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Liu Z, Li R, Cao Y, Xie L. Design and navigation method of a soft robot for single-port transvesical radical prostatectomy. Int J Comput Assist Radiol Surg 2024; 19:1783-1795. [PMID: 38635119 DOI: 10.1007/s11548-024-03122-1] [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: 07/03/2023] [Accepted: 03/22/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Currently, the rigid instruments used for laparoscopic radical resection of prostate cancer not only have the risk of damage to tissues, blood vessels, and nerves, but their limited freedom will also cause surgical blind areas. Soft robots are expected to solve these issues due to inherent flexibility, compliance, and safe interaction with tissues and organs. In addition, to achieve high surgical accuracy and provide precise guidance for surgeons, the navigation method should be studied for the soft robot. METHODS A soft robot system for single-port transvesical radical prostatectomy (STRP) is developed, and a navigation method combining fiber Bragg gratings and electromagnetic tracking is proposed for the soft robot. To validate the soft robot design and the effectiveness of the navigation method, different groups of experiments are conducted. RESULTS The proposed navigation method can achieve accurate location and shape sensing of the soft manipulator. The experiments show that the maximum tip sensing error is 2.691 mm, which is 5.38 % of the robot length for static configurations, and that the average tip sensing error is 1.966 mm, which corresponds to 3.93 % of the robot length for dynamic scenarios. Additionally, phantom tests demonstrate that the designed soft robot can enter the prostate through navigation guidance in a master-slave control mode and cover the entire prostate space. CONCLUSIONS The designed soft robot system, due to its soft structure, good flexibility, and accurate navigation, is expected to improve surgical safety and precision, thereby exhibiting significant potential for STRP.
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Affiliation(s)
- Zefeng Liu
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Ru Li
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yongfeng Cao
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Le Xie
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, 200240, China.
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2
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Kolanukuduru KP, Busby D, Grauer R, Choudhary MK, Mandel A, Maheshwari A, Tewari AK, Menon M. Outcomes after precision prostatectomy: safety, efficacy and transference of skills. World J Urol 2024; 42:394. [PMID: 38985306 DOI: 10.1007/s00345-024-05074-2] [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: 03/15/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE Precision Prostatectomy (PP) is a viable treatment option for men with unilateral dominant cancer who are interested in preserving functional outcomes. To date, the data published about the outcomes of this technique has come from a single center only (Henry Ford - HF). We present the surgical, functional, and oncological outcomes of the first series of patients to undergo PP outside of HF, to demonstrate the safety and reproducibility of the technique. METHODS Between 2022 and 2023, PP was offered to select patients who were interested in preserving their functional status. Men who underwent PP were followed at 3 monthly intervals; information regarding their functional status was simultaneously obtained. Men who had biochemical recurrence were advised to undergo remnant biopsy. If residual cancer was detected, then remnant removal was performed. RESULTS The median age and median PSA of the study group was 63 years and 6.89 ng/ml respectively. The median operative and console times were 196.5 and 154 minutes. No intra-operative complications were noted. Three patients had a total of three post-operative complications. Three patients had biochemical recurrence; cancer was not detected in any of these patients on postoperative biopsies of the prostatic remnant. At 12 months, 91% of patients reported using 0 pads/day and 90.9% of pre-operatively potent patients were potent at 12 months. CONCLUSION PP is a safe and reproducible technique that can ensure cancer control and preservation of functional status in select patients. Further studies with large sample sizes and longer follow-up are required to ascertain the long-term outcomes of this surgical technique.
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Affiliation(s)
| | - Dallin Busby
- Department of Urology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manish K Choudhary
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Asher Mandel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Maheshwari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ash K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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3
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Pozzi T, Coppola S, Catozzi G, Colombo A, Chioccola M, Duscio E, Di Marco F, Chiumello D. Mechanical power during robotic-assisted laparoscopic prostatectomy: an observational study. J Clin Monit Comput 2024:10.1007/s10877-024-01170-1. [PMID: 38884875 DOI: 10.1007/s10877-024-01170-1] [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: 01/05/2024] [Accepted: 04/24/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Robotic-assisted laparoscopic radical prostatectomy (RALP) requires pneumoperitoneum and steep Trendelenburg position. Our aim was to investigate the influence of the combination of pneumoperitoneum and Trendelenburg position on mechanical power and its components during RALP. METHODS Sixty-one prospectively enrolled patients scheduled for RALP were studied in supine position before surgery, during pneumoperitoneum and Trendelenburg position and in supine position after surgery at constant ventilatory setting. In a subgroup of 17 patients the response to increasing positive end-expiratory pressure (PEEP) from 5 to 10 cmH2O was studied. RESULTS The application of pneumoperitoneum and Trendelenburg position increased the total mechanical power (13.8 [11.6 - 15.5] vs 9.2 [7.5 - 11.7] J/min, p < 0.001) and its elastic and resistive components compared to supine position before surgery. In supine position after surgery the total mechanical power and its elastic component decreased but remained higher compared to supine position before surgery. Increasing PEEP from 5 to 10 cmH2O within each timepoint significantly increased the total mechanical power (supine position before surgery: 9.8 [8.4 - 10.4] vs 12.1 [11.4 - 14.2] J/min, p < 0.001; pneumoperitoneum and Trendelenburg position: 13.8 [12.2 - 14.3] vs 15.5 [15.0 - 16.7] J/min, p < 0.001; supine position after surgery: 10.2 [9.4 - 10.7] vs 12.7 [12.0 - 13.6] J/min, p < 0.001), without affecting respiratory system elastance. CONCLUSION Mechanical power in healthy patients undergoing RALP significantly increased both during the pneumoperitoneum and Trendelenburg position and in supine position after surgery. PEEP always increased mechanical power without ameliorating the respiratory system elastance.
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Affiliation(s)
- Tommaso Pozzi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, Milan, Italy
| | - Giulia Catozzi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Andrea Colombo
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, Milan, Italy
| | - Mara Chioccola
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Eleonora Duscio
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, Milan, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Davide Chiumello
- Department of Health Sciences, University of Milan, Milan, Italy.
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, Milan, Italy.
- Coordinated Research Center On Respiratory Failure, University of Milan, Milan, Italy.
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4
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Xie S, Wood TC, Dasgupta P, Aydin A. Robot Assisted Laparoscopic Surgery in Gynaecology: An Evolving Assistive Technology. Surg Innov 2024; 31:324-330. [PMID: 38446503 PMCID: PMC11047015 DOI: 10.1177/15533506241238038] [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: 03/07/2024]
Abstract
Laparoscopic surgery is extensively utilized to treat a range of gynaecological conditions and pathologies. The advantages of laparoscopic surgery include the minimalization of blood loss and scarring, improved recovery times, and shorter hospital admissions. However, robotic technologies have had an increasing presence within gynaecological laparoscopic surgery in recent decades. This literature review therefore aims to discuss laparoscopy from 3 perspectives. First, the evolution of laparoscopy is reviewed with a focus on its origins, its transition from a diagnostic to an operative tool, and its role in present-day gynaecology. Second, interventions for benign gynaecological conditions (including excision of benign ovarian tumours, total laparoscopic hysterectomy, and laparoscopic myomectomy) are reviewed. The laparoscopic management of malignant gynaecology (including ovarian cancer, endometrial cancer, and cervical cancer) is also discussed. Finally, whilst robot-assisted laparoscopic surgery is experiencing rapid technological advancement, it is pertinent to consider the extent of its benefits when compared to open or conventional laparoscopic approaches in gynaecological surgery.
