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Hattori Y, Yamamoto A, Nagoshi A, Fujiwara T, Kambe T, Igarashi A, Akagi N, Shibasaki N, Kawakita M, Yamasaki T. Totally retroperitoneal approach for robot-assisted nephroureterectomy with bladder cuff without repositioning. Asian J Endosc Surg 2024; 17:e13317. [PMID: 38692582 DOI: 10.1111/ases.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Robot-assisted nephroureterectomy (RANU) for upper urinary tract urothelial carcinoma is typically performed via the transperitoneal approach because of limited surgical space. However, a retroperitoneal approach may be preferable in patients with a history of abdominal surgery or in those in whom pelvic lymph node dissection is unnecessary. MATERIALS AND SURGICAL TECHNIQUES RANU via the retroperitoneal approach was selected for two patients diagnosed with high-grade upper urothelial carcinoma with a history of abdominal surgery. Nephrectomy was performed in the 90° flank position, and the bed was tilted at 20°. The retroperitoneal space was extended, and the robot trocar was subsequently repositioned in the left lower quadrant. After redocking the robot, the distal ureter was dissected, and the bladder cuff was resected en bloc along with the kidney and the ureter. Neither patient had any complications within 3 months postoperatively. DISCUSSION By devising a new technique for trocar placement, total retroperitoneal RANU without repositioning was possible, even in a small patient.
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Affiliation(s)
- Yuto Hattori
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Akihiro Yamamoto
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Akihiko Nagoshi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tasuku Fujiwara
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takanari Kambe
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Igarashi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naoki Akagi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Noboru Shibasaki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshinari Yamasaki
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
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O’Rourke TK, Thakker PU, Hemal AK. Refined step-by-step narrative review of robotic radical nephroureterectomy in the management of upper tract urothelial carcinoma. Transl Androl Urol 2024; 13:846-856. [PMID: 38855600 PMCID: PMC11157402 DOI: 10.21037/tau-23-209] [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: 04/04/2023] [Accepted: 03/25/2024] [Indexed: 06/11/2024] Open
Abstract
Background and Objective Upper tract urothelial carcinoma (UTUC) is a challenging clinical entity to diagnose and manage. Recent advances in robotic technology have permitted optimization of surgical technique in robot-assisted radical nephroureterectomy with bladder cuff excision (RNU/BCE), regional lymphadenectomy, and intra or perioperative instillation of intravesical chemotherapy. This has optimized the management of bulky upper tract disease and high-grade disease not amenable to segmental ureterectomy or nephron-sparing surgery. The purpose of this article is to highlight and review the surgical technique if RNU/BCE and regional lymphadenectomy utilized in our high-volume clinical practice. Methods A review of our surgical approach was summarized for this narrative article. This technique has been refined over a course of more than 150 cases and 12 years of local experience with the procedure, as well as through multiple da Vinci® robotic surgical systems over the years. Key Content and Findings RNU/BCE, regional template-based lymphadenectomy, and intra or perioperative instillation of intravesical chemotherapy is technically feasible and the procedure has been optimized via multiple iterations with a decade of local experience. The appropriate steps are outlined in this review. Conclusions RNU/BCE, regional template-based lymphadenectomy, and intra or perioperative instillation of intravesical chemotherapy provides a refined, standardized, efficient approach for management of UTUC in appropriately selected patients. This surgical technique has also been undertaken in elderly patients including those with advanced age (>80 years old) with significant medical co-morbidities due to imperative, symptomatic indications. Further, this approach may be facilely adapted by urologists familiar with all forms of robotic renal surgery.
