | - Salpi Salibian
- Hoag Memorial Presbyterian Hospital, 6011, Hoag Urologic Oncology, Newport Beach, California, United States;
| | - Simone Crivellaro
- University of Illinois at Chicago College of Medicine, 12247, Urology, Chicago, Illinois, United States;
| |
Collapse
|
42
|
Covas Moschovas M, Bhat S, Rogers T, Noel J, Reddy S, Patel V. Da Vinci Single-Port Robotic Radical Prostatectomy. J Endourol 2021; 35:S93-S99. [PMID: 34499553 DOI: 10.1089/end.2020.1090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The field of robotic surgery continues to evolve and the advent of the single-port (SP) platform is another step toward the future. The SP platform is a new technology that has promising implications for urologic surgery. Since the Food and Drug Administration (FDA) cleared this platform in 2018, multiple urologic procedures have been described, with radical prostatectomy being the most common. This article aims to describe and illustrate the step-by-step technique of SP radical prostatectomy. We have described our technique from the patient positioning and trocar placement until the anastomosis. We included in the video compilation surgical steps such as bladder dropping and anterior bladder neck dissection, posterior bladder neck and seminal vesicles, posterior prostate dissection and nerve sparing, apical dissection and dorsal venous complex control, posterior reconstruction and anastomosis, and lymph node dissection.
Collapse
Affiliation(s)
- Marcio Covas Moschovas
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, Florida, USA
| | - Seetharam Bhat
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, Florida, USA
| | - Travis Rogers
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, Florida, USA
| | - Jonathan Noel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, Florida, USA
| | - Sunil Reddy
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, Florida, USA
| | - Vipul Patel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, Florida, USA
| |
Collapse
|
43
|
Khalil MI, Joseph JV. Extraperitoneal Single-Port Robot-Assisted Radical Prostatectomy. J Endourol 2021; 35:S100-S105. [PMID: 34499546 DOI: 10.1089/end.2021.0440] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Robot-assisted radical prostatectomy (RARP) is currently the standard minimally invasive procedure for the surgical management of localized prostate cancer. It has been shown that the minimally invasive robotic approach offers comparable oncologic and functional outcomes with potential advantages, including decreased blood loss, shorter hospital stay, and recovery period when compared with open surgery. Generally, the transperitoneal RARP approach is the most commonly performed among robotic surgeons, owing to its wider space and early adoption. However, similar oncologic outcomes have been reported with the extraperitoneal approach. Owing to its perceived technical difficulty, extraperitoneal RARP is less adopted nowadays. This approach, however, has its merits particularly in cases where intraperitoneal access can be problematic with extensive adhesions from previous surgeries. Also, extraperitoneal approach allows for minimal bowel manipulation, less steep Trendelenburg positioning, and less pneumoperitoneum, which reflect on early recovery of bowel function after RARP. Both transperitoneal and extraperitoneal approaches can be performed using either the conventional multiport robotic system or the more recent single-port (SP) robotic system. With respect to extraperitoneal RARP, there has been an increased adoption of the SP system, with purported advantages such as better cosmesis, less postoperative analgesic and opioid requirements, and shorter duration of hospital stay. Herein, we describe the technical steps relevant to extraperitoneal single-port robot-assisted radical prostatectomy, and elaborate on the clinical outcomes reported in the literature.
Collapse
Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
44
|
Lenfant L, Corrigan D, Beksac AT, Schwen Z, Kaouk J. Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method. BJU Int 2021; 128:688-691. [PMID: 34487399 DOI: 10.1111/bju.15588] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Louis Lenfant
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA.,Urology Department, Hôpital Pitié-Salpêtrière, GRC n°5, PREDICTIVE ONCO-UROLOGY, AP-HP, Sorbonne University, Paris, France
| | - Dillon Corrigan
- Department of Quantitative Health Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Alp Tuna Beksac
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Zeyad Schwen
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Jihad Kaouk
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
| |
Collapse
|
45
|
Abaza R. The Case for Transperitoneal Robotic Prostatectomy. J Endourol 2021; 35:1119-1120. [PMID: 33899500 DOI: 10.1089/end.2021.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ronney Abaza
- Central Ohio Urology Group, LLC, Columbus, Ohio, USA
| |
Collapse
|
46
|
Kim HJ, Choi GS, Song SH, Park JS, Park SY, Lee SM, Choi JA. An initial experience with a novel technique of single-port robotic resection for rectal cancer. Tech Coloproctol 2021; 25:857-864. [PMID: 34052901 DOI: 10.1007/s10151-021-02457-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The da Vinci single-port (SP) system is designed to facilitate single-incision robotic surgery in a narrow space. We developed a new procedure of rectal resection using this system. The aim of the present study was to evaluate the technical feasibility and safety of SP robotic rectal resection for rectal cancer patients based on our initial experience. METHODS A study was conducted on consecutive patients with mid or low rectal cancer who had SP robotic resection at our institution between July and September 2020. The demographic characteristics, perioperative data, and pathology results of the patients were retrospectively analyzed. RESULTS There were 5 patients (3 males, 2 females, median age 57 years (range 36-73 years). The median tumor height from the anal verge was 4 cm (range 3-5 cm). Two patients received preoperative chemoradiotherapy for advanced rectal cancer. A single docking was conducted, and the median docking time was 4 min 20 s (range 3 min 30 s to 5 min). The median total operation time was 195 min (range 155-240 min), and the median time of pelvic dissection was 45 min (range 36-62 min). All patients had circumferential and distal tumor-free resection margins. One patient experienced an anastomosis-related complication. The median duration of hospital stay was 7 days (range 7-8 days). CONCLUSIONS Our initial experience suggests that SP robotic rectal resection is safe and feasible. Further clinical trials comparing SP and multiport robotic rectal resection should be conducted to verify the superior aspects of this new system.