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Affiliation(s)
- Siwen Xie
- Department of Surgical & Intervention Engineering, King’s College London, London, UK
| | - Thomas Charles Wood
- Department of Obstetrics and Gynaecology, The Hillingdon Hospital, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King’s College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King’s College London, London, UK
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5
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Checcucci E, De Cillis S, Alladio E, Piramide F, Volpi G, Granato S, Zamengo D, Bignante G, Amparore D, Piana A, Manfredi M, Vallariello E, Stura I, Di Dio M, Autorino R, Porpiglia F, Fiori C. Ten-year functional and oncological outcomes of a prospective randomized controlled trial comparing laparoscopic versus robot-assisted radical prostatectomy. Prostate 2024; 84:832-841. [PMID: 38572570 DOI: 10.1002/pros.24702] [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] [Received: 10/23/2023] [Revised: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Among prostate cancer (PCa) treatment options, mini-invasive surgical approaches have gained a wide diffusion in the last decades. The aim of this study was to present oncological, functional, and quality of life data after 10 years of follow-up of a prospective randomized controlled trial (RCT) (ISRCTN11552140) comparing robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) for the treatment of PCa. METHODS Patients with localized PCa were randomized to undergo LRP or RARP between January 2010 and January 2011. Functional (continence and potency) and oncological (prostate-specific antigen, biochemical recurrence [BCR] and BCR-free survival [BCRFS]) variables were evaluated. BCRFS curves were estimated by the Kaplan-Meier method and compared using the log-rank test. Machine learning partial least square-discriminant analysis (PLS-DA) was used to identify the variables characterizing more the patients who underwent RARP or LRP. RESULTS Seventy-five of the originally enrolled 120 patients remained on follow-up for 10 years; 40 (53%) underwent RARP and 35 (47%) LRP. Continence and potency recovery rates did not show significant differences (p = 0.068 and p = 0.56, respectively), despite a Δ12% for continence and Δ8% for potency in favor of the robotic approach. However, the quality of continence (in terms of International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] score) and erection (in terms of International Index of Erectile Function-5 [IIEF-5] score) was significantly better after 10 years in the robotic group (p = 0.02 and p < 0.001). PLS-DA revealed that LRP was characterized by the worst functional-related outcomes analyzing the entire follow-up period. Four (10%) and six (17%) patients experienced BCR in RARP and LRP groups, respectively (p = 0.36), with an overall 10-year BCR-free survival of 88% and 78% (p = 0.16). CONCLUSIONS Comparable continence and potency rates were observed between RARP and LRP after a 10-year follow-up. However, the RARP group exhibited superior totally dry rate and erection quality. No difference in terms of oncological outcomes was found.
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Affiliation(s)
- Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Sabrina De Cillis
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Federico Piramide
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Davide Zamengo
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Gabriele Bignante
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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6
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Brime Menendez R, García Rojo E, Hevia Palacios V, Feltes Ochoa JA, Justo Quintas J, Lista Mateos F, Fraile A, Manfredi C, Belli S, Bozzini G, Romero Otero J. Da Vinci vs. Hugo RAS for robot-assisted radical prostatectomy: a prospective comparative single-center study. World J Urol 2024; 42:336. [PMID: 38762627 DOI: 10.1007/s00345-024-05045-7] [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: 12/12/2023] [Accepted: 05/06/2024] [Indexed: 05/20/2024] Open
Abstract
PURPOSE To evaluate Hugo RAS against the Da Vinci system for Robot-Assisted Radical Prostatectomy (RARP) in prostate cancer treatment. METHODS We compared outcomes of 150 patients with prostate cancer undergoing RARP with either Hugo or Da Vinci systems. Our analysis included operative, postoperative, pathological, and functional outcomes. RESULTS Both groups had 75 patients. Baseline characteristics and tumor features were similar. Intraoperatively, Da Vinci had a shorter docking time (10.45 vs. 18.62 min, p = 0.02), but total operative times were comparable (145.34 vs 138.95, p = 0.85). Hugo outperformed in neck dissection and lymphadenectomy times (22 vs 13.67 min, p = 0.027 and 37.82 vs 45.77 min, p = 0.025). Postoperative metrics like stay duration, catheter time, and complications showed no significant difference. Functional results, using IPSS and IIEF5, were similar between systems. Six Da Vinci patients (8%) and nine Hugo patients (12%) experienced social incontinence (p = 0.072). Pathological outcomes like T stage, Gleason Score, and nodes removed were alike. However, Hugo had more positive surgical margins (20% vs. 10.67%, p = 0.034). CONCLUSIONS RARP outcomes using Hugo RAS were similar to the Da Vinci system in our study. More research and extended follow-up are required to ascertain long-term oncological and functional results.
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Affiliation(s)
- Ricardo Brime Menendez
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Esther García Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Vital Hevia Palacios
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Javier Amalio Feltes Ochoa
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Juan Justo Quintas
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Fernando Lista Mateos
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Agustín Fraile
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simone Belli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giorgio Bozzini
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Javier Romero Otero
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain.
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7
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Marino F, Moretto S, Rossi F, Gandi C, Gavi F, Bientinesi R, Campetella M, Russo P, Bizzarri FP, Scarciglia E, Ragonese M, Foschi N, Totaro A, Lentini N, Pastorino R, Sacco E. Robot-Assisted Radical Prostatectomy Performed with the Novel Hugo™ RAS System: A Systematic Review and Pooled Analysis of Surgical, Oncological, and Functional Outcomes. J Clin Med 2024; 13:2551. [PMID: 38731080 PMCID: PMC11084580 DOI: 10.3390/jcm13092551] [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: 03/18/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: to assess surgical, oncological, and functional outcomes of robot-assisted radical prostatectomy (RARP) performed using the novel Hugo™ RAS system. Methods: A systematic review was conducted following the PRISMA guidelines, using PubMed, Web of Science, Scopus, and Embase databases. Eligible papers included studies involving adult males undergoing RARP with the Hugo™ RAS platform, with at least ten patients analyzed. The pooled analysis was performed using a random-effect model. Results: Quantitative analysis was conducted on 12 studies including 579 patients. The pooled median docking time, console time, and operative time were 11 min (95% CI 7.95-14.50; I2 = 98.4%, ten studies), 142 min (95% CI 119.74-164.68; I2 = 96.5%, seven studies), and 176 min (95% CI 148.33-203.76; I2 = 96.3%, seven studies), respectively. The pooled median estimated blood loss was 223 mL (95% CI 166.75-280.17; I2 = 96.5%, eleven studies). The pooled median length of hospital stay and time to catheter removal were 2.8 days (95% CI 1.67-3.89; I2 = 100%, ten studies) and 8.3 days (95% CI 5.53-11.09; I2 = 100%, eight studies), respectively. The pooled rate of postoperative CD ≥ 2 complications was 4.1% (95% CI 1-8.5; I2 = 63.6%, eleven studies). The pooled rate of positive surgical margins and undetectable postoperative PSA were 20% (95% CI 12.6-28.5; I2 = 71.5%, nine studies) and 94.2% (95% CI 87.7-98.6; I2 = 48.9%, three studies), respectively. At three months, a pooled rate of social continence of 81.9% (95% CI 73.8-88.9; I2 = 66.7%, seven studies) was found. Erectile function at six months was 31% in one study. Conclusions: despite the preliminary nature of the evidence, this systematic review and pooled analysis underscores the feasibility, safety, and reproducibility of the Hugo™ RAS system in the context of RARP.