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Affiliation(s)
- Timothy K. O’Rourke
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Parth U. Thakker
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ashok K. Hemal
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Stout TE, Said MA, Tracy CR, Steinberg RL, Nepple KG, Gellhaus PT. Technique and outcomes of robotic-assisted retroperitoneal radical nephrectomy. Transl Androl Urol 2023; 12:1518-1527. [PMID: 37969765 PMCID: PMC10643383 DOI: 10.21037/tau-23-270] [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: 05/10/2023] [Accepted: 09/15/2023] [Indexed: 11/17/2023] Open
Abstract
Background Robotic retroperitoneal partial nephrectomy (rRPN) has numerous advantages over transperitoneal surgery, including direct access to the renal hilum and posterior tumors, and avoidance of the peritoneal cavity in patients with a hostile abdomen. Although the use of the retroperitoneal approach has increased over the last decade, there is little literature on robotic retroperitoneal radical nephrectomy (rRRN), which has similar benefits over the transperitoneal approach. The aim of this study was to describe our technique for robotic retroperitoneal nephrectomy (rRN) and assess its feasibility and outcomes at a high-volume center. Methods A retrospective review of patients who underwent some form of rRN [rRRN, robotic retroperitoneal simple nephrectomy (rRSN), or robotic retroperitoneal nephroureterectomy (rRNU)] at a single institution between 2013 and 2023. Patient characteristics, operative data, and postoperative complication rates were assessed. The technique for rRN was detailed. Results A total of 13 renal units in 12 patients were included for analysis (7 rRRN, 5 rRSN, 1 rRNU). Median patient age was 64.0 years, and median body mass index (BMI) was 36.0 kg/m2. Indications for retroperitoneal surgery were prior abdominal surgery in all patients, including three with bowel diversions, super morbid central obesity in two patients, and a large ventral hernia in one patient. Median operative time was 213 minutes and median estimated blood loss (EBL) was 85 cc. Median postoperative length of stay (LOS) was 3 days, and only one patient experienced a Clavien-Dindo grade ≥3 complication within 90 days of surgery. Conclusions The retroperitoneal approach for robotic-assisted nephrectomy is feasible and associated with similar outcomes as the transperitoneal approach. This approach may prove beneficial in select patients with significant prior abdominal surgery including those who are morbidly obese.
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Affiliation(s)
- Thomas E Stout
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mohammed A Said
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Chad R Tracy
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ryan L Steinberg
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kenneth G Nepple
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Paul T Gellhaus
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Franco A, Ditonno F, Manfredi C, Johnson AD, Mamgain A, Feldman-Schultz O, Feng CL, Pellegrino AA, Mir MC, Porpiglia F, Crivellaro S, De Nunzio C, Chow AK, Autorino R. Robot-assisted Surgery in the Field of Urology: The Most Pioneering Approaches 2015-2023. Res Rep Urol 2023; 15:453-470. [PMID: 37842031 PMCID: PMC10575039 DOI: 10.2147/rru.s386025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Robot-assisted surgery has emerged as a transformative technology, revolutionizing surgical approaches and techniques that decades ago could barely be imagined. The field of urology has taken charge in pioneering a new era of minimally invasive surgery with the ascent of robotic systems which offer enhanced visualization, precision, dexterity, and enabling surgeons to perform intricate maneuvers with improved accuracy. This has led to improved surgical outcomes, including reduced blood loss, lower complication rates, and faster patient recovery. The aim of our review is to present an evidence-based critical analysis on the most pioneering robotic urologic approaches described over the last eight years (2015-2023).
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, “Luigi Vanvitelli” University, Naples, Italy
| | | | | | | | - Carol L Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
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Pellegrino AA, Mima M, Crivellaro S. Application of the single-port robotic platform during radical nephroureterectomy for upper tract urothelial carcinoma: feasibility of the single-port robot in the multi-quadrant setting. Transl Androl Urol 2023; 12:1469-1474. [PMID: 37814701 PMCID: PMC10560342 DOI: 10.21037/tau-23-48] [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: 01/20/2023] [Accepted: 07/26/2023] [Indexed: 10/11/2023] Open
Abstract
Urothelial carcinoma of the upper tract (UTUC) is a malignancy that accounts for 5-10% of all urothelial carcinomas. Radical surgery is the primary treatment option due to the high rate of invasive stages at the time of diagnosis. Nephroureterectomy (NU) with bladder cuff excision is the current standard of care. While laparoscopic NU has been established since 1991, many centres still perform open surgery due to the complexity of laparoscopic instrumentation and the steep learning curve for excising the bladder cuff. With the increasing adoption of the multi-port (MP) robotic surgery, NU has increasingly been performed using this platform. The use of MP robotic systems for NU has been challenged by the need for patient repositioning and/or redocking of the robot, which can consume valuable operative time. The transition from the daVinci Si to the daVinci Xi system has seen a noticeable reduction in redocking and patient repositioning. However, owing to the multi-quadrant nature of the surgery in question, the use of multiple ports and external instrument clashing are still persistent problems. Moreover, there is a growing interest in utilizing a retroperitoneal approach for robot-assisted NU due to its potential benefits such as improved control of hilar structures, reduction of blood loss, shorter operative time and hospital stay, reduced complications and decreased postoperative discomfort. The application of the daVinci single-port (SP) robotic platform during radical NU for UTUC is feasible and has the potential to improve the current surgical approach. Indeed, the use of a SP platform may solve the problem of patient repositioning and redocking of the robot, improve superficial aesthetic outcome and minimize external instrument clashing. While maintaining an optimal oncological control, the retroperitoneal approach, which has been difficult to replicate and adopt using the MP approach, may become standard practice. However, more studies are needed to confirm the benefit of this approach and ultimately determine the impact of the daVinci SP on the management of UTUC.