Collapse
Affiliation(s)
- H J Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University , 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| | - G-S Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University , 807 Hogukro, Buk-gu, Daegu, 41404, South Korea.
| | - S H Song
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University , 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| | - J S Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University , 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| | - S Y Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University , 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| | - S M Lee
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University , 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| | - J A Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University , 807 Hogukro, Buk-gu, Daegu, 41404, South Korea
| |
Collapse
|
47
|
Kaouk J, Beksac AT, Abou Zeinab M, Duncan A, Schwen ZR, Eltemamy M. Single Port Transvesical Robotic Radical Prostatectomy: Initial Clinical Experience and Description of Technique. Urology 2021; 155:130-137. [PMID: 34038749 DOI: 10.1016/j.urology.2021.05.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our surgical technique and early results for the single port (SP) transvesical robotic radical prostatectomy using the da Vinci SP surgical system. PATIENTS & METHODS Twenty patients underwent SP radical prostatectomy through a transvesical approach. Through a 3 cm suprapubic incision, the bladder was incised and a GelPOINT mini system was used for floating docking. Through the gel port, the dedicated SP robotic port, a 12 mm assistant port, and a flexible suction tubing were introduced. RESULTS All cases were completed successfully without need for extra ports or conversion. No intraoperative complications were recorded. Median (IQR) total robotic time was 119 (99-127) minutes. Median (IQR) estimated blood loss was 135 (100-162) mL. Median (IQR) hospital length of stay was 4.4 (3.9-22.2) hours. None of the patients required opioids use after discharge. Median (IQR) time with a Foley catheter after surgery was 4 (4-6) days and 75% of the patients had immediate continence within 48 hours after Foley catheter removal. 85% were totally continent within 10 days after catheter removal. Three patients (15%) had positive surgical margins (all focal) on pathology. Two patients had transvesical lymph node dissection with 4 and 15 lymph nodes negative on final pathology. CONCLUSION We demonstrated the feasibility of SP robotic transvesical radical prostatectomy and pelvic lymph node dissection using a dedicated SP robotic platform. Favorable perioperative outcomes were seen, along with low complication rate, same day discharge, elimination of opioid requirement, and high rate of immediate recovery of continence as well as a low positive margin rate.
Collapse
Affiliation(s)
- Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Alp Tuna Beksac
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Alisa Duncan
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zeyad R Schwen
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Eltemamy
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
48
|
Minimizing minimally invasive surgery: Current status of the single-port robotic surgery in Urology. Actas Urol Esp 2021; 45:345-352. [PMID: 34088433 DOI: 10.1016/j.acuroe.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The novel da Vinci Single-Port (SP) robotic platform received the US FDA approval in 2018. The device, specifically conceived for single-site approach, is pushing through the limits of minimally invasive surgery. We sought to provide a comprehensive overview of the current status of the clinical experiences accomplished by the da Vinci SP in urology, and to discuss future perspectives. METHODS A non-systematic literature review was performed focusing on single port articles in urological surgery using Medline/PubMed and Embase search electronic engines. The authors analyzed findings and a brief report of the clinical experience for surgical procedures completed by the SP platform was described. RESULTS The current data available from single-port robotic established the safety and feasibility of urologic procedures using this novel platform. However, the results come from single-center case series, small cohorts and retrospective studies that need to be cautiously interpreted. Additional evidence is required to determine the asset of the SP platform in the urological community. CONCLUSIONS The SP robotic system opens new frontiers on the surgical scenery facilitating the completion of urological surgeries through a single incision. Further comparative studies will be required to assess perioperative and long-term oncological and functional outcomes among SP, multi-arm robotic and open approaches.
