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Billah M, Sheckley F, Nguyen J, Iarajuli T, Raver M, Rudnick B, Ahmed M. Single Port Modified Partial Nephrectomy: Novel Simultaneous Access to Peritoneal and Retroperitoneal Partial Nephrectomy, Initial Clinical Experience. J Endourol 2024; 38:444-449. [PMID: 38323547 DOI: 10.1089/end.2023.0502] [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: 02/08/2024] Open
Abstract
Introduction and Objective: Since its Food and Drug Administration (FDA) approval in 2018, Intuitive Surgical DaVinci single port (SP) robotic platform has been an effectively used technology for multiple urologic procedures. The purpose of this study is to share our early intraoperative and perioperative outcomes and potential benefits for performing a lower anterior access (LAA) incision for SP robot-assisted partial nephrectomy (SP-RAPN). The LAA incision enables performing a trans- or retroperitoneal (RP) approach through the same incision and eases the transition to a RP approach. Methods: This study is a prospective review of 78 SP-RAPN cases between March 2021 and January 2023 by an experienced robotic surgeon. A single 2-3 cm oblique incision parallel to the external oblique muscle, one-third of the distance between the iliac crest and umbilicus, was used to insert the multichannel port to perform the RAPN. We extracted intra- and perioperative data of these patients to share the outcomes of this approach. Results: SP-RAPN was effectively completed in 78 patients (38 females and 40 males) without conversion to open or laparoscopic techniques. The mean age was 61.2 ± 12.1 years. The mean tumor size was 3.0 ± 1.2 cm, 43 were right-sided masses, and 35 were left sided. The R.E.N.A.L Nephrometry score ranged from (4-11) with an average of 7.0 ± 1.9. Average operating room time was 90.5 ± 24.6 minutes, estimated blood loss was 88.3 ± 134 mL, and length of stay of 1.07 ± 0.7 days. Of the 78 cases, 40 required clamping of the renal artery with average warm ischemia time of 19.4 ± 6.7 minutes in patients who underwent clamping. No complications in all of 78 patients. Conclusions: This study demonstrates the feasibility and reproducibility of SP-RAPN using a LAA incision. This incision provides a standardized approach for surgeons to transition to the RP approach using the SP platform.
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Affiliation(s)
- Mubashir Billah
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Fahad Sheckley
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jennifer Nguyen
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Teona Iarajuli
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Michael Raver
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Benjamin Rudnick
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
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Berry JM, Hill H, Vetter JM, Bhayani SB, Henning GM, Pickersgill NA, Sivaraman A, Figenshau RS, Kim EH. Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses. J Robot Surg 2023; 17:2149-2155. [PMID: 37256454 PMCID: PMC10230457 DOI: 10.1007/s11701-023-01637-4] [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: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4-6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.
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Affiliation(s)
- James M Berry
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
| | - Hayden Hill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Joel M Vetter
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Grant M Henning
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Nicholas A Pickersgill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Arjun Sivaraman
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - R Sherburne Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
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3
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Harrison R, Ahmed M, Billah M, Sheckley F, Lulla T, Caviasco C, Sanders A, Lovallo G, Stifelman M. Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes. J Robot Surg 2023; 17:223-231. [PMID: 35648289 DOI: 10.1007/s11701-022-01415-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022]
Abstract
The objective of this study was to compare the perioperative and short-term functional and oncological outcomes of single-port and multiport robotic-assisted laparoscopic partial nephrectomy using propensity-score analysis. We evaluated all patients who underwent robotic partial nephrectomy at our institution between January 2019 and October 2020. Patient demographics, intraoperative data, and postoperative outcomes were collected and analyzed. Propensity-score matching was performed on age, sex, body mass index, prior abdominal surgery, and nephrometry score using the optimal matching method. A post hoc sensitivity analysis was performed to examine the robustness of the results. In total, 48 and 238 patients underwent single-port and multiport robotic partial nephrectomy, respectively. Following propensity-score matching, 48 multiport cases were matched 1:1 to single-port cases. The single-port cohort had lower median opioid use at postoperative day 1 (4.6 vs 9.8 MME, p = 0.0209) and cumulative hospital stay (5.1 vs 9.3 MME, p = 0.0357). Single port also had a shorter median length of stay (1.4 vs 1.6 days, p = 0.0045), although the post hoc sensitivity analysis showed no difference between the groups [- 0.13 (95% CI; - 0.580, 0.315, p = 0.5607). There were no significant differences in operative time, estimated blood loss, ischemia time, transfusions received, or positive margin rates. In conclusion, based on our early experience, single-port robotic partial nephrectomy is a safe and acceptable alternative to multiport robotic partial nephrectomy, providing comparable perioperative and postoperative outcomes while reducing inpatient opioid use.