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Affiliation(s)
- Antony A. Pellegrino
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Mahmoud Mima
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Franco A, Ditonno F, Feng C, Manfredi C, Sturgis MR, Farooqi M, Del Giudice F, Coogan C, Ferro M, Zhang C, Wu Z, Yang B, Wang L, Autorino R. Minimally Invasive Radical Nephroureterectomy: 5-Year Update of Techniques and Outcomes. Cancers (Basel) 2023; 15:4585. [PMID: 37760553 PMCID: PMC10527300 DOI: 10.3390/cancers15184585] [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: 08/15/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
The gold standard treatment for non-metastatic upper tract urothelial cancer (UTUC) is represented by radical nephroureterectomy (RNU). The choice of surgical technique in performing UTUC surgery continues to depend on several factors, including the location and extent of the tumor, the patient's overall health, and very importantly, the surgeon's skill, experience, and preference. Although open and laparoscopic approaches are well-established treatments, evidence regarding robot-assisted radical nephroureterectomy (RANU) is growing. Aim of our study was to perform a critical review on the evidence of the last 5 years regarding surgical techniques and outcomes of minimally invasive RNU, mostly focusing on RANU. Reported oncological and function outcomes suggest that minimally invasive RNU is safe and effective, showing similar survival rates compared to the open approach.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Department of Urology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, 37126 Verona, Italy
| | - Carol Feng
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Morgan R. Sturgis
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Mustafa Farooqi
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Christopher Coogan
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy;
| | - Chao Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Bo Yang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (C.Z.); (Z.W.); (B.Y.); (L.W.)
| | - Riccardo Autorino
- Department of Urology, Rush University, Chicago, IL 60612, USA; (A.F.); (F.D.); (C.F.); (C.M.); (M.R.S.); (M.F.); (C.C.)
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Morizane S, Stein H, Komiya T, Kaneta H, Takenaka A. Retroperitoneal robot-assisted laparoscopic nephroureterectomy using the da Vinci Xi and SP systems: Initial experiences in cadaveric models. Investig Clin Urol 2023; 64:380-387. [PMID: 37417563 DOI: 10.4111/icu.20230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/16/2023] [Accepted: 04/05/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To investigate the feasibility and optimal port placements of robot-assisted laparoscopic nephroureterectomy (RANU) via the retroperitoneal approach in the lateral decubitus and supine positions using the da Vinci Xi (DVXi) and da Vinci SP (DVSP) systems. MATERIALS AND METHODS We performed lateral decubitus extraperitoneal RANU on the right side and supine extraperitoneal RANU on the left side using the DVXi and DVSP systems without repositioning in two fresh cadavers. In addition, paracaval and pelvic lymphadenectomies were performed simultaneously during both surgical procedures. The operative time of each procedure was calculated, and the technical details associated with these procedures were evaluated. RESULTS Lateral decubitus and supine extraperitoneal RANU using the DVXi and DVSP systems were achieved without repositioning. The surgeon console time ranged from 89 to 178 minutes, and no major technical complications were observed. However, carbon dioxide insufflation into the abdominal cavity was observed owing to a peritoneal breach during the creation of the surgical workspace, particularly in the supine position. Compared with the DVXi system, the DVSP system was more suitable for RANU using the retroperitoneal approach, except for renal handling. CONCLUSIONS The DVXi and DVSP systems are feasible for performing lateral decubitus and supine extraperitoneal RANU without patient repositioning. The lateral decubitus position may be better than the supine position, and the DVSP system is more suitable for retroperitoneal RANU than the DVXi system. Nevertheless, further studies should be performed in clinical settings to validate our results.