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Affiliation(s)
- Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Stefano Moretto
- Department of Urology, Humanitas Clinical and Research Center, 20089 Milan, Italy;
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Francesco Rossi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
- Department of Urology, Ospedale Isola Tiberina—Gemelli Isola, 00186 Rome, Italy
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
| | - Marco Campetella
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
- Department of Urology, Ospedale Isola Tiberina—Gemelli Isola, 00186 Rome, Italy
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
| | - Francesco Pio Bizzarri
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
- Department of Urology, Ospedale Isola Tiberina—Gemelli Isola, 00186 Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.R.); (C.G.); (F.G.); (R.B.); (P.R.); (F.P.B.); (E.S.); (M.R.); (N.F.); (A.T.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
| | - Nicolò Lentini
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (N.L.); (R.P.)
| | - Roberta Pastorino
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (N.L.); (R.P.)
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Emilio Sacco
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy; (M.C.); (E.S.)
- Department of Urology, Ospedale Isola Tiberina—Gemelli Isola, 00186 Rome, Italy
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8
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Kulis T, Samalavicius NE, Hudolin T, Venckus R, Penezic L, Nausediene V, Willeke F, Kastelan Z. Robotic-assisted radical prostatectomy: a multicenter experience with the Senhance Surgical System. World J Urol 2024; 42:39. [PMID: 38244127 DOI: 10.1007/s00345-023-04732-1] [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: 07/19/2023] [Accepted: 10/28/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Robotic-assisted surgery for radical prostatectomy is becoming a standard treatment, and respective implementations are expanding. The Senhance Surgical System is a robotic system with existing but limited data on radical prostatectomy, including a lack of multicenter study experiences. The TRUST study aims to fill this gap and explores observations for radical prostatectomy with the Senhance Surgical System. METHODS Between August 2019 and November 2022, 375 patients met inclusion criteria from two European sites. Patients' surgical procedure times, data on conversion, malfunction, adverse events, and pain scores were registered and evaluated. Outcomes were calculated for both sides, combined as a total and compared between the initial (1st-150th case) and later (> 150th case) period. RESULTS The median operating time was 190 min (IQR: 167.5-215.0) and the median docking time was 3 min (IQR: 2.0-5.0). Eighteen cases (4.8%) were converted to standard laparoscopy and two (0.5%) to open. Two perioperative (0.5%) and eleven postoperative adverse events (2.9%) occurred, mostly (83.3%) categorized as mild. Pain scores were reduced from an average of 3.4 (± 1.4) on the postoperative day to 0.9 (± 0.7) at discharge. Compared to our previous data and based on a comparison between our initial and later period, operating time seems to plateau. However, docking time, complication, and conversion rates were successfully reduced. CONCLUSION We demonstrate progressing safety and efficiency for robotic-assisted radical prostatectomy with the Senhance Surgical System.
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Affiliation(s)
- Tomislav Kulis
- Department of Urology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Narimantas E Samalavicius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Tvrtko Hudolin
- Department of Urology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Raimundas Venckus
- Department of Urology, Klaipeda University Hospital, Klaipeda, Lithuania
| | - Luka Penezic
- Department of Urology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Vaida Nausediene
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Management of Human Health Activities, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Frank Willeke
- Deparment of General and Visceral Surgery, Marien Hospital, Siegen, Germany
| | - Zeljko Kastelan
- Department of Urology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
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9
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Holze S, Kuntze AS, Mende M, Neuhaus P, Truss MC, Do HM, Dietel A, Franz T, Stolzenburg JU. Assessment of different continence definitions in the context of the randomized multicenter prospective LAP-01 trial-Does the best definition change over time? Eur J Med Res 2024; 29:58. [PMID: 38238789 PMCID: PMC10795395 DOI: 10.1186/s40001-024-01662-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND A uniform definition of continence is urgently needed to allow the comparison of study results and to estimate patient outcomes after radical prostatectomy (RP). To identify a practical definition that includes both objective and subjective aspects in a tangible way, we assessed different continence definitions and evaluated which best reflects the patients' subjective perception of continence. METHODS Our analyses included 718 patients that underwent either robot-assisted radical prostatectomy (RARP) or laparoscopic radical prostatectomy (LRP) in a multicenter randomized patient-blinded trial. Continence was assessed through patient questionnaires prior to and at 3, 6 and 12 months after surgery which included the number of pads used per day, the ICIQ-SF and the question "Do you suffer from incontinence? (yes/no)" to assess subjective continence. We used Krippendorff's Alpha to calculate the agreement of different continence definitions with the subjective perception. RESULTS At 3 months, the "0/safety pad" definition shows the highest agreement by alpha = 0.70 (vs. 0.63 for "0 pads" and 0.37 for "0-1 pad"). At 6 and 12 months "0 pads" is the better match, with alpha values of 0.69 (vs. 0.62 and 0.31) after 6 months and 0.70 (vs. 0.65 and 0.32) after 12 months. The ICIQ-SF score shows good correlation with the subjective continence at 3 months (alpha = - 0.79), the coefficient then decreasing to - 0.69 and - 0.59 at 6 and 12 months. CONCLUSION The best continence definition according to the patients' perspective changes over time, "0 pads" being the superior criterion in the long-term. We recommend using the 0-pad definition for standardized continence reporting, as it is simple yet as accurate as possible given the inevitably high subjectivity of continence perception. Trial registration The LAP-01 trial was registered with the U.S. National Library of Medicine clinical trial registry (clinicaltrials.gov), NCT number: NCT03682146, and with the German Clinical Trial registry (Deutsches Register Klinischer Studien), DRKS ID number: DRKS00007138.
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Affiliation(s)
- Sigrun Holze
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Anna Sophie Kuntze
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Meinhard Mende
- Clinical Trial Centre Leipzig, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Petra Neuhaus
- Clinical Trial Centre Leipzig, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Michael C Truss
- Department of Urology, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Germany
| | - Hoang Minh Do
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Anja Dietel
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Toni Franz
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Jens-Uwe Stolzenburg
- Department of Urology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Kadonosono K, Enaida H. Robotics-assisted Tools in Macular Surgery. Int Ophthalmol Clin 2024; 64:153-161. [PMID: 38146888 DOI: 10.1097/iio.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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11
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Yuan J, He Q, Zheng Y, Lv Q, Hu X, Wang D, Tian J, Ren S. Early outcomes of single-site versus multi-port robotic-assisted radical prostatectomy: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107263. [PMID: 37977045 DOI: 10.1016/j.ejso.2023.107263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Single-site robotic-assisted radical prostatectomy (ssRARP) has been promoted in many institutions due to its minimally invasive approach. This review aimed to investigate early outcomes of ssRARP in comparison with multi-port robotic-assisted radical prostatectomy (mpRARP). METHODS A systematic literature search was performed for articles related to ssRARP case series and studies that compared ssRARP with mpRARP. The primary outcomes were functional and oncological outcomes, incision length, length of hospital stay and cost. RESULTS 24 ssRARP case series involving 1385 cases, and 11 comparative studies involving 573 ssRARP cases and 980 mpRARP cases were included. Rate of immediate, 3-month, 6-month and 12-month recovery of continence in the ssRARP case series were 41 % [95 % CI: 0.38-0.45], 70 % [95 % CI: 0.67-0.73], 90 % [95 % CI: 0.87-0.93] and 93 % [95 % CI: 0.90-0.96]. 3-month potency recovery and positive surgical margin rate were 53 % [95 % CI: 0.46-0.60] and 21 % [95 % CI: 0.19-0.24]. No significant differences were detected between ssRARP and mpRARP in terms of 3-month (OR: 1.12; 95 % CI: 0.80-1.57) or 6-month (OR: 0.72; 95 % CI: 0.36-1.46) continence recovery rate, 3-month potency recovery rate (OR: 0.92; 95 % CI: 0.50-1.70), positive surgical margin rate (OR: 0.83; 95 % CI: 0.62-1.11), biochemical recurrence rate or total cost. Furthermore, ssRARP was associated with a significantly shorter length of incision and hospital stay. CONCLUSION ssRARP has significant advantages in cosmetic effect, length of incision and rapid recovery. Consequently, ssRARP is expected to become the preferred form although more evidence is needed to determine its long-term effect.