Collapse
|
49
|
Ganesan V, Steinberg RL, Garbens A, Trivedi H, Sorokin I, Roehrborn CA, Johnson BA, Gahan JC. Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis. J Robot Surg 2021; 16:295-300. [PMID: 33837950 DOI: 10.1007/s11701-021-01236-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/02/2021] [Indexed: 01/18/2023]
Abstract
Robotic-assisted simple prostatectomy (RASP) has proven to be an effective minimally invasive option for benign prostatic enlargement (BPE) in recent years. Single-site surgery is theorized to reduce post-operative pain beyond traditional minimally invasive approaches. We sought to assess whether use of a single-port robotic platform decreases post-operative opioid use in patients undergoing robotic-assisted simple prostatectomy (RASP). A retrospective review was performed of all patients undergoing RASP our institution from November 2017 to July 2019. Demographic, intraoperative, and post-operative data, including morphine equivalent (ME) use, were collected. Patients were stratified by robotic platform utilized. Propensity score matching using nearest neighbor method was performed using prostate volume, Charlson comorbidity index (CCI), and post-op ketorolac use in 4:1 fashion. Chi-squared analysis and Kruskal-Wallis analyses were utilized. Two-hundred-and-seven men underwent RASP. After matching, 80 patients (64 multi-port, 16 single-port) were included in the analysis. Groups were comparable for age, body mass index, CCI, prostate volume, prior opioid use, and use of scheduled ketorolac post op. The single-port approach was associated with a reduction in MEs once admitted to the floor (5 vs. 11 mg, p = 0.025) and an increase in the proportion of patients who did not require any narcotics post-operatively (44 vs. 19%, p = 0.036). In a propensity matched cohort of patients undergoing RASP at a single institution, use of the single-port robotic system conferred a significant decrease in post-operative narcotic use by approximately 50%.
Collapse
Affiliation(s)
- Vishnu Ganesan
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Ryan L Steinberg
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Alaina Garbens
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Hersh Trivedi
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Igor Sorokin
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Claus A Roehrborn
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Brett A Johnson
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern, 2001 Inwood Dr., WCB3, Suite 4.878, Dallas, TX, 75390 MC 9110, USA.
| |
Collapse
|
50
|
Francavilla S, Abern MR, Dobbs RW, Vigneswaran HT, Talamini S, Antonelli A, Simeone C, Crivellaro S. Single-Port robot assisted partial nephrectomy: initial experience and technique with the da Vinci Single-Port platform (IDEAL Phase 1). Minerva Urol Nephrol 2021; 74:216-224. [PMID: 33769009 DOI: 10.23736/s2724-6051.21.03919-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To evaluate the safety and feasibility of robotic-assisted laparoscopic partial nephrectomy (RAPN) performed using the da Vinci Single-Port (SP) platform. METHODS A retrospective review was conducted from December 2018 to December 2019 of 14 consecutive patients with localized renal cancer who underwent SP robot-assisted partial nephrectomy at a single institution. The procedures were performed by 2 experienced robotic surgeons, reproducing the steps of the standard multiport robotic approach to partial nephrectomy. A transperitoneal approach was utilized with a 2.5 cm para-rectus incision with one assistant 12 mm laparoscopic port. RESULTS No conversions to open or laparoscopic surgery occurred and no additional laparoscopic assistant ports were required. The median total operative time was 202 (162-231) minutes and the median total room time was 258 (215-295) minutes. The warm ischemia time averaged 20 minutes ± 8 minutes. 2 patients required angioembolization due to postoperative acute bleeding (Clavien-Dindo Grade 3a complication). Trifecta outcome (<25 min warm ischemia, no perioperative complications and negative margins) was achieved in 79% of patients. In one case, a positive margin was present. The median length of stay was of 1 day (Interquartile Range 1-2) with a median pain score on postoperative day 1 of 3.5 (Interquartile Range 2.4-5). 1/14 (7%) patient needed narcotic use at one week from discharge. At a median follow up of 5.0 (4.0-8.0) months, no patients have had evidence of disease recurrence. CONCLUSIONS In this initial cohort, considering the introduction of a new technology, we observed satisfactory outcomes for several key perioperative variables including operative time, warm ischemia time, surgical margins, hospital stay, pain requirements in patients undergoing RAPN with the SP platform. For experienced robotic surgeons, RAPN with the SP platform is a safe and feasible approach for single site partial nephrectomy.
Collapse
Affiliation(s)
- Simone Francavilla
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA - .,Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy - .,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy -
| | - Michael R Abern
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan W Dobbs
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Hari T Vigneswaran
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan Talamini
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Alessandro Antonelli
- Urology Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, Azienda Ospedaliero Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | | | - Simone Crivellaro
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|