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Affiliation(s)
- Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Hubert Stein
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Takayuki Komiya
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Hiroyuki Kaneta
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Huang EYH, Tai MC, Chung HJ, Chang YH, Huang WJ. Effects of different combinations of radical nephroureterectomy and bladder cuff excision procedures for upper tract urothelial carcinoma on bladder recurrence. Int Braz J Urol 2023; 49:469-478. [PMID: 37267612 PMCID: PMC10482446 DOI: 10.1590/s1677-5538.ibju.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/02/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE To compare the effects of different combinations of radical nephroureterectomy (RNU) and bladder cuff excision (BCE) surgical procedures on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS This retrospective observational study included 452 patients who underwent RNU with BCE for UTUC between January 2010 and December 2020. The patients were classified into three groups based on different combinations of RNU and BCE surgical procedures: open RNU with open BCE (group 1, n=104), minimally invasive (MIS) RNU with open BCE (group 2, n=196), and MIS RNU with intracorporeal BCE (group 3, n=152). Data on demographics, body mass index, history, preoperative renal function, perioperative status, tumor characteristics, histopathology, and recurrence conditions were collected. Multivariate Cox regression analyses were performed to determine the impact of the surgical procedures on IVR. P-values < 0.05 were considered statistically significant. RESULTS After a median follow-up of 29.5 months, the IVR rate was 29.6% and the IVR-free survival rate was the lowest in group 2 (group 1 vs. group 2 vs. group 3: 69.0% vs. 55.1% vs. 67.5%; log-rank P=0.048). The overall survival rate was comparable among the three groups. Multivariate analysis revealed that group 2 had a significantly higher risk of IVR than group 1 (hazard ratio=1.949, 95% confidence interval=1.082-3.511, P=0.026), while groups 1 and 3 had similar risks. CONCLUSIONS For patients with UTUC, MIS RNU with open BCE is associated with a higher risk of IVR than open RNU with open BCE and MIS RNU with intracorporeal BCE.
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Affiliation(s)
- Eric Yi-Hsiu Huang
- Taipei Veterans General HospitalDepartment of UrologyTaipeiTaiwanDepartment of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung UniversityCollege of Medicine and Shu-Tien Urological Research CenterDepartment of UrologyTaipeiTaiwanDepartment of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Meng-Che Tai
- National Yang Ming Chiao Tung UniversityCollege of Medicine and Shu-Tien Urological Research CenterDepartment of UrologyTaipeiTaiwanDepartment of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Taipei Veterans General Hospital Taoyuan BranchDepartment of SurgeryDivision of UrologyTaoyuanTaiwanDivision of Urology, Department of Surgery, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Hsiao-Jen Chung
- Taipei Veterans General HospitalDepartment of UrologyTaipeiTaiwanDepartment of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung UniversityCollege of Medicine and Shu-Tien Urological Research CenterDepartment of UrologyTaipeiTaiwanDepartment of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Hwa Chang
- Taipei Veterans General HospitalDepartment of UrologyTaipeiTaiwanDepartment of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung UniversityCollege of Medicine and Shu-Tien Urological Research CenterDepartment of UrologyTaipeiTaiwanDepartment of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - William J. Huang
- Taipei Veterans General HospitalDepartment of UrologyTaipeiTaiwanDepartment of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung UniversityCollege of Medicine and Shu-Tien Urological Research CenterDepartment of UrologyTaipeiTaiwanDepartment of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Sparwasser P, Frey L, Fischer ND, Thomas A, Dotzauer R, Surcel C, Brandt MP, Mager R, Höfner T, Haferkamp A, Tsaur I. First Comparison of Retroperitoneal Versus Transperitoneal Robot-Assisted Nephroureterectomy with Bladder Cuff: A Single Center Study. Ann Surg Oncol 2023:10.1245/s10434-023-13363-0. [PMID: 37099087 DOI: 10.1245/s10434-023-13363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION After recent presentation of the first complete robot-assisted retroperitoneal nephroureterectomy with bladder cuff (RRNU) for patients with upper tract urothelial cancer (UTUC), we aimed to compare this new surgical technique with robot-assisted transperitoneal nephroureterectomy (TRNU) representing the current standard of care. METHODS Robot-assisted nephroureterectomies (NUs) were retrospectively analyzed and compared based on two groups: transperitoneal versus retroperitoneal approach. Baseline data were collected for patient demographics, tumor characteristics, intra- (EAUiaiC) and postoperative (Clavien-Dindo) complications, and perioperative variables. Tumor characteristics included grade of malignancy, clinical stage, and surgical margin status. Short-term follow-up data including 30-day readmission rates were collected. Statistical analyses were performed assuming a significant p-value of < 0.05. RESULTS The analysis includes perioperative patient data after proven UTUC of 24 TRNU versus 12 RRNU (mean age: 70 versus 71 years; BMI: 25.9 versus 26.1 kg/m2; CCI score ≥ 4: 83% versus 75%; ASA score ≥ 3: 37% vs 33%). Intraoperative (16.4% vs 0%, p = 0.35) and postoperative (25% vs 12.5%, p = 0.64) complications demonstrated no significant discrepancy. Notably, RRNU demonstrated significantly shorter surgery time (p < 0.05) and length of stay (p < 0.05). There was no significant difference in histopathological tumor characteristics, whereas significantly more lymph nodes were removed through RRNU (11.0±3.3 vs. 6.4±5.1, p < 0.05). Finally, no statistical difference was shown in short-term follow-up. CONCLUSION We report the first head-to-head comparison between RRNU and TRNU. RRNU proves to be a safe and feasible approach which appears to be non-inferior to TRNU. RRNU expands the spectrum of minimally invasive treatment options, particularly for patients with major previous abdominal surgery.