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Affiliation(s)
- Jiazheng Yuan
- Chengdu Medical College, Chengdu, 610500, China; Department of Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Qinyu He
- Department of Operations Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Yang Zheng
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Qian Lv
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Dong Wang
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Jingzhi Tian
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Shangqing Ren
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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Brument M, Kulawik J, Cornu JN. RE: Baunacke M, et al. Insufficient utilization of care in male incontinence surgery: health care reality in Germany from 2006 to 2020 and a systematic review of the international literature. World J Urol. 2023 Jul;41(7):1813-1819. World J Urol 2023; 42:5. [PMID: 38133661 DOI: 10.1007/s00345-023-04756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Mathilde Brument
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France
| | - Justine Kulawik
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France
| | - Jean-Nicolas Cornu
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France.
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Haney CM, Kowalewski KF, Westhoff N, Holze S, Checcuci E, Neuberger M, Haapiainen H, Egen L, Antti K, Porpiglia F, Stolzenburg JU. Robot-assisted Versus Conventional Laparoscopic Radical Prostatectomy: A Systematic Review and Meta-analysis of Randomised Controlled Trials. Eur Urol Focus 2023; 9:930-937. [PMID: 37353415 DOI: 10.1016/j.euf.2023.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 06/25/2023]
Abstract
CONTEXT Robot-assisted radical prostatectomy (RARP) has largely replaced conventional laparoscopic radical prostatectomy (LRP) even though the costs are significantly higher. Justification for this change is the hope for better postoperative functional results because of better dissection of the neurovascular bundle. OBJECTIVE To perform a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing RARP and LRP for the primary outcome of continence (use of 0 pads or 1 safety pad) at 12 mo after surgery. EVIDENCE ACQUISITION We searched the CENTRAL, MEDLINE, and Web of Science databases for RCTs comparing RARP versus LRP for adults with localised prostate cancer (PC). Where possible, individual-patient data were obtained. Secondary outcomes were potency for patients potent at baseline; a trifecta of patients continent and potent and no recurrence/further treatment; positive surgical margins; biochemical recurrence; and further treatment for PC. The systematic review was registered prospectively (reviewregistry1190 on www.researchregistry.com/). EVIDENCE SYNTHESIS Five RCTs were identified. Three trial teams provided data. For another trial, only published data were available. The fifth trial was terminated prematurely because of insufficient recruitment and thus could not be included. Overall, data for 1205 randomised patients were available. At 12 mo, there was no significant difference between the two groups regarding continence (odds ratio [OR] 1.95, 95% confidence interval [CI] 0.67-5.62). However, at 3 mo and 6 mo there were significant differences in favour of RARP. Significantly more patients who were potent at baseline and underwent a robot-assisted nerve-sparing approach were potent at 12 mo (OR 4.05, 95% CI 1.63-10.09). CONCLUSION At 12 mo after surgery there are no differences in continence between RARP and LRP. Short-term continence benefits of RARP were observed. Potent patients undergoing RARP consistently show better potency postoperatively. PATIENT SUMMARY We analysed differences between robot-assisted removal of the prostate and conventional keyhole surgery for removal of the prostate. At 12 mo after surgery, there were no differences in continence outcomes between the two approaches. However, patients who were potent at baseline and underwent robot-assisted surgery were more likely to be potent at 12 mo.
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Affiliation(s)
- Caelán Max Haney
- Department of Urology, University Hospital Leipzig, Leipzig, Germany.
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sigrun Holze
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Enrico Checcuci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Manuel Neuberger
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Henry Haapiainen
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Luisa Egen
- Department of Urology and Urologic Surgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kaipia Antti
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
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14
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Haapiainen H, Murtola TJ, Koskimäki J, Riikonen J, Pakarainen T, Haney CM, Raitanen M, Kaipia A. Robot-assisted versus three-dimensional laparoscopic radical prostatectomy: 12-month outcomes of a randomised controlled trial. BJU Int 2023; 132:505-511. [PMID: 37461186 DOI: 10.1111/bju.16132] [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] [Indexed: 07/27/2023]
Abstract
OBJECTIVES To compare functional and oncological outcomes of robot-assisted laparoscopic prostatectomy (RALP) to three-dimensional laparoscopic radical prostatectomy (3D-LRP) at 12 months after surgery. PATIENTS AND METHODS Prospective randomised single-centre study of 145 consecutive men referred to radical prostatectomy in a tertiary referral centre in Finland. Patients were randomised 1:1 to the RALP (N = 75) and 3D-LRP (N = 70) groups. The primary outcome was urinary continence evaluated with the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) incontinence domain score at 12 months after surgery. Secondary outcomes included the use of protective pads at 12 months after surgery, EPIC-26 domain scores of irritative/obstructive, bowel, sexual and hormonal symptoms, positive surgical margin (PSM) rate, and biochemical recurrence (BCR). Complication frequency within the 3-month period after surgery was evaluated according to Clavien-Dindo classification. Statistical significance between groups was analysed using Mann-Whitney, chi-square and Fisher's exact tests. The trial was terminated after interim analysis based on no statistically significant difference in EPIC-26 urinary incontinence domain scores. Altogether 145 patients of the target accrual of 280 patients were recruited. RESULTS Postoperative continence at 12 months after surgery according to the EPIC-26 incontinence domain was 79.25 in both groups (P = 0.4). Between group difference was -5.8 (95% confidence interval -15.2 to 3.6). There was no statistically significant difference in the rates of PSM or BCR between the two surgical modality groups. CONCLUSION We were unable to demonstrate a difference between the RALP and 3D-LRP groups for functional and oncological outcomes at 12 months after surgery.
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Affiliation(s)
- Henry Haapiainen
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Teemu J Murtola
- Department of Urology, TAYS Cancer Center, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Koskimäki
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | - Jarno Riikonen
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | | | - Caelán M Haney
- Department of Urology, University Hospital Leipzig, Leipzig, Germany
| | - Mika Raitanen
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
- Department of Urology, TAYS Cancer Center, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Kaipia
- Department of Urology, TAYS Cancer Center, Tampere, Finland
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Yamamoto S, Kuroki Y, Ide T, Tanaka S, Hirahara R, Takamori A, Nishimura T, Suzuma K, Kadonosono K, Enaida H. Customization of a passive surgical support robot to specifications for ophthalmic surgery and preliminary evaluation. Jpn J Ophthalmol 2023; 67:637-644. [PMID: 37561308 DOI: 10.1007/s10384-023-01017-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To customize a passive surgery support robot for ophthalmic surgery and preliminarily evaluate its performance. STUDY DESIGN Prospective observational study. METHODS The range of motion of the arm was analyzed during ophthalmic surgery and, based on this analysis, a commercially available passive robot was customized for surgical support for ophthalmic surgery; following which a prototype robot was constructed. To examine the effects on the brachial muscle during surgical operations with and without the prototype robot, surface electromyograms of the biceps and triceps were analyzed after performing continuous curvilinear capsulorrhexis (CCC) and suturing the sclerocorneal wound in a cataract surgery simulation. Six surgeons performed cataract surgery, and the degree of arm stability and muscle fatigue during surgery were evaluated using a visual analog scale. RESULTS During surgery, the prototype robot enabled fixation of the elbow and wrist at any position within the surgeon's range of motion, expanding the range of motion of the hand and fingers and stabilizing operability. Surface electromyography showed a significant decrease in the mean amplitude value of the biceps brachii during both CCC and suturing (p < 0.0001). No significant difference was observed in the triceps brachii. The arm stability and muscle fatigue were improved by 83.3% on the visual analog scale with the prototype robot compared with that without protpotype robot. CONCLUSION The use of a passive prototype robot may improve arm stability and reduce muscle fatigue during ophthalmic surgery.