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Affiliation(s)
- Robert Harrison
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.,Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Mubashir Billah
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA
| | - Fahad Sheckley
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA
| | - Tina Lulla
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Christina Caviasco
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA
| | - Angeline Sanders
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA
| | - Gregory Lovallo
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.,Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Michael Stifelman
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.,Hackensack Meridian School of Medicine, Hackensack, NJ, USA
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Carbonara U, Amparore D, Borregales LD, Caliò A, Ciccarese C, Diana P, Erdem S, Marandino L, Marchioni M, Muselaers CH, Palumbo C, Pavan N, Pecoraro A, Roussel E, Warren H, Wu ZJ, Campi R, Bertolo R. Single-port robotic partial nephrectomy: impact on perioperative outcomes and hospital stay. Ther Adv Urol 2023; 15:17562872231172834. [PMID: 37325290 PMCID: PMC10265377 DOI: 10.1177/17562872231172834] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/13/2023] [Indexed: 06/17/2023] Open
Abstract
Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SP-robotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both via a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multi-arms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional 'multi-arms' robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic versus multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN.
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Affiliation(s)
| | - Daniele Amparore
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Turin, Italy
| | - Leonardo D. Borregales
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | - Anna Caliò
- Department of Pathology and Diagnostic, University of Verona, Verona, Italy
| | - Chiara Ciccarese
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pietro Diana
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Selcuk Erdem
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Division of Urologic Oncology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Laura Marandino
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Marchioni
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, SS Annunziata Hospital, ‘G. D’Annunzio’ University of Chieti, Chieti, Italy
| | - Constantijn H.J. Muselaers
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlotta Palumbo
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands; Urology Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Nicola Pavan
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Urology Clinic, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Angela Pecoraro
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Eduard Roussel
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Hannah Warren
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Zhen-Jie Wu
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Riccardo Campi
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Bertolo
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
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5
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Li KP, Chen SY, Wang CY, Yang L. Perioperative and oncologic outcomes of single-port versus conventional robotic-assisted partial nephrectomy: an evidence-based analysis of comparative outcomes. J Robot Surg 2022; 17:765-777. [DOI: 10.1007/s11701-022-01491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
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6
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Okhawere KE, Beksac AT, Wilson MP, Korn TG, Meilika KN, Harrison R, Morgantini L, Ahmed M, Mehrazin R, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Stifelman MD, Kaouk J, Crivellaro S, Badani KK. A Propensity-Matched Comparison of the Perioperative Outcomes Between Single-Port and Multi-Port Robotic Assisted Partial Nephrectomy: A Report from the Single Port Advanced Research Consortium (SPARC). J Endourol 2022; 36:1526-1531. [PMID: 36053713 DOI: 10.1089/end.2022.0115] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: Single-port (SP) robotic surgery is a new technology and early in its adoption curve. The goal of this study is to compare the perioperative outcomes of SP to multi-port (MP) robotic technology for partial nephrectomy. Materials and Methods: This is a prospective cohort study of patients who have undergone robot-assisted partial nephrectomy using SP and MP technology. Baseline demographic, clinical, and tumor-specific characteristics and perioperative outcomes were compared using χ2, t-test, and Mann-Whitney U test in the overall cohort and in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. Results: After propensity matching, 146 SP patients were matched with 146 MP patients. SP and MP groups had similar mean age (58 ± 12 years vs 59 ± 12 years; p = 0.606) and proportion of men (54.11% vs 52.05%; p = 0.725). The SP had a longer mean ischemia (18.29 ± 10.49 minutes vs 13.79 ± 6.29 minutes; p < 0.001). Estimated blood loss (EBL) and length of hospital stay (LOS), operative time, positive margin rate, and any complication rate were similar between the two groups. Conclusions: SP partial nephrectomy had a longer ischemia time, and a comparable LOS, EBL, operative time, positive margin rates, and complication rates to MP. These early data are encouraging. However, the role of SP requires further study and should evaluate safety and long-term data when compared with the standard MP technique.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alp Tuna Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael P Wilson