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Affiliation(s)
- P Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany.
| | - L Frey
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - N D Fischer
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A Thomas
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R Dotzauer
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - C Surcel
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - M P Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - T Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - I Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
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Lund L. A new important tool to report and analyse adverse incidents that all urologists should use Editorial comment to: Nisen H, Erkkilä K, Ettala O, Ronkainen H, et al. Intraoperative complications in kidney tumor surgery: critical grading for the European Association of Urology intraoperative adverse incident classification. Scand J Urol. 2022 Jun 22:1-8. Scand J Urol 2022; 56:423-424. [PMID: 36068967 DOI: 10.1080/21681805.2022.2119276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Lars Lund
- Professor, DMSci, Department of Urology, Odense University Hospital, Denmark
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Nisen H, Erkkilä K, Ettala O, Ronkainen H, Isotalo T, Nykopp T, Seikkula H, Seppänen M, Tramberg M, Palmberg C, Kilponen A, Pogodin-Hannolainen D, Mustonen S, Veitonmäki T. Intraoperative complications in kidney tumor surgery: critical grading for the European Association of Urology intraoperative adverse incident classification. Scand J Urol 2022; 56:293-300. [PMID: 35730592 DOI: 10.1080/21681805.2022.2089228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The European Association of Urology committee in 2020 suggested a new classification, intraoperative adverse incident classification (EAUiaiC), to grade intraoperative adverse events (IAE) in urology. AIMS We applied and validated EAUiaiC, for kidney tumor surgery. PATIENTS AND METHODS A retrospective multicenter study was conducted based on chart review. The study group comprised 749 radical nephrectomies (RN) and 531 partial nephrectomies (PN) performed in 12 hospitals in Finland during 2016-2017. All IAEs were centrally graded for EAUiaiC. The classification was adapted to kidney tumor surgery by the inclusion of global bleeding as a transfusion of ≥3 units of blood (Grade 2) or as ≥5 units (Grade 3), and also by the exclusion of preemptive conversions. RESULTS A total of 110 IAEs were recorded in 13.8% of patients undergoing RN, and 40 IAEs in 6.4% of patients with PN. Overall, bleeding injuries in major vessels, unspecified origin and parenchymal organs accounted for 29.3, 24.0, and 16.0% of all IEAs, respectively. Bowel (n = 10) and ureter (n = 3) injuries were rare. There was no intraoperative mortality. IAEs were associated with increased tumor size, tumor extent, age, comorbidity scores, surgical approach and indication, postoperative Clavien-Dindo (CD) complications and longer stay in hospital. 48% of conversions were reactive with more CD-complications after reactive than preemptive conversion (43 vs. 25%). CONCLUSIONS The associations between IAEs and preoperative variables and postoperative outcome indicate good construct validity for EAUiaiC. Bleeding is the most important IAE in kidney tumor surgery and the inclusion of transfusions could provide increased objectivity.
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Affiliation(s)
- Harry Nisen
- Department of Urology, Abdominal Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Kaisa Erkkilä
- Department of Surgery, Porvoo Hospital, Porvoo, Finland
| | - Otto Ettala
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Hanna Ronkainen
- Department of Urology, Oulu University Hospital, Oulu, Finland
| | - Taina Isotalo
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Timo Nykopp
- Department of Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Heikki Seikkula
- Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Marjo Seppänen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Margus Tramberg
- Department of Surgery, Kymenlaakso Central Hospital, Kotka, Finland
| | | | - Ansa Kilponen
- Department of Surgery, Kainuu Central Hospital, Kajaani, Finland
| | | | | | - Thea Veitonmäki
- Deparment of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland
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