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Affiliation(s)
- Soichiro Yamamoto
- Department of Ophthalmology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yohei Kuroki
- Department of Ophthalmology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shin Tanaka
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Rintaro Hirahara
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Tomohisa Nishimura
- Department of Ophthalmology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
- Mikawa Eye Clinic, Saga, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
| | - Hiroshi Enaida
- Department of Ophthalmology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
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Broe M, Carbin Joseph DD, Casson H, Innes M, Adamou C, Fragkoulis G, Moschonas D, Kusuma VRM, Hicks J, Patil K, Perry MJA, Abou Chedid W. Assessment of routine same-day discharge surgery for robot-assisted radical prostatectomy. World J Urol 2023; 41:2679-2684. [PMID: 37668719 DOI: 10.1007/s00345-023-04566-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: 06/02/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION It is important for robotic surgery to be cost-effective, especially by reducing the length of stay (LOS). Therefore, we developed a protocol for day-case robot-assisted radical prostatectomy (RARP). This study aimed to validate this as a safe practice of care and to assess the potential benefits to the hospital and patient. METHODS In this single-centre study, all patients booked for RARP between April 2022 and October 2022 were screened for suitability for day case. All tumour types were included. Exclusion criteria were a history of complex abdominal surgeries, salvage prostatectomy, body mass index (BMI) > 35 and patient living alone or > 150 km away from the hospital. All day-case RARPs were performed as a morning case with a protocol for review throughout the day with evening discharge if mobilising independently and eating/drinking well. The primary outcome of the study was success rate of discharge home on day of surgery (DOS) with secondary outcomes of readmissions and complications. A patient questionnaire was completed at home including both visual analogue scale (VAS) for pain and satisfaction rating. RESULTS Forty-five patients underwent day-case RARP over a 6-month period with minimum of 30 days of follow-up. 41/45 (91%) had successful DOS discharge home. The four admissions overnight were due to dizziness, low oxygen saturation, intraoperative complications and a diagnosis of COVID-19. There were no readmissions and no 30-day complications. The most common issues at home were catheter discomfort and constipation with low mean VAS pain score and low nausea reported. The overall patient satisfaction rating was very high at 4.8/5, and 97% said they would recommend to a family member. The cost saving for the hospital was 400 pounds per patient. CONCLUSION Day-case procedure is a viable, safe and efficient pathway for appropriately selected and counselled patients undergoing RARP.
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Affiliation(s)
- Mark Broe
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | | | - Helen Casson
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Maria Innes
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Constantinos Adamou
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Gerasimos Fragkoulis
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Dimitrios Moschonas
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Venkata Ramana Murthy Kusuma
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - James Hicks
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Krishna Patil
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Matthew James Alexander Perry
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Wissam Abou Chedid
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
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Autorino R. Robotic surgery in urology: Recent advances. Asian J Urol 2023; 10:385-387. [PMID: 38024432 PMCID: PMC10659975 DOI: 10.1016/j.ajur.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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Carbonara U, Lippolis G, Rella L, Minafra P, Guglielmi G, Vitarelli A, Lucarelli G, Ditonno P. Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy: A single center analysis. Asian J Urol 2023; 10:423-430. [PMID: 38024441 PMCID: PMC10659983 DOI: 10.1016/j.ajur.2023.05.005] [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: 11/10/2022] [Revised: 04/01/2023] [Accepted: 05/04/2023] [Indexed: 12/01/2023] Open
Abstract
Objective In the last 10 years, robotic platforms allowed to resume of some alternative surgical approaches, including perineal robot-assisted radical prostatectomy (p-RARP). Herein, we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months. Methods Patients presenting low- or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected. Baseline, intraoperative, pathological, and postoperative data were collected and then analyzed. Results Thirty-seven p-RARP cases were included. Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4. Body mass index of ≥25 kg/m2 was reported by 24 (64.9%) patients, as well as 7 (18.9%) patients reported a past surgical history. Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL, respectively. The median operative time was 242 min. The positive surgical margin rate was 45.9%. In terms of postoperative complications, 10 patients reported complications with any grade; however, a single case (2.7%) of major (Clavien-Dindo grade ≥3) complication was observed. No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up. Recovery of continence rates were 67.6%, 75.7%, and 92.9%, at 6 months, 12 months, and 24 months after surgery, respectively. Conclusion p-RARP is a challenging but safe minimally invasive approach for selected patients with prostate cancer suitable for radical prostatectomy, showing outstanding functional recovery. Despite positive surgical margin rates being relatively high, no cases of biochemical recurrence or distant metastasis were reported after a median follow-up of 30 months.
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Affiliation(s)
- Umberto Carbonara
- Department of Emergency and Organ Transplantation, Urology Unit, Aldo Moro University, Bari, Italy
| | - Giuseppe Lippolis
- Department of Emergency and Organ Transplantation, Urology Unit, Aldo Moro University, Bari, Italy
| | - Luciano Rella
- Department of Emergency and Organ Transplantation, Urology Unit, Aldo Moro University, Bari, Italy
| | - Paolo Minafra
- Department of Emergency and Organ Transplantation, Urology Unit, Aldo Moro University, Bari, Italy
| | - Giuseppe Guglielmi
- Department of Emergency and Organ Transplantation, Urology Unit, Aldo Moro University, Bari, Italy
| | - Antonio Vitarelli
- Department of Emergency and Organ Transplantation, Urology Unit, Aldo Moro University, Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology Unit, Aldo Moro University, Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology Unit, Aldo Moro University, Bari, Italy
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Gao Y, Yang Y, Li X, Wang T, Cheng Q, Jia Z, Niu SX, Zhang XY, Wang BJ, Zhang X. Vesicoprostatic muscle reconstruction: a step further for immediate and early urinary continence. World J Urol 2023:10.1007/s00345-023-04398-9. [PMID: 37093318 DOI: 10.1007/s00345-023-04398-9] [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: 11/22/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVES The vesicoprostatic muscle (VPM) is a longitudinal smooth muscle that originates from the trigone of the bladder or the opening of the ureter and is involved in urination as part of the detrusor apron. We explored the effect of VPM reconstruction on immediate and early recovery of urinary continence in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP). PATIENTS AND METHODS A total of 523 patients with localized prostate cancer were enrolled from June 2018 to June 2020. All patients were diagnosed in our department based on magnetic resonance imaging and pathological findings on prostate biopsy. After 1:1 propensity score matching, 105 patient pairs were matched. The study was approved by our institutional review board and all surgeries were performed by three experienced high-volume surgeons. Demographic data, total operation time, pathological outcomes, the urinary continence rates of the two groups at different times after RALP, and factors influencing postoperative urinary continence after RALP were recorded. Student's t test was used to compare continuous variables and the Pearson χ2 test to compare categorical variables. Logistic regression analysis was used to identify factors affecting immediate and early postoperative urinary control. RESULTS VPM reconstruction promoted immediate and early recovery of urinary continence (immediate continence, 66.67 vs. 40.00%, P = 0.000; 3-month continence, 80.95 vs. 64.76%, P = 0.008). CONCLUSIONS VPM reconstruction improved immediate and early urinary continence in patients who underwent RALP.
