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Tatenuma T, Ebara S, Kawase M, Sasaki T, Ikehata Y, Nakayama A, Toide M, Yoneda T, Sakaguchi K, Teishima J, Inoue T, Kitamura H, Saito K, Koga F, Urakami S, Koie T, Makiyama K. Association of hospital volume with perioperative and oncological outcomes of robot-assisted laparoscopic radical prostatectomy: a retrospective multicenter cohort study. BMC Urol 2023; 23:14. [PMID: 36721169 PMCID: PMC9887802 DOI: 10.1186/s12894-023-01178-w] [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: 07/06/2022] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This retrospective multicenter cohort study investigated the association of hospital volume with perioperative and oncological outcomes in patients treated with robot-assisted radical prostatectomy (RARP). METHODS We collected the clinical data of patients who underwent RARP at eight institutions in Japan between September 2012 and August 2021. The patients were divided into two groups based on the treatment site-high- and non-high-volume hospitals. We defined a high-volume hospital as one where RARP was performed for more than 100 cases per year. RESULTS After excluding patients who received neoadjuvant therapy, a total of 2753 patients were included in this study. In the high-volume hospital group, console time and estimated blood loss were significantly (p < 0.001) lower than that of the non-high-volume hospital group. However, the continence rate at 3 months after RARP, positive surgical margins, and prostate-specific antigen (PSA)-relapse-free survival showed no significant differences between the two groups. Furthermore, the console time was significantly shorter after 100 cases in the non-high-volume hospital group but not in the high-volume hospital group. CONCLUSIONS A higher hospital volume was significantly associated with shorter console time and less estimated blood loss. However, oncological outcomes and early continence recovery appear to be comparable regardless of the hospital volume in Japan.
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Affiliation(s)
- Tomoyuki Tatenuma
- grid.470126.60000 0004 1767 0473Department of Urology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawaku, Yokohama, Kanagawa 2360004 Japan
| | - Shin Ebara
- Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Makoto Kawase
- grid.256342.40000 0004 0370 4927Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takeshi Sasaki
- grid.260026.00000 0004 0372 555XDepartment of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshinori Ikehata
- grid.267346.20000 0001 2171 836XDepartment of Urology, University of Toyama, Toyama, Japan
| | - Akinori Nakayama
- grid.416093.9Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Masahiro Toide
- grid.415479.aDepartment of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tatsuaki Yoneda
- grid.415466.40000 0004 0377 8408Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Kazushige Sakaguchi
- grid.410813.f0000 0004 1764 6940Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Jun Teishima
- grid.257022.00000 0000 8711 3200Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Takahiro Inoue
- grid.260026.00000 0004 0372 555XDepartment of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroshi Kitamura
- grid.267346.20000 0001 2171 836XDepartment of Urology, University of Toyama, Toyama, Japan
| | - Kazutaka Saito
- grid.416093.9Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Fumitaka Koga
- grid.415479.aDepartment of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Shinji Urakami
- grid.410813.f0000 0004 1764 6940Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Takuya Koie
- grid.256342.40000 0004 0370 4927Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhide Makiyama
- grid.470126.60000 0004 1767 0473Department of Urology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawaku, Yokohama, Kanagawa 2360004 Japan
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Kato D, Namiki S, Ueda S, Takeuchi Y, Takeuchi S, Kawase M, Kawase K, Nakai C, Takai M, Iinuma K, Nakane K, Koie T. Validation of standardized training system for robot-assisted radical prostatectomy: comparison of perioperative and surgical outcomes between experienced surgeons and novice surgeons at a low-volume institute in Japan. MINIM INVASIV THER 2022; 31:1103-1111. [PMID: 35352619 DOI: 10.1080/13645706.2022.2056707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Although robot-assisted radical prostatectomy (RARP) has become a standard treatment modality in patients with prostate cancer (PCa), RARP is a complicated and difficult surgical procedure due to the risk of serious surgery-related complications. This study aimed to evaluate the validation of a standardized training system for RARP in patients with PCa at a single institute. MATERIAL AND METHODS We retrospectively reviewed the clinical and pathological records of 155 patients with PCa who underwent RARP at Gifu University between August 2018 and April 2021. We developed an institutional program for new surgeons based on the separation of the RARP procedure into six checkpoints. The primary endpoints were surgical outcomes and perioperative complications among three groups (expert, trainer, and novice surgeon groups). RESULTS The console time was significantly longer in the novice surgeon group than in the other groups. Regarding bladder neck dissection, ligation of lateral pedicles, and vesicourethral anastomosis, the operative time was significantly shorter in the expert group than in the other groups. Surgery-related complications occurred in 15 patients (9.7%). CONCLUSIONS Our training system for RARP might help reduce the influence of the learning curve on surgical outcomes and ensure that the surgeries performed at low-volume institutions are safe and effective.