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Talia G Korn
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Harrison
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Luca Morgantini
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, Pennsylvania, USA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami, Florida, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, Washington, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Palacios AR, Morgantini L, Trippel R, Crivellaro S, Abern MR. Comparison of Perioperative Outcomes Between Retroperitoneal Single-Port and Multiport Robot-Assisted Partial Nephrectomies. J Endourol 2022; 36:1545-1550. [PMID: 35856826 DOI: 10.1089/end.2022.0346] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: To report early institutional experience with the single-port robotic platform and compare perioperative outcomes between single-port robot-assisted partial nephrectomies (SP-RAPN) and multiport robot-assisted partial nephrectomies (MP-RAPN) when utilizing a retroperitoneal approach. Methods: A retrospective chart review of patients who underwent SP-RAPN or MP-RAPN at our institution between November 1, 2013 and May 30, 2021 was performed. Surgical platforms were compared through univariate analysis using the Kruskal-Wallis test for continuous variables and χ2 test for categorical variables. Results: A total of 20 SP-RAPN and 42 MP-RAPN were performed utilizing a retroperitoneal approach. Patients who underwent SP-RAPN were more likely to have a lower radius, endophytic/exophytic, nearness, anterior/posterior, location score (4 vs 6; p = 0.0084) and their masses tended to be more exophytic, although this was not statistically significant (p = 0.0535). Patients undergoing SP-RAPN had a shorter postoperative length of hospital stay (1 vs 2 days; p < 0.0001). There were no significant differences in operative time, estimated blood loss, ischemia time, positive margin rate, malignant histology, postoperative complication rate, or Clavien-Dindo complication grade. Conclusion: Retroperitoneal SP-RAPN appear to be safe without compromising perioperative outcomes when compared with MP-RAPN for low-complexity renal masses. Further studies are recommended to assess the role of the SP for higher-complexity renal masses and to characterize variables that influence the observed difference in length of hospital stay.
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Affiliation(s)
- Arnold R Palacios
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Luca Morgantini
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ryan Trippel
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael R Abern
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
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8
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Kim J, Na J, Lee J, Jang WS, Han WK. Clinical implications for da Vinci SP partial nephrectomy in high complexity tumors; Propensity score matching analysis. J Endourol 2022; 36:1290-1295. [PMID: 35699058 DOI: 10.1089/end.2022.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare surgical outcomes between robot-assisted laparoendoscopic single-site surgery using the da Vinci Si or Xi system and the da Vinci SP system for partial nephrectomy. MATERIAL AND METHODS From 2008 to 2020, 66 partial nephrectomies were performed using a single-site robotic approach: 44 used the da Vinci Xi or Si system (R-LESS group) and 22 used the da Vinci SP system (SP group). After 1:1 propensity score-matching, surgical outcomes were compared between groups Results: Median patient age was 51.5 years. Median tumor size was 2.1 cm and was not significantly different between groups. Median operation time was longer in the R-LESS group (R-LESS vs SP: 180 min vs 155 min, p=0.034), but median warm ischemic time was comparable between groups. Estimated blood loss was higher in the R-LESS group (R-LESS vs SP: 215 mL vs 20 mL, p<0.001). Median operation time was significantly shorter in the SP group in patients with moderate to high complexity tumors (R-LESS vs SP: 200 min vs 172 min, p=0.035). Rates of trifecta achievement were similar between groups (63.6% in both groups, p=1.00). CONCLUSIONS R-LESS and da Vinci SP methods are both feasible approaches for single-site incision robotic partial nephrectomy. The da Vinci SP platform allows "true" single-site surgery without additional ports and provides a wider working space. It was associated with better performance than R-LESS partial nephrectomy. In moderate to high complex tumors, operation time was shorter with SP partial nephrectomy than with R-LESS partial nephrectomy, suggesting that the SP method is especially advantageous for managing complex renal tumors.