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Affiliation(s)
- Yu Gao
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yang Yang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, People's Republic of China
| | - Tao Wang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Qiang Cheng
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhuo Jia
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shao-Xi Niu
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiang-Yi Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Bao-Jun Wang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China.
- Department of Urology, PLA Military General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Xu Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China.
- Department of Urology, PLA Military General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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20
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Xie F, Wagh A, Wu R, Hogarth DK, Sun J. Robotic-assisted bronchoscopy in the diagnosis of peripheral pulmonary lesions. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2023; 1:30-35. [PMID: 39170876 PMCID: PMC11332856 DOI: 10.1016/j.pccm.2023.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/07/2022] [Accepted: 01/09/2023] [Indexed: 08/23/2024]
Abstract
More peripheral pulmonary lesions (PPLs) are detected by low-dose helical computed tomography (CT) either incidentally or via dedicated lung cancer screening programs. Thus, using methods for safe and accurate diagnosis of these lesions has become increasingly important. Transthoracic needle aspiration (TTNA) and transbronchial lung biopsy (TBLB) are routinely performed during the diagnostic workup for PPLs. However, TTNA often carries the risk of pneumothorax, uncontrollable airway hemorrhage, and does not allow mediastinal staging in one procedure. In contrast, traditional TBLB often has a poorer diagnostic yield despite fewer complications. With the ongoing development of technology applied to bronchoscopy, guided bronchoscopy has become widely used and the diagnostic yield of TBLB has improved. Additionally, guided bronchoscopy continues to demonstrate a better safety profile than TTNA. In recent years, robotic-assisted bronchoscopy (RAB) has been introduced and implemented in the diagnosis of PPLs. At present, RAB has two platforms that are commercially available: Monarch™ and Ion™; several other platforms are under development. Both systems differ in characteristics, advantages, and limitations and offer features not seen in previous guided bronchoscopy. Several studies, including cadaveric model studies and clinical trials, have been conducted to examine the feasibility and performance of RAB using these two systems; large multicenter studies are underway. In this review, published experimental results, focusing on diagnostic yield and complications of RAB, are analyzed and the potential clinical application of RAB is discussed, which will enable the operators to have a clear overview of RAB.
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Affiliation(s)
- Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Ajay Wagh
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Ruolan Wu
- Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
| | - D. Kyle Hogarth
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
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21
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Yang CH, Chen LH, Lin YS, Hsu CY, Tung MC, Huang SW, Wu CH, Ou YC. Incorporating VR-RENDER Fusion Software in Robot-Assisted Partial Prostatectomy: The First Case Report. Curr Oncol 2023; 30:1699-1707. [PMID: 36826092 PMCID: PMC9955092 DOI: 10.3390/curroncol30020131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Currently, the active surveillance of men with favorable intermediate-risk localized prostate cancer (PCa) is a longstanding controversy, in terms of their oncological outcomes, and radical prostatectomy would constitute a similar concern of overtreatment, regarding its functional outcomes. Thus, focal therapy could be considered in men belonging to favorable intermediate-risk group. Among all focal therapies, high-intensity focused ultrasound (HIFU) was the most studied methodology in clinical trials. Although HIFU provided better functional outcomes than radical prostatecomy, the oncological outcomes were inferior in men with intermediate-risk localized PCa. Two articles have been published discussing the feasibility and clinical outcomes of robot-assisted partial prostatectomy (RAPP), and both the functional and oncological outcomes were superior than those with HIFU. However, the rate of positive surgical margins (PSMs) was reported as high in the literature. Here, we present a case of favorable intermediate-risk localized PCa with an isolated tumor at the anterior apex. After reconstructing a personal three-dimensional (3D) image, we utilized it in a 3D image-guided precise excise, followed by intraoperative frozen specimen review. We found that this method may present a resolution to the high PSM rate documented in the current literature regarding RAPP. This method merits further study with a well-designed prospective study.
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Affiliation(s)
- Che-Hsueh Yang
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Li-Hsun Chen
- Asian Institute of Telesurgery, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
- Correspondence: (L.-H.C.); (Y.-C.O.)
| | - Yi-Sheng Lin
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Chao-Yu Hsu
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Min-Che Tung
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Shih-Wei Huang
- Asian Institute of Telesurgery, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
- Division of General Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
| | - Chi-Hsiang Wu
- Asian Institute of Telesurgery, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
- Department of Urology, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Correspondence: (L.-H.C.); (Y.-C.O.)
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22
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Lympho-SPECT/CT as a Key Tool in the Management of a Patient with Chylous Ascites. Biomedicines 2023; 11:biomedicines11020282. [PMID: 36830819 PMCID: PMC9953622 DOI: 10.3390/biomedicines11020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Chylous ascites is a rare form of ascites usually associated with cirrhosis, abdominal malignancies, surgeries or infections. We presented a case of chylous ascites after robotic laparoscopic prostatectomy (PLDN-RALP), in which the correct diagnosis was achieved by SPECT/CT lymphoscintigraphy. A 72-year-old male developed chylous ascites after surgery and underwent lymphoscintigraphy with radiolabeled albumin nanocolloids for the supplementary study of the lymph flow and to detect a possible site of leakage. The scintigraphic imaging demonstrated the abdominal effusion and lymph stasis in the left iliac region. The combination of planar imaging with SPECT/CT can resolve the assessment of chylous disorders.
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23
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Salkowski M, Checcucci E, Chow AK, Rogers CC, Adbollah F, Liatsikos E, Dasgupta P, Guimaraes GC, Rassweiler J, Mottrie A, Breda A, Crivellaro S, Kaouk J, Porpiglia F, Autorino R. New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology. Ther Adv Urol 2023; 15:17562872231177781. [PMID: 37325289 PMCID: PMC10265325 DOI: 10.1177/17562872231177781] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
Over the past 20 years, the field of robotic surgery has largely been dominated by the da Vinci robotic platform. Nevertheless, numerous novel multiport robotic surgical systems have been developed over the past decade, and some have recently been introduced into clinical practice. This nonsystematic review aims to describe novel surgical robotic systems, their individual designs, and their reported uses and clinical outcomes within the field of urologic surgery. Specifically, we performed a comprehensive review of the literature regarding the use of the Senhance robotic system, the CMR-Versius robotic system, and the Hugo RAS in urologic procedures. Systems with fewer published uses are also described, including the Avatera, Hintori, and Dexter. Notable features of each system are compared, with a particular emphasis on factors differentiating each system from the da Vinci robotic system.
