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Xia Z, Fu X, Li J, Yuan X, Wu J, Tang L. Application of robot-assisted radical prostatectomy in men over 75 years: an analysis of comparative outcomes. Aging Male 2023; 26:2166919. [PMID: 36988199 DOI: 10.1080/13685538.2023.2166919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE This study aimed to summarize the current evidence regarding the feasibility of robot-assisted radical prostatectomy (RARP) in men aged over 75 years. METHOD A comprehensive search of four electronic databases (China National Knowledge Infrastructure, PubMed, Web of Science, and Cochrane Library) was performed to identify eligible comparative studies as of April 2022. Parameters, including perioperative results and oncological and functional outcomes, were evaluated. RESULTS Seven articles with 7575 patients undergoing RARP were included in this study. Patients with prostate cancer were grouped by age ≥ 75 years versus < 75 years. Our results demonstrated that compared with the older group, the younger group had better potency (p < .00001). However, there were no significant differences in operation time (p = .29), estimated blood loss (p = .13), length of hospital stay (p = .48), complications (p = .22), continence (p = .21), positive surgical margin (p = .28), and biochemical recurrence (p = .74) between the groups. CONCLUSION Our study revealed that the perioperative, oncological, and functional outcomes in men aged over 75 years undergoing RARP were not significantly different from those of their younger counterparts. RARP is feasible in men aged over 75 years.
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Affiliation(s)
- Zhongyou Xia
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Xueqin Fu
- Department of Breast Surgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinzhu Yuan
- Blood Purification Center of Department of Nephrology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Nanchong, Sichuan, China
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Lingtong Tang
- Department of Clinical Laboratory, The People's Hospital of Gao County, Yibin, Sichuan, China
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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).
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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
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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.
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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.
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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: 6] [Impact Index Per Article: 6.0] [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.
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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
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Hoeh B, Wenzel M, Hohenhorst L, Köllermann J, Graefen M, Haese A, Tilki D, Walz J, Kosiba M, Becker A, Banek S, Kluth LA, Mandel P, Karakiewicz PI, Chun FKH, Preisser F. Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy. Front Surg 2022; 8:825183. [PMID: 35273992 PMCID: PMC8901727 DOI: 10.3389/fsurg.2021.825183] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 01/23/2023] Open
Abstract
Context Meticulous knowledge about the anatomy of the prostate and surrounding tissue represents a crucial and mandatory requirement during radical prostatectomy for reliable oncological and excellent replicable, functional outcomes. Since its introduction two decades ago, robotic-assisted laparoscopic radical prostatectomy (RALP) has evolved to become the predominant surgical approach in many industrialized countries. Objective To provide and highlight currently available literature regarding prostate anatomy and to help in improving oncological and functional outcomes in RALP. Methods/Evidence Acquiring PubMed database was searched using the following keywords: “robotic-assisted radical prostatectomy,” “anatomy,” “neurovascular bundle,” “nerve,” “periprostatic fascia,” “pelvis,” “sphincter,” “urethra,” “urinary incontinence,” and “erectile dysfunction.” Relevant articles and book chapters were critically reviewed and if eligible, they were included in this review. Results New evidence in regards to prostatic anatomy and surgical approaches in RALP has been reported in recent years. Besides detailed anatomical studies investigating the meticulous structure of the fascial structures surrounding the prostate and neurovascular bundle preservation, debate about the optimal RALP approach is still ongoing, inspired by recent publications presenting promising functional outcomes following modifications in surgical approaches. Conclusions This review provides a detailed overview of the current knowledge of prostate anatomy, its surrounding tissue, and its influence on key surgical step development for RALP.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- *Correspondence: Benedikt Hoeh
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Marina Kosiba
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Severine Banek
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Luis A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Li J, Li Y, Cao D, Xia Z, Meng C, Peng L, Wei Q. Outpatient versus inpatient robot-assisted radical prostatectomy: a meta-analysis of comparative outcomes. J Endourol 2021; 36:468-476. [PMID: 34913766 DOI: 10.1089/end.2021.0643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To provide a systematic analysis of outcomes comparing outpatient and inpatient robot-assisted radical prostatectomy (RARP) for prostate cancer based on the best available evidence. METHODS A comprehensive search of electronic databases (PubMed, Web of Science, Scopus, and Cochrane Library) was conducted to determine eligible comparative studies as of July 2021. The Newcastle-Ottawa scale was used to assess the quality of the included studies. Parameters including perioperative, oncological, and functional outcomes were collected. RESULTS Nine studies with 2721 patients were included, of which 831 underwent outpatient RARP and 1890 underwent inpatient RARP. The combined results demonstrated that compared with the inpatient group, the outpatient group had shorter operation time (WMD -8.59 95% CI -14.08 to -3.10, p = 0.002) and lower overall complication rate (OR 0.64, 95% CI 0.44 to 0.95, p = 0.03). However, there were no significant differences regarding estimated blood loss, readmission rate, positive surgical margin, and urinary continence rates between the groups. CONCLUSIONS Outpatient RARP does not increase the incidence of complications and readmissions compared with inpatient RARP. This suggests that routine same-day discharge after providing patients with RARP is safe and feasible.
