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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: 10] [Impact Index Per Article: 3.3] [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%.
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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.
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Masieri L, Sforza S, Grosso AA, Valastro F, Tellini R, Cini C, Landi L, Taverna M, Elia A, Mantovani A, Minervini A, Carini M. Robot-assisted laparoscopic pyeloplasty in children: a systematic review. MINERVA UROL NEFROL 2020; 72:673-690. [DOI: 10.23736/s0393-2249.20.03854-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kostakis ID, Sran H, Uwechue R, Chandak P, Olsburgh J, Mamode N, Loukopoulos I, Kessaris N. Comparison Between Robotic and Laparoscopic or Open Anastomoses: A Systematic Review and Meta-Analysis. ROBOTIC SURGERY (AUCKLAND) 2019; 6:27-40. [PMID: 31921934 PMCID: PMC6934120 DOI: 10.2147/rsrr.s186768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using a robotic approach and compare them with those done using laparoscopic or open approaches through meta-analysis. METHODS A systematic review was conducted for articles comparing robotic with laparoscopic and/or open operations (colectomy, low anterior resection, gastrectomy, Roux-en-Y gastric bypass (RYGB), pancreaticoduodenectomy, radical cystectomy, pyeloplasty, radical prostatectomy, renal transplant) published up to June 2019 searching Medline, Scopus, Google Scholar, Clinical Trials and the Cochrane Central Register of Controlled Trials. Studies containing information about outcomes related to hand-sewn anastomoses were included for meta-analysis. Studies with stapled anastomoses or without relevant information about the anastomotic technique were excluded. We also excluded studies in which the anastomoses were performed extracorporeally in laparoscopic or robotic operations. RESULTS We included 83 studies referring to the aforementioned operations (4 randomized controlled and 79 non-randomized, 10 prospective and 69 retrospective) apart from colectomy and low anterior resection. Anastomoses done using robotic instruments provided similar results to those done using laparoscopic or open approach in regards to anastomotic leak or stricture. However, there were lower rates of stenosis in robotic than in laparoscopic RYGB (p=0.01) and in robotic than in open radical prostatectomy (p<0.00001). Moreover, all anastomoses needed more time to be performed using the robotic rather than the open approach in renal transplant (p≤0.001). CONCLUSION Robotic anastomoses provide equal outcomes with laparoscopic and open ones in most operations, with a few notable exceptions.
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Affiliation(s)
- Ioannis D Kostakis
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Harkiran Sran
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Raphael Uwechue
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Pankaj Chandak
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathon Olsburgh
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nizam Mamode
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ioannis Loukopoulos
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Nicos Kessaris
- Department of Nephrology and Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Masieri L, Sforza S, Mari A, Morselli S, Tellini R, Di Maida F, Vignolini G, Serni S, Carini M, Minervini A. Robot-assisted pyeloplasty for ureteropelvic junction obstruction: experience from a tertiary referral center. MINERVA UROL NEFROL 2019; 71:168-173. [DOI: 10.23736/s0393-2249.19.03328-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rassweiler J, Klein J, Goezen AS. Retroperitoneal laparoscopic non-dismembered pyeloplasty for uretero-pelvic junction obstruction due to crossing vessels: A matched-paired analysis and review of literature. Asian J Urol 2018; 5:172-181. [PMID: 29988898 PMCID: PMC6033199 DOI: 10.1016/j.ajur.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/21/2017] [Accepted: 10/30/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare laparoscopic Anderson-Hynes pyeloplasty (LAHP) and retroperitoneal laparoscopic YV-pyeloplasty (LRYVP) in ureteropelvic junction obstruction (UPJ) in presence of a crossing vessels (CV). METHODS Our database showed 380 UPJO-cases,who underwent laparoscopic retroperitoneal surgery during the last 2 decades including 206 non-dismembered LRYVP, 157 dismembered pyeloplasties LAHP, and 17 cases of laparoscopic ureterolysis. Among them 198 cases were suitable for a matched-pair (2:1) analysis comparing laparoscopic retroperitoneal non-dismembered LRYVP (Group 1, n = 131) and dismembered LAHP (Group 2, n = 67) in presence of a crossing vessel. Patients were matched according to age, gender, kidney functions, and obstruction grade. Complications were graded according to modified Clavien-classification. RESULTS Comparative data were similar between both groups (LRYVP vs. LAHP) including mean operating time (112 min vs. 114 min), complication rates (4.2% vs. 7.3%) mainly Grade 1-2 according to Clavien classification, and success rates (90% vs. 89%). These results reflected in the reviewed literature indicate that LRYVP provides the advantage of minimal dissection in case of CV with similar outcome. However, redundant pelvis and anteriorly crossing vessels still require a dismembered pyeloplasty LAHP. CONCLUSION LRYVP has achieved similar results compared with the previous golden standard of open surgery, especially in case of crossing vessels apart from presence of a redundant pelvis or anteriorly crossing vessel. This can be further improved when using the small access retroperitoneoscopic technique respectively mini-laparoscopy.
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Affiliation(s)
- Jens Rassweiler
- Department of Urology and Pediatric Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heibronn, Germany
| | - Jan Klein
- Department of Urology, Medical School Ulm, University of Ulm, Ulm, Germany
| | - Ali Serdar Goezen
- Department of Urology and Pediatric Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heibronn, Germany
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