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Affiliation(s)
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | | | - Craig C. Rogers
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Firas Adbollah
- Department of Urology, VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Evangelos Liatsikos
- Department of Urology, University General Hospital of Patras, Patras, Greece
| | - Prokar Dasgupta
- King’s Health Partners Academic Surgery, King’s College London, London, UK
| | | | - Jens Rassweiler
- Department of Urology and Andrology, Danube Private University, Krems, Austria
| | - Alexander Mottrie
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Simone Crivellaro
- Department of Urology, University of Illinois Chicago, Chicago, IL, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology and San Luigi Gonzaga Hospital, University of Turin, Torino, Italy
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24
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Sun G, Liang Z, Jiang Y, Ma S, Chen S, Liu R. Clinical Analysis of Perioperative Outcomes on Neoadjuvant Hormone Therapy before Laparoscopic and Robot-Assisted Surgery for Localized High-Risk Prostate Cancer in a Chinese Cohort. Curr Oncol 2022; 29:8668-8676. [PMID: 36421336 PMCID: PMC9689847 DOI: 10.3390/curroncol29110683] [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: 10/08/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyze the perioperative outcomes of neoadjuvant hormone therapy (NHT) before laparoscopic and robot-assisted surgery for localized high-risk prostate cancer in a Chinese cohort. METHODS The clinical data of 385 patients with localized high-risk prostate cancer who underwent radical prostatectomy (RP) in our hospital from January 2019 to June 2021 were analyzed retrospectively, including 168 patients with preoperative NHT and 217 patients with simple surgery. Clinical characteristics were compared in the above two groups, the laparoscopic RP (LRP) cohort (n = 234) and the robot-assisted laparoscopic radical prostatectomy (RALP) cohort (n = 151), respectively. RESULTS In the overall cohort, compared with the control group, the NHT group had a shorter operative time, less blood loss, a lower positive surgical margin rate, and a higher proportion of Gleason score (GS) downgrading after the operation (p < 0.05). However, there was no significant difference in hospitalization time, biochemical recurrence, urine leakage, urinary continence, or prostate-specific antigen (PSA) progression-free survival (p > 0.05). In the LRP cohort, it was found that the NHT group also had shorter operative time, less blood loss, lower positive surgical margin rate, a higher proportion of GS downgrading after the operation, and faster recovery of urinary control than the control group (p < 0.05). There was no marked difference in hospitalization time, biochemical recurrence, urinary leakage, or PSA progression-free survival. However, in the RALP cohort, the NHT group had a significant difference in the GS downgrading after the operation compared with the control group (p < 0.05). In the overall cohort, multiple analyses showed that initial PSA level, GS at biopsy, clinical T stage, lymph node invasion, use of NHT, and surgical methods were significantly associated with positive surgical margin (p < 0.05) while NHT did not account for biochemical recurrence (p > 0.05). CONCLUSIONS NHT can lower the difficulty of surgery, reduce positive surgical margin rate, and help recovery in short-term urinary control in patients with high-risk prostate cancer after LRP. However, we do not have evidence on the benefit of NHT in high-risk PCa patients treated with RALP. For these patients, surgery can be performed as early as possible.
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25
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Robotic-assisted Versus Laparoscopic Radical Prostatectomy: 12-month Outcomes of the Multicentre Randomised Controlled LAP-01 Trial. Eur Urol Focus 2022; 8:1583-1590. [PMID: 35216946 DOI: 10.1016/j.euf.2022.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/14/2022] [Accepted: 02/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recently, our LAP-01 trial demonstrated superiority of robotic-assisted laparoscopic radical prostatectomy (RARP) over conventional laparoscopic radical prostatectomy (LRP) with respect to continence at 3 mo. OBJECTIVE To compare the continence, potency, and oncological outcomes between RARP and LRP in the 12-mo follow-up. DESIGN, SETTING, AND PARTICIPANTS In this multicentre, randomised, patient-blinded controlled trial, patients referred for radical prostatectomy to four hospitals in Germany were randomly assigned (3:1) to undergo either RARP or LRP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Continence was assessed as a patient-reported outcome through validated questionnaires. Secondary endpoints included potency and oncological outcomes. Data were statistically analysed by bivariate tests and multivariable models. RESULTS AND LIMITATIONS At 12 mo, follow-up data were available for 701 of 782 patients. Continence at 6 and 12 mo after surgery was better in RARP patients, however no longer statistically significant (p = 0.068 and 0.38, respectively). Patients who were potent at baseline and underwent nerve-sparing surgery reported significantly higher potency after RARP, as defined by the capability to maintain an erection sufficient for intercourse at 3 (p = 0.005), 6 (p = 0.018), and 12 mo (p = 0.013). There were no statistically significant differences in oncological outcomes at 12 mo. It is a limitation that the influence of different anastomotic techniques was not investigated in this study. CONCLUSIONS Both LRP and RARP offer a high standard of therapy for prostate cancer patients. However, robotic assistance offers better functional outcomes in specific areas such as potency and early continence in patients who are eligible for nerve-sparing RP. PATIENT SUMMARY We compared outcomes 12 mo after radical prostatectomy between robotic-assisted and conventional laparoscopy. Both methods were equivalent with respect to oncological outcomes. Better recovery of continence in patients with robotic-assisted surgery, which was observed at 3 mo, blurred up to 12 mo. A benefit of robotic-assisted surgery was also observed in potency.
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26
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Alba S, Fimognari D, Crocerossa F, Ascalone L, Pullano C, Chiaravalloti F, Chiaradia F, Carbonara U, Ferro M, de Cobelli O, Pagliarulo V, Lucarelli G, Battaglia M, Damiano R, Cantiello F. Neuraxial anesthesia versus general anesthesia in patients undergoing three-dimensional laparoscopic radical prostatectomy: Preliminary results of a prospective comparative study. Asian J Urol 2022. [PMID: 37538165 PMCID: PMC10394281 DOI: 10.1016/j.ajur.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective Neuraxial anesthesia (NA) showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery. We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy (t-3DLRP) and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia (GA). Methods A prospective, double-center, double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed. A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA. Results The two group were similar in all demographic, clinical, and pathological variables. Postoperative blood gas parameters were within physiologic limits in both groups. Muscle relaxation was adequate for surgery during both NA and GA. Median length of stay was 1 day shorter for NA group than GA group (5 days vs. 6 days, p=0.05). t-3DLRP under NA had a statistically lower rate of minor complications (4.8% vs. 19.0%, p=0.03) and less postoperative pain (median numeric rating scale 3 vs. 4, p=0.01) compared to GA. No major complications were observed in both groups. Significantly more patients were willing to undergo a similar intervention under NA than GA (p=0.04). Conclusion t-3DLRP under NA is a feasible and safe procedure, with less postoperative pain and fewer minor complications than the same procedure under GA. NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.
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27
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Carbonara U, Minafra P, Papapicco G, De Rienzo G, Pagliarulo V, Lucarelli G, Vitarelli A, Ditonno P. Xi Nerve-sparing Robotic Radical Perineal Prostatectomy: European Single-center Technique and Outcomes. EUR UROL SUPPL 2022; 41:55-62. [PMID: 35633830 PMCID: PMC9133767 DOI: 10.1016/j.euros.2022.04.014] [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: 04/14/2022] [Indexed: 12/01/2022] Open
Abstract
Background Radical prostatectomy (RP) represents the standard of care for the treatment of patients with organ-confined prostatic cancer. Historically, perineal RP has been described as the first surgical approach for the complete removal of the prostatic gland. In the past years, robotic techniques provided some technical advantages that allow resuming alternative approaches, such as robotic radical perineal prostatectomy (r-RPP). Objective To present in detail the technique of Xi nerve-sparing r-RPP and to report perioperative, oncological, and functional outcomes from a European tertiary center. Design setting and participants Patients with low- or intermediate-risk prostatic cancer not suitable for active surveillance and prostate volume up to 60 ml who underwent r-RPP between November 2018 and December 2020 were identified. Surgical procedure All patients underwent Xi nerve-sparing r-RPP. Measurements Baseline characteristics and intraoperative, pathological, and postoperative data were collected and analyzed. The complications were reported according to the standardized methodology to report complications proposed by European Association of Urology guidelines. Results and limitations Overall, our series included 26 patients who underwent r-RPP. Patients' median age was 62.5 yr. Thirteen (50%) and eight (30.7%) patients showed a body mass index (BMI) of 25-30 and >30, respectively. A history of past surgical procedures was present in seven (26.8%) patients. The median prostate volume was 40 (interquartile range [IQR]: 28-52) ml. The median operative time and blood lost were 246 (IQR: 230-268) min and 275 (IQR: 200-400) ml, respectively. Overall, four (15.4%) patients reported intraoperative complications and five (19.2%) reported postoperative complications, with one (3.8%) reporting major complications (Clavien-Dindo ≥3). No patient with biochemical recurrence (BCR) was reported at 1 yr of follow-up. Continence rates were 73.0%, 84.6%, and 92.3%, respectively, at 3, 6, and 12 mo after surgery. Erectile potency recovery rates were 57.1%, 66.6%, and 80.9% at 3, 6, and 12 mo of follow-up, respectively. Conclusions Xi r-RPP is a challenging but safe minimally invasive approach for selected patients. No patient reported BCR at 12 mo. The choice of the surgical approach for RP is likely to be based on the patient's characteristics as well as the surgeon's preferences. Patient summary Our study suggests that Xi radical perineal prostatectomy is a safe minimally invasive approach for patients with low- or intermediate-risk prostatic cancer, and complex abdominal surgical history or comorbidities.