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Affiliation(s)
- Daiki Kato
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Sanae Namiki
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Shota Ueda
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | | | - Shinichi Takeuchi
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Makoto Kawase
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Kota Kawase
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Chie Nakai
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
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Ryan JPC, Lynch O, Broe MP, Swan N, Moran D, McGuire B, Mulvin D. Robotic-assisted radical prostatectomy-impact of a mentorship program on oncological outcomes during the learning curve. Ir J Med Sci 2021; 191:479-484. [PMID: 33638797 DOI: 10.1007/s11845-021-02556-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The learning curve for robotic-assisted radical prostatectomy (RARP) is estimated to be about 50-200 cases. This study will evaluate the benefit of a mentorship programme after completing a mini-fellowship in RARP by an experienced surgeon who previously trained in open and laparoscopic surgery. METHODS Our study was a retrospective comparative analysis of RARP performed by a single consultant urologist. A retrospective chart review of the first 120 cases was performed. The 120 patients were divided into three groups of 40 cases. For the first 40 cases, an appropriately qualified mentor was present. The peri-operative and oncological outcomes were compared between the three groups. RESULTS Operative times significantly decreased with experience (250 min vs 234 min vs 225 min, p < 0.05). Complication rates, estimated blood loss, and length of stay were similar between all groups. There was a higher rate of positive margins in the final group (20% vs 17.5% vs 32.5%, p < 0.5). There was a greater number of pT3 tumours in group 3 (42%, n = 17) compared to groups 1 and 2 (20%, n = 8, and 22.5%, n = 9) which may account for the higher rate of positive margins in this group. CONCLUSION In the transition of an experienced laparoscopic surgeon to robotic surgery, we showed that there is a benefit of a mentorship programme after a mini-fellowship in reducing the impact of the learning curve on patient outcomes. Ongoing mentorship may be of benefit in cases where a high volume of tumour is suspected and should be avoided in the early part of the learning curve to maximise oncological outcomes.
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Affiliation(s)
- James P C Ryan
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland.
| | - Olwyn Lynch
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Mark P Broe
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Niall Swan
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Diarmaid Moran
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Barry McGuire
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - David Mulvin
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
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Effective intracorporeal space in robot-assisted multiquadrant surgery in a pediatric inanimate model. J Robot Surg 2020; 15:25-30. [PMID: 32266666 DOI: 10.1007/s11701-020-01065-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
Pediatric robot-assisted surgery is technically challenging, but it is becoming the most desirable approach for most of the pediatric urological abdominal surgical procedures. Distance between ports has been adopted based on adult surgery experience. Currently, there is scarce information and literature about effective trocar position and distance between ports for highly complex pediatric multiquadrant surgery. The aim of this study is to evaluate the most effective way of port placement for pediatric multiquadrant robot-assisted surgery using an inanimate model. Two inanimate models simulating the abdominal area of an older infant were created: model (1) 33.3 × 29.6 × 11.5 cm and model (2) 15 × 13 × 8 cm. A simulation of a robot-assisted laparoscopic Mitrofanoff procedure was performed in both models simulating appendix procurement and subsequent anastomosis to the bladder dome. In the first model, the simulation was performed in two ways: (a) adult trocars were placed with a distance of 4 cm between them and placed longitudinally and (b) ports were placed by triangulating the camera 2 cm in a cephalic fashion. In the second model, (a) scenario was used as described above (c) single port crossing the arms. Volume of the first model was 11,335.32 cm3. Simulation (b) reached higher percentage of volumes without arm clash (30.19 vs. 41.92%, p = 0.021). In the second model with a volume of 1560 cm3, simulation (a) reached a volume percentage of 65.15% without arm clash and allowing the multiquadrant advance, while simulation (c) could not be performed due to arm collision and the inability to advance and see the four quadrants. Triangulation and increasing the distance away from the point of interest improve intracorporeal EWS for multiquadrant complex pediatric surgery.