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Affiliation(s)
- Jinze Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China;
| | - Yunxiang Li
- North Sichuan Medical College [Search North Sichuan Medical College], 74655, Nanchong, Sichuan, China, Nanchong, China, 637000;
| | - Dehong Cao
- Department of Urology, West China Hospital, Guoxue Xiang #37, Chengdu, Sichuan, P.R. China, Chengdu, China, 610041;
| | - Zhongyou Xia
- Affiliated Hospital of North Sichuan Medical College, 117913, Nanchong Central Hospital, Nanchong, China, 637000;
| | - Chunyang Meng
- North Sichuan Medical College [Search North Sichuan Medical College], 74655, Nanchong, China;
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, China;
| | - Qiang Wei
- Sichuan University West China Hospital, 34753, Urology, No. 37, Guoxue Alley, Chengdu, Sichuan, P.R. China, Chengdu, Sichuan, China, 610041;
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7
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Bertolo R, Garisto J, Bove P, Mottrie A, Rocco B. Perioperative Outcomes Between Single-Port and "Multi-Port" Robotic Assisted Radical Prostatectomy: Where do we stand? Urology 2021; 155:138-143. [PMID: 34153366 DOI: 10.1016/j.urology.2021.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report the results of the first quantitative synthesis of literature data from studies comparing Single-Port Robot-Assisted Radical Prostatectomy performed using the novel SP surgical platform (SP-RARP) versus RARP performed by using multi-arms robotic systems. METHODS Studies comparing the use of da Vinci SP versus that of other available multi-arms da Vinci platforms were eligible for inclusion in the present review. From selected studies, data were extracted by using a standardized data extraction form. Patients baseline demographics and disease characteristics and perioperative variables of interest for the present review (operative time, blood losses, complications, length of stay and positive surgical margins rate) were noted whenever available. Weighted mean difference (WMD) was used as a summary measure for continuous outcomes, whereas the odds ratio with 95% confidence interval (CI) was calculated for binary variables. Pooled estimates were calculated by using the random-effect model to account for clinical heterogeneity. Statistical analysis was performed using Review manager 5.3 (Cochrane Collaboration, Oxford, UK). RESULTS Four comparative studies were retrieved, analysing a total of 610 patients. Baseline characteristics of treatment groups were statistically similar. No significant differences were found when comparing SP-RARP versus multi-arms robotic systems in terms of operative time, blood losses, complications rate and positive surgical margins. Conversely, SP-RARP was found to allow for a shorter hospital stay (WMD = -0.79 days, 95% CI = -1.07; -0.52, P-value < .001). CONCLUSION The adoption of the SP platform for duplicating the technique of minimally-invasive RARP appears to be safe and feasible.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
| | - Juan Garisto
- Veteran Affairs Boston Healthcare System, Boston, MA
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy; Department of Surgery, Urology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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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.
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Garisto J, Bertolo R, Reese S, Bove P, Kaouk J. Minimizing minimally invasive surgery: Current status of the single-port robotic surgery in Urology. Actas Urol Esp 2021. [PMID: 33612358 DOI: 10.1016/j.acuro.2020.05.007] [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: 10/22/2022]
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.
