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Ji H, Wu Q, Ji J, Qian Y, Cai L, Bai K, Cao Q, Yang X, Cao Y, Lv Q, Li P. Modified robot-assisted nephroureterectomy with ureteral catheterization for radical resection of the distal ureter: Procedures and short-term outcomes. Heliyon 2024; 10:e29198. [PMID: 38644863 PMCID: PMC11033093 DOI: 10.1016/j.heliyon.2024.e29198] [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: 11/08/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Objectives To describe a bladder cuff excision method modified with ureteral catheterization to better visualize the ureteral orifice during robot-assisted nephroureterectomy (RANU). Methods We retrospectively analyzed 66 patients with upper urinary tract urothelial carcinoma of the renal pelvis and/or upper-mid ureter treated between January 2020 and January 2023. Among them, 32 patients (group A) underwent RANU supported by ureteral catheterization, and the remaining patients (group B) received routine transperitoneal RANU. Postoperative cystoscopy was performed routinely to compare the rates of residual ureteral orifice between the two groups. Results Surgeries were completed uneventfully in all 66 patients, without blood transfusion or conversion to open procedures. The operative time, estimated blood loss, and postoperative length of hospital stay were similar between both groups. However, the mean time required for BCE in group A was shorter than that in group B (9.5 min vs. 16.0 min, p = 0.006). Cystoscopy at postoperative three months showed no ipsilateral ureteral orifice in group A, but residual ureteral orifice was found in 23.5% of patients in group B. During a short follow-up period of 16 months, no patients in group A experienced bladder tumor recurrence. However, two patients (5.9%) in group B developed bladder tumor recurrence, with one experiencing local tumor recurrence at the level of the ureteral stump. Conclusions Our novel technique enables complete ureteral retrieval, accurate and rapid bladder cuff excision, which makes the procedure less invasive and safely reproducible during robot-assisted nephroureterectomy.
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Affiliation(s)
- Hao Ji
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Jianbo Ji
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Department of Urology, Yancheng Third People's Hospital, Yancheng Clinical Medical College, Nanjing Medical University, Yancheng, PR China
| | - Yuhang Qian
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Kexin Bai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yongke Cao
- Department of English, Nanjing Medical University, Nanjing, PR China
| | - Qiang Lv
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
- Department of Urology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, PR China
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Ito H, Shimomai W, Matsuzaki Y, Suzuki J, Kuroiwa K, Ashizawa N, Yanagida S, Isaka K. Validate robot-assisted total laparoscopic hysterectomy with four equally-spaced ports without an assistant port. J Robot Surg 2024; 18:55. [PMID: 38280032 DOI: 10.1007/s11701-023-01800-x] [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: 10/30/2023] [Accepted: 12/16/2023] [Indexed: 01/29/2024]
Abstract
To evaluate the usefulness of robot-assisted total laparoscopic hysterectomy with four equally-spaced ports (RA-TLH/4e) without an assistant port. In RA-TLH/4e, four da Vinci ports were placed horizontally at a height of 4 cm above the umbilicus with 8 cm equal spacing. Poor development of the surgical field or difficult forceps manipulations were handled with the endoscope and forceps movement (port-hopping). Patient background, surgical outcomes, complications, port-hopping frequency were compared in three groups: RA-TLH/4e, RA-TLH with four unequally-spaced ports (RA-TLH/4u), and conventional RA-TLH with five ports (RA-TLH/5). There were no significant differences in patient background or surgical outcomes among the three groups except for age, preparation time, and hospital stay, and no cases of laparotomy conversion or serious complications. RA-TLH/4e had fewer port-hoppings than RA-TLH/4u. The minimum abdominal width showed a weak negative correlation with port-hopping frequency in RA-TLH/4u, but not in RA-TLH/4e. RA-TLH/4e allowed for a reduction in personnel and costs compared to RA-TLH/5. The equal placement of four ports allowed sufficient port spacing even for patients with narrow abdominal widths. In addition, the port-hopping technique was able to fully compensate for the lack of an assistant port. RA-TLH/4e is a highly useful technique that not only excels in safety but also reduces costs.