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Affiliation(s)
- Umberto Carbonara
- Corresponding author. Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. Tel. +39 342 755 2215; Fax: +39 080 559 5236.
| | | | - Giuseppe Papapicco
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Gaetano De Rienzo
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Vincenzo Pagliarulo
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Antonio Vitarelli
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation – Urology Unit, Aldo Moro University, Bari, Italy
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Sarchi L, Mottaran A, Bravi CA, Paciotti M, Farinha R, Piazza P, Puliatti S, De Groote R, De Naeyer G, Gallagher A, Breda A, Mottrie A. Robot-assisted radical prostatectomy feasibility and setting with the Hugo™ robot-assisted surgery system. BJU Int 2022; 130:671-675. [PMID: 35689414 DOI: 10.1111/bju.15819] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Sarchi
- ORSI Academy, Ghent, Belgium.,Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Angelo Mottaran
- ORSI Academy, Ghent, Belgium.,Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Andrea Bravi
- ORSI Academy, Ghent, Belgium.,Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Marco Paciotti
- ORSI Academy, Ghent, Belgium.,Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.,Department of Urology, Humanitas Research Hospital- IRCCS, Rozzano, Italy
| | | | - Pietro Piazza
- ORSI Academy, Ghent, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Puliatti
- ORSI Academy, Ghent, Belgium.,Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alexandre Mottrie
- ORSI Academy, Ghent, Belgium.,Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
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29
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Moretti TBC, Reis LO. The devil is still in the details of robotic assisted radical prostatectomy data. World J Urol 2022; 40:1239-1240. [PMID: 35157104 DOI: 10.1007/s00345-022-03962-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Tomás Bernardo Costa Moretti
- UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, Sao Paulo state, Brazil
| | - Leonardo Oliveira Reis
- UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, Sao Paulo state, Brazil.
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30
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Deng W, Chen R, Zhu K, Cheng X, Xiong Y, Liu W, Zhang C, Li Y, Jiang H, Zhou X, Sun T, Chen L, Liu X, Wang G, Fu B. Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis. JOURNAL OF ONCOLOGY 2021; 2021:4375722. [PMID: 34970314 PMCID: PMC8714374 DOI: 10.1155/2021/4375722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). MATERIALS AND METHODS 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. RESULTS Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group (p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group (p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group (p = 0.192 and p = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up (p = 0.013 and p = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups (p = 0.228). CONCLUSIONS For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.
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Affiliation(s)
- Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Ru Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Department of Urology, The First Hospital of Putian City, Putian, Fujian Province, China
| | - Ke Zhu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Xiaofeng Cheng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Yunqiang Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Yulei Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Hao Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Ting Sun
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
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31
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Reiss AB, Saeedullah U, Grossfeld DJ, Glass AD, Pinkhasov A, Katz AE. Prostate cancer treatment and the relationship of androgen deprivation therapy to cognitive function. Clin Transl Oncol 2021; 24:733-741. [PMID: 34743290 DOI: 10.1007/s12094-021-02727-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
Prostate cancer is the second most common form of cancer in men. For advanced, high risk prostate cancer, androgen deprivation therapy (ADT) is the preferred treatment and can induce remission, but resistance to ADT brings biochemical recurrence and progression of cancer. ADT brings adverse effects such as erectile dysfunction, decreased libido, and diminished physical strength. It is estimated that between 25 and 50% of men on ADT manifest some form of cognitive dysfunction that may be self-reported or reported by a family member. There is concern that impaired cognitive function with ADT is due to loss of testosterone support. Testosterone and its metabolites are known to possess neuroprotective properties. While a direct causal relationship between ADT and cognitive decline in prostate cancer patients has not been established, this review describes the controversy surrounding the possible connection between ADT and neurocognitive deterioration. The cellular and molecular mechanisms believed to underlie the protection of neuronal integrity by androgens are discussed. Results from animal models and human clinical studies are presented. Finally, we call attention to lifestyle modifications that may minimize cognitive issues in prostate cancer patients.
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Affiliation(s)
- A B Reiss
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA.
| | - U Saeedullah
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
| | - D J Grossfeld
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
| | - A D Glass
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
| | - A Pinkhasov
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
| | - A E Katz
- Biomedical Research Institute, NYU Long Island School of Medicine, 101 Mineola Boulevard, Suite 4-004, Mineola, NY, 11501, USA
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32
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Deng W, Liu X, Liu W, Zhang C, Zhou X, Chen L, Guo J, Wang G, Fu B. Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups. Front Oncol 2021; 11:714680. [PMID: 34631541 PMCID: PMC8495117 DOI: 10.3389/fonc.2021.714680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/02/2021] [Indexed: 01/09/2023] Open
Abstract
Objective We aimed to analyze the perioperative, functional, and oncologic outcomes following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for patients with localized prostate cancer (PCa) characterized by a large prostate volume (PV; ≥50 ml) over a minimum of 2 years follow-up. Materials and Methods Patients undergoing RARP and LRP for localized PCa with a large PV were included in the final analysis. The perioperative, functional, and oncologic outcomes were analyzed between the two groups. Results All operations were successfully completed without open conversion in both groups. The mean operative time and estimated blood loss in the RARP group were significantly decreased compared to those in the LRP group (139.4 vs. 159.0 min, p = 0.001, and 124.2 vs. 157.3 ml, p = 0.003, respectively). Patients in the RARP arm had significantly lower proportions of grade II or lower and of higher than grade II postoperative complications compared with those in the LRP group (7.9% vs. 17.1%, p = 0.033, and 1.6% vs. 6.7%, p = 0.047, respectively). No significant differences in terms of the rates of pT3 disease, positive surgical margin, and positive lymph node were noted between the two groups. Moreover, no significant difference in the median specimen Gleason score was observed between the RARP and LRP groups (6 vs. 7, p = 0.984). RARP vs. LRP resulted in higher proportions of urinary continence upon catheter removal (48.4% vs. 33.3%, p = 0.021) and at 3 (65.1% vs. 50.5%, p = 0.025) and 24 (90.5% vs. 81.0%, p = 0.037) months post-operation. The median erectile function scores at 6 and 24 months post-operation in the RARP arm were also significantly higher than those in the LRP arm (15 vs. 15, p = 0.042, and 15 vs. 13, p = 0.026, respectively). Kaplan–Meier analyses indicated that the biochemical recurrence-free survival and accumulative proportion of continence were statistically comparable between the two groups (p = 0.315 and p = 0.020, respectively). Conclusions For surgically managing localized PCa with a large prostate (≥50 ml), RARP had a tendency toward a lower risk of postoperative complications and better functional preservation without cancer control being compromised when compared to LRP.
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Affiliation(s)
- Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ju Guo
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
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