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10
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Lenfant L, Aminsharifi A, Kim S, Kaouk J. Predictive factors of postoperative complications and hospital readmission after implementation of the single-port robotic platform: A single-center and single-surgeon experience. Int J Urol 2021; 28:530-537. [PMID: 33527543 DOI: 10.1111/iju.14503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/20/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To measure the incidence, and identify potential risk factors of conversion, postoperative complication and readmission for patients treated with urological robotic single-port surgery. METHODS All consecutive urological surgery procedures carried out with the single-port robotic platform by the same surgeon in a single institution between September 2018 and March 2020 were included in this retrospective analysis. Demographic data, main perioperative outcomes and information related to the surgical technique were gathered and analyzed. A logistic regression model was used to assess predictive factors for any grade and high-grade (e.g. Clavien grade ≥3) postoperative complications, as well as predictive factors for readmission. RESULTS Analysis included 221 patients, of whom 194 (88%) underwent pelvic surgery and 27 (12.2%) underwent upper urinary tract surgery. Only one patient was converted to open surgery in the entire cohort. A total of 40 patients (18.1%) experienced postoperative complications, with grade ≥3 postoperative complications in 7.6% of the entire cohort. On multivariable analysis, the factors significantly associated with the risk of postoperative complication of any grade were diabetes (P < 0.001), perineal approach (P < 0.01) and postoperative pain management with opioids (P = 0.01). Only diabetes (P = 0.03) predicted a grade ≥3 complication. Overall, 17 patients (7.7%) were readmitted during the 3 months after surgery. A body mass index >30 kg/m2 was the only identified predictor of readmission (P = 0.01). CONCLUSION A wide range of pelvic, extraperitoneal and upper-tract urological procedures can be carried out using the robotic single-port platform with a minimal conversion rate and low complication or readmission rate.
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Affiliation(s)
- Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,CRG 5, Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière University Hospital, Urology, Sorbonne University, Paris, France
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Affiliation(s)
- Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health, 980118, Richmond, VA, 23298-0118, USA.
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
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12
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Minafra P, Carbonara U, Vitarelli A, Lucarelli G, Battaglia M, Ditonno P. Robotic radical perineal prostatectomy: tradition and evolution in the robotic era. Curr Opin Urol 2021; 31:11-17. [PMID: 33229862 DOI: 10.1097/mou.0000000000000830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To provide an updated review of robotic radical perineal prostatectomy (r-RPP) with emphasis on the recent advances in terms of surgical technique, outcomes, and new robotic platforms. RECENT FINDING The technological innovations in the urological field have been applied to radical prostatectomy with the aim of preserving important anatomical structures and reduce patients' morbidity and mortality. In recent years, robotic surgery contributed to resurge radical perineal prostatectomy. In 2014, the Cleveland Clinic group was the first to demonstrate the utility of a robotic approach in RPP. To date, the majority of the reported studies showed that r-RPP has noninferior perioperative, short-term oncological, and functional outcomes compared with the traditional robot-assisted radical prostatectomy (RARP). Given these benefits, r-RPP is a promising approach in selected patients, such as obese ones. Moreover, robotic perineal pelvic lymph node dissection performed through the same incision of r-RPP and the new Single-Port (SP) Robotic System represent further steps towards the overcoming of some intrinsic limitation of this surgical approach making this technique suitable for a larger number of patients with prostatic cancer. SUMMARY Overall, r-RPP represents a reliable and effective novel surgical technique. However, more studies with long-term follow-up are needed to clarify the advantages over RARP.