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Affiliation(s)
- Hiroe Ito
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Wakiko Shimomai
- Robotic Surgery Center, Tokyo International Ohori Hospital, Mitaka City, Tokyo, Japan
| | - Yoshihiko Matsuzaki
- Robotic Surgery Center, Tokyo International Ohori Hospital, Mitaka City, Tokyo, Japan
| | - Jiro Suzuki
- Robotic Surgery Center, Tokyo International Ohori Hospital, Mitaka City, Tokyo, Japan
| | - Kako Kuroiwa
- Department of Obstetrics and Gynecology, Musashino Red Cross Hospital, Musashino City, Tokyo, Japan
| | - Naohiro Ashizawa
- Department of Obstetrics and Gynecology, Tokyo Yamato Hospital, Tokyo, Japan
| | - Satoshi Yanagida
- Department of Obstetrics and Gynecology, The Jikei University Hospital, Tokyo, Japan
| | - Keiichi Isaka
- Robotic Surgery Center, Tokyo International Ohori Hospital, Mitaka City, Tokyo, Japan
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Morizane S, Stein H, Komiya T, Kaneta H, Takenaka A. Retroperitoneal robot-assisted laparoscopic nephroureterectomy using the da Vinci Xi and SP systems: Initial experiences in cadaveric models. Investig Clin Urol 2023; 64:380-387. [PMID: 37417563 DOI: 10.4111/icu.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/16/2023] [Accepted: 04/05/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To investigate the feasibility and optimal port placements of robot-assisted laparoscopic nephroureterectomy (RANU) via the retroperitoneal approach in the lateral decubitus and supine positions using the da Vinci Xi (DVXi) and da Vinci SP (DVSP) systems. MATERIALS AND METHODS We performed lateral decubitus extraperitoneal RANU on the right side and supine extraperitoneal RANU on the left side using the DVXi and DVSP systems without repositioning in two fresh cadavers. In addition, paracaval and pelvic lymphadenectomies were performed simultaneously during both surgical procedures. The operative time of each procedure was calculated, and the technical details associated with these procedures were evaluated. RESULTS Lateral decubitus and supine extraperitoneal RANU using the DVXi and DVSP systems were achieved without repositioning. The surgeon console time ranged from 89 to 178 minutes, and no major technical complications were observed. However, carbon dioxide insufflation into the abdominal cavity was observed owing to a peritoneal breach during the creation of the surgical workspace, particularly in the supine position. Compared with the DVXi system, the DVSP system was more suitable for RANU using the retroperitoneal approach, except for renal handling. CONCLUSIONS The DVXi and DVSP systems are feasible for performing lateral decubitus and supine extraperitoneal RANU without patient repositioning. The lateral decubitus position may be better than the supine position, and the DVSP system is more suitable for retroperitoneal RANU than the DVXi system. Nevertheless, further studies should be performed in clinical settings to validate our results.
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Affiliation(s)
- Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Hubert Stein
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Takayuki Komiya
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Hiroyuki Kaneta
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Saini S, Pathak RA, Hemal AK. Robotic nephroureterectomy in the management of upper tract urothelial cancer: inching toward standard of care? Int Urol Nephrol 2022; 54:1777-1785. [PMID: 35610528 DOI: 10.1007/s11255-022-03225-1] [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: 02/10/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
Abstract
Upper-tract urothelial carcinoma is a relatively rare malignancy. Current guidelines strongly recommend radical nephroureterectomy with bladder cuff excision and template-based lymph node dissection for all high-risk upper-tract urothelial carcinomas. Although the open approach is still considered the standard of care, evolution of minimally invasive approaches especially the robotic-assisted approach, has been found to be oncologically equivalent. Since its initial description in 2006, the surgical technique as well as the robotic surgical system has gone through a major evolution. With well-established advantages of the minimally invasive approach, robotic radical nephroureterectomy also has the ability to address both upper and lower urinary tract simultaneously without the need of patient repositioning, standardized single docking technique, ease of performing crucial steps like excision of ureterovesical junction and bladder cuff with watertight cystotomy closure, allowing perioperative instillation of intra-vesical chemotherapy. Robot-assisted radical nephro-ureterectomy and template-based lymph node dissection is gradually emerging as the current standard of care to achieve the best possible oncologic and functional outcomes. In this review article we are focusing on the evolution of this approach in the management of upper-tract urothelial carcinoma along with a review of oncologic outcomes.