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Cost, training and simulation models for robotic-assisted surgery in pediatric urology. World J Urol 2019; 38:1875-1882. [PMID: 31209563 DOI: 10.1007/s00345-019-02822-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/21/2019] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Laparoscopic procedures in pediatric urology have been shown to be safe and effective over the last number of years. Coupled with this is the technological trend to provide minimally invasive options for even the most complex pediatric patients. Whilst robotic platforms continue to try to demonstrate superior patient outcomes in adults with mixed results, the utilization of robotic platforms for pediatric urology is increasing. METHODS A review of the current literature was undertaken to assess the evidence for training models and cost-effectiveness of robotic-assisted pediatric urology. CONCLUSIONS A growing body of evidence in this field has demonstrated that robotic platforms are safe and effective in children and can provide additional reconstructive benefits due to motion scaling, magnification, stereoscopic views, instrument dexterity and tremor reduction. The main drawbacks remain the financial implications associated with this platform through purchase, maintenance, and disposable costs. This review addresses some of the addresses issues pertaining to cost, training and simulation for robotic-assisted surgery in pediatric urology.
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Fernandez N, Farhat WA. A Comprehensive Analysis of Robot-Assisted Surgery Uptake in the Pediatric Surgical Discipline. Front Surg 2019; 6:9. [PMID: 30915338 PMCID: PMC6422870 DOI: 10.3389/fsurg.2019.00009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/15/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: Robotic assisted surgery (RAS) is one of the most recent surgical approaches that has quickly been adopted by the pediatric urology community. Over the last decade, a vast amount of manuscripts has been published, supporting the safety and applicability of RAS in the pediatric population. The quality of published literature about this innovative technology remains supported by case-reports and retrospective case-series. Historical behavior of literature productivity and implementation of laparoscopy followed a similar trend. We present the historical publication uptake of RAS in pediatric urology and other surgical disciplines using a bibliometric comparison of the most cited manuscripts. Materials and Methods: A systematic search and review of the literature was undertaken by the authors. Literature search was performed in OVID, PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. The search period included all publications between 1985 and June 2018. All languages were included. Data analysis for graphical representation was performed using VOSviewer® version 1.6.8 and Impact Index Analysis was used to adjust the citations by the time since publication. Results: A total of 1,014 titles were identified. After applying exclusion criteria, 200 papers were included for the RAS arm and 402 for the laparoscopic one. Case-series was the most common type of publication. Average citations for laparoscopic manuscripts was 23 (SD ± 31) and for RAS was 20 (SD ± 31.5). The impact index analysis showed an average of 95 (SD ± 167) for laparoscopic manuscripts vs. 66 (SD ± 101) for RAS. The laparoscopic manuscript with the highest citation count had 199 citations with an impact index of 12.1. And the RAS manuscript with the highest citation count had 280 citations and an impact index of 4.3. Conclusion: Literature productivity in pediatric laparoscopic and RAS has quickly grown. Pediatric Urologists play a key role in the introduction of this innovative tool. Literature supporting its implementation and future consolidation requires to focus on increasing the level of evidence.
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Affiliation(s)
- Nicolas Fernandez
- Division of Urology, Hospital for SickKids, University of Toronto, Toronto, ON, Canada.,Department of Urology, Fundación Santa Fe de Bogota, Bogota, Colombia.,Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Walid A Farhat
- Division of Urology, Hospital for SickKids, University of Toronto, Toronto, ON, Canada
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