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Affiliation(s)
- Paolo Minafra
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, SS. Annunziata Hospital, Taranto, Italy
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, VCU Health, Richmond, Virginia, USA
| | - Antonio Vitarelli
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, National Cancer Institute IRCCS 'Giovanni Paolo II", Bari, Italy
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Lenfant L, Garisto J, Sawczyn G, Wilson CA, Aminsharifi A, Kim S, Schwen Z, Bertolo R, Kaouk J. Robot-assisted Radical Prostatectomy Using Single-port Perineal Approach: Technique and Single-surgeon Matched-paired Comparative Outcomes. Eur Urol 2020; 79:384-392. [PMID: 33357990 DOI: 10.1016/j.eururo.2020.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/03/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Radical perineal prostatectomy (RPP) has been revived with the advent of single-port (SP) robotic surgery. However, its interest and precise role need to be evaluated and better defined. OBJECTIVE To describe in detail the technique of SP-RPP and compare initial perioperative outcomes with those of multiport robot-assisted transperitoneal radical prostatectomy (MP-RARP). DESIGN, SETTING, AND PARTICIPANTS From October 2018 to June 2020, perioperative data of 26 consecutive patients who underwent SP-RPP for localized prostate cancer (PCa) in a single institution were prospectively entered into an institutional review board-approved database. Data of 86 consecutive patients treated from September 2017 to September 2018 with MP-RARP by the same surgeon, before the beginning of the SP experience, were used as comparators. SURGICAL PROCEDURE SP-RPP was performed using the SP robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) according to the technique described in the supplementary video. MEASUREMENTS Demographics, and intra- and postoperative data were analyzed in a matched-paired design with a 1:1 ratio on the following factors: age at surgery, prostate-specific antigen level, preoperative Gleason score, and history of abdominal surgery. RESULTS AND LIMITATIONS After matching, baseline characteristics were comparable except for the rate of prior laparotomy, which was higher in the SP-RPP group (52% vs 8%, p < 0.001). In the SP-RPP group, 84% of the patients had a high risk and an unfavorable intermediate risk of positive surgical margins (PSMs) versus 57% in the MP-RARP group (p = 0.03). While the rate of nonlimited PSMs (ie, >3 mm) was higher in the SP-RPP group (38.5% vs 7.7%, p < 0.01), the number of patients with biochemical recurrence at 1 yr was comparable between SP-RPP and MP-RARP (1 vs 3, p = 0.3). CONCLUSIONS SP-RPP is a complex procedure for patients with a complex surgical history and high-risk localized PCa with limited alternative therapeutic options. PATIENT SUMMARY Our study suggests that patients with high-risk localized prostate cancer and limited treatment options due to a complex abdominal surgical history (ie, frozen pelvis) may be suitable candidates for single-port radical perineal prostatectomy.
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Affiliation(s)
- Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Department, GRC n°5, Predictive Onco-urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clark A Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Covas Moschovas M, Bhat S, Rogers T, Thiel D, Onol F, Roof S, Sighinolfi MC, Rocco B, Patel V. Applications of the da Vinci single port (SP) robotic platform in urology: a systematic literature review. Minerva Urol Nephrol 2020; 73:6-16. [PMID: 32993277 DOI: 10.23736/s2724-6051.20.03899-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Robotic surgical technology has evolved to include a new platform specifically designed for the single-port (SP) approach. Benefits of the da Vinci SP are still under investigation. This study aimed to review the urological literature since the first report of the use of the platform. EVIDENCE ACQUISITION We performed a systematic literature review of PubMed, Medline, and Web of Science databases on June 15, 2020 searching for all available articles of da Vinci SP use from December 2014 (date of the first clinical report of da Vinci SP in the urology) until June 1, 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. EVIDENCE SYNTHESIS A total of 43 articles were eligible for inclusion. Ten studies reported different surgeries and techniques on cadavers while the rest described the clinical experience of different groups. We divided our article and tables into preclinical experience with surgery on cadavers, radical prostatectomy (RP) approach, and multiple types of procedures described in the same study. CONCLUSIONS The application of da Vinci SP in urologic procedures after five years of the first clinical investigation is feasible and safe. Radical prostatectomy is the most common intervention performed with this robot. Some groups described benefits in terms of less postoperative pain and early discharge, especially with the extraperitoneal approach. However, further studies with larger sample sizes and longer follow-up are awaited.