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Affiliation(s)
- Sumit Saini
- Department of Urology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ram Anil Pathak
- Department of Urology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ashok Kumar Hemal
- Department of Urology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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Abstract
First proposed by Kimball and Ferris in 1933 for the treatment of papillary tumors in the upper urinary tract, radical nephroureterectomy (RNU) with bladder cuff excision remains the gold standard for management of high-risk upper tract urothelial carcinoma involving the proximal ureter and/or pelvicaliceal system. Over three decades since the first description of laparoscopic RNU, minimally invasive approaches to RNU have continued to evolve and become increasingly utilized. More recently, robot-assisted RNU (RARNU) has increasingly become a viable approach. Specifically, RARNU affords a reduction in perioperative morbidity and improved convalescence as a minimally invasive approach, all while adhering to traditional open surgical principles and providing surgeons with improved technical ergonomics and streamlined operating room logistics, particularly with the advent of the da Vinci Xi platform. In this study, we describe our approach to transperitoneal RARNU, including indications, operating room setup, step-by-step surgical technique, and perioperative care.
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Affiliation(s)
- Jason P Joseph
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Padraic O'Malley
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Li-Ming Su
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
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Attalla K, Patnaik S, Vellos T, Mehrazin R. Management of distal ureter and bladder cuff at the time of nephroureterectomy: surgical techniques and predictors of outcome. Future Oncol 2019; 15:2385-2393. [PMID: 31237445 DOI: 10.2217/fon-2019-0064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Open radical nephroureterectomy (NU) with removal of the ureter and bladder cuff is the 'gold standard' in the treatment of high-grade urothelial cancers of the upper urinary tract. A salient issue is the management of the distal ureter and bladder cuff at time of surgery. Which technique confers superior oncologic benefit is of particular interest since this disease process is notoriously plagued with high intravesical recurrence rates. Although open radical NU is the 'gold standard', the maturation of minimally invasive surgery formidably challenges approaches considered 'gold standard'. We thus sought to critically review the literature comparing perioperative and oncologic outcomes in the approaches used to manage the distal ureter and bladder cuff in patients undergoing radical NU.
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Affiliation(s)
- Kyrollis Attalla
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shyam Patnaik
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ted Vellos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Tamhankar AS, Patil SR, Ahluwalia P, Gautam G. Current Status of Lymphadenectomy During Radical Nephroureterectomy for Upper Tract Urothelial Cancer-Yes, No or Maybe? Indian J Surg Oncol 2018; 9:418-426. [PMID: 30288011 DOI: 10.1007/s13193-018-0807-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/26/2018] [Indexed: 01/30/2023] Open
Abstract
While pelvic lymphadenectomy during radical cystectomy for bladder cancer is a well-established standard of care, the same does not hold true for upper tract urothelial carcinoma (UTUC). Indeed, a template-based lymphadenectomy is rarely, if ever, performed in conjunction with radical nephroureterectomy at most centres across the globe. While multiple studies have explored the staging and therapeutic role of lymphadenectomy in cases of UTUC, there remain large gaps in our understanding of the indications, extent and safety of this procedure as an adjunct to nephroureterectomy. This article elucidates the current knowledge on outcomes, benefits and complications of template-based lymphadenectomy during radical nephroureterectomy for UTUC. We also explore the current evidence-based guidelines on this controversial topic.
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Affiliation(s)
- Ashwin Sunil Tamhankar
- Section of Urologic Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Saurabh Ramesh Patil
- Section of Urologic Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Puneet Ahluwalia
- Section of Urologic Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Gagan Gautam
- Section of Urologic Oncology, Department of Surgical Oncology, Max Institute of Cancer Care, New Delhi, India
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Kumar R. What's inside? Indian J Urol 2018; 34:168-169. [PMID: 30034124 PMCID: PMC6034418 DOI: 10.4103/iju.iju_195_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Rajeev Kumar
- Editor, Indian Journal of Urology, Professor of Urology, All India Institute of Medical Sciences, New Delhi, India
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