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Affiliation(s)
| | - Seetharam Bhat
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Travis Rogers
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | - Fikret Onol
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Shannon Roof
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
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Bertolo R, Cipriani C, Garisto J, Bove P. Single-port versus multi-port: will “one for all” ever become a new standard for robot-assisted radical prostatectomy? J Robot Surg 2020; 15:143-145. [DOI: 10.1007/s11701-020-01124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 12/25/2022]
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Floating docking technique: a simple modification to improve the working space of the instruments during single-port robotic surgery. World J Urol 2020; 39:1299-1305. [PMID: 32601981 DOI: 10.1007/s00345-020-03307-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To compare the range of motion and ergonomic characteristics of single-port robotic instruments in the setting of the "floating" versus "flat" docking technique using the GelPOINT® system. MATERIAL AND METHODS The basic principle of the floating docking technique resides in the GelSeal cap and trocar (s) being 8 cm off the skin level with the Alexis® acting as a conduit between the trocar (s) and the body while preserving insufflation. In the setting of a dry lab study, we measured the range of motion of one robotic instrument with the "floating" and the "flat" docking technique in two different situations depending on whether the distance between the incision and the target was more or less than 10 cm. RESULTS The minimum required distances between the target and the tip of the cannula for activation of the wrist and elbow were 5 and 10 cm, respectively. When the target was near to the cannula (i.e., less than 10 cm), the floating technique was associated with a significant increase in the range of motion of the instrument in all directions. The working space volume of the instrument was increased by more than 390% (from 101 to 497 cm3) when the surgeon switched from flat (standard) to the floating technique in the setting of a target close (i.e., less than 10 cm) to the cannula CONCLUSION: The floating docking technique is a simple and effective way to increase the working surgical space, especially in confined and narrow surgical fields with a target closer than 10 cm from the skin.
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Andras I, Mazzone E, van Leeuwen FWB, De Naeyer G, van Oosterom MN, Beato S, Buckle T, O'Sullivan S, van Leeuwen PJ, Beulens A, Crisan N, D'Hondt F, Schatteman P, van Der Poel H, Dell'Oglio P, Mottrie A. Artificial intelligence and robotics: a combination that is changing the operating room. World J Urol 2019; 38:2359-2366. [PMID: 31776737 DOI: 10.1007/s00345-019-03037-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of the current narrative review was to summarize the available evidence in the literature on artificial intelligence (AI) methods that have been applied during robotic surgery. METHODS A narrative review of the literature was performed on MEDLINE/Pubmed and Scopus database on the topics of artificial intelligence, autonomous surgery, machine learning, robotic surgery, and surgical navigation, focusing on articles published between January 2015 and June 2019. All available evidences were analyzed and summarized herein after an interactive peer-review process of the panel. LITERATURE REVIEW The preliminary results of the implementation of AI in clinical setting are encouraging. By providing a readout of the full telemetry and a sophisticated viewing console, robot-assisted surgery can be used to study and refine the application of AI in surgical practice. Machine learning approaches strengthen the feedback regarding surgical skills acquisition, efficiency of the surgical process, surgical guidance and prediction of postoperative outcomes. Tension-sensors on the robotic arms and the integration of augmented reality methods can help enhance the surgical experience and monitor organ movements. CONCLUSIONS The use of AI in robotic surgery is expected to have a significant impact on future surgical training as well as enhance the surgical experience during a procedure. Both aim to realize precision surgery and thus to increase the quality of the surgical care. Implementation of AI in master-slave robotic surgery may allow for the careful, step-by-step consideration of autonomous robotic surgery.
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Affiliation(s)
- Iulia Andras
- ORSI Academy, Melle, Belgium
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elio Mazzone
- ORSI Academy, Melle, Belgium
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fijs W B van Leeuwen
- ORSI Academy, Melle, Belgium
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Urology, Antoni Van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geert De Naeyer
- ORSI Academy, Melle, Belgium
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Urology, Antoni Van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Shane O'Sullivan
- Department of Pathology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Pim J van Leeuwen
- Department of Urology, Antoni Van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alexander Beulens
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
- Netherlands Institute for Health Services (NIVEL), Utrecht, The Netherlands
| | - Nicolae Crisan
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Frederiek D'Hondt
- ORSI Academy, Melle, Belgium
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Peter Schatteman
- ORSI Academy, Melle, Belgium
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Henk van Der Poel
- Department of Urology, Antoni Van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paolo Dell'Oglio
- ORSI Academy, Melle, Belgium.
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.
- Department of Urology, Antoni Van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
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