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Affiliation(s)
- Jinu Kim
- Yonsei University College of Medicine, 37991, Department of Urology, Urological Science Institute, Seoul, Seodaemun-gu, KR, Korea (the Republic of);
| | - Joonchae Na
- Yonsei University College of Medicine, 37991, Department of Urology, Yonsei-ro, 50-1, Seodaemun-gu, Seoul, Korea (the Republic of), 03722.,Yonging Severance Hospital, Department of Urology, Dongbaekjukjeon-daero, 363, Giheung-gu, Yongin-si, Gyeonggi-do, Korea (the Republic of), 16995;
| | - Jongsoo Lee
- Yonsei University College of Medicine, 37991, Department of Urology, Urological Science Institute, Seoul, Seodaemun-gu, Korea (the Republic of);
| | - Won Sik Jang
- Yonsei University College of Medicine, Department of Urology and Urological Science Institute, Seoul, Korea (the Republic of);
| | - Woong Kyu Han
- Yonsei University Health System, Urology, Urological Science Institute, 134 Shinchon-dong Seodaemun-gu, Seoul, Korea (the Republic of), 120-752;
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9
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Glaser ZA, Burns ZR, Fang AM, Saidian A, Magi-Galluzzi C, Nix JW, Rais-Bahrami S. Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements. J Robot Surg 2022; 16:695-703. [PMID: 34406630 DOI: 10.1007/s11701-021-01271-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/26/2021] [Indexed: 11/26/2022]
Abstract
Evidence supporting the safe use of the single-port (SP) robot for partial nephrectomy is scarce. The purpose of this study was to compare perioperative outcomes for patients undergoing robotic assisted SP vs multi-port (MP) partial nephrectomy (PN) in a time-matched cohort. All patients with clinically localized renal masses who underwent robotic PN from January 2019 to March 2020 were evaluated. Patients were stratified according to SP vs MP approach. Postoperative analgesia was administered in accordance with department-wide opioid stewardship protocol and outpatient opioid use was tracked. Total of 78 patients underwent robotic PN with 26 patients in the SP cohort. The majority of renal masses had low-complexity (53, 67.9%) R.E.N.A.L. nephrometry scores, without a significant difference between the two cohorts (p = 0.19). A retroperitoneal approach was performed in 16 (20.5%) patients overall, though more commonly via the SP robotic approach (13 vs 3, p < 0.001). Mean operative time for SP cases was 183.9 ± 63.5 min vs 208.6 ± 65.0 min in the MP cohort (p = 0.12). Rate of conversion to radical nephrectomy was 3.8% vs 9.6% for SP vs MP cases, respectively, (p = 0.37). The majority of patients were discharged on postoperative day one (67.9%) irrespective of operative approach (p = 0.60). There were no differences in inpatient milligram morphine equivalents administered (MME, p = 0.08) or outpatient postoperative MME prescribed (p = 0.21) between the two cohorts. In this retrospective single-institution study, SP robotic approach offers similar short-term perioperative outcomes to MP platforms for minimally invasive, nephron-sparing surgery. Using the SP system was not associated with a reduction in postoperative opioid analgesic requirements.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35294, USA.
| | - Zachary R Burns
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35294, USA
| | - Andrew M Fang
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35294, USA
| | - Ava Saidian
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35294, USA
| | | | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35294, USA
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35294, USA
- O'Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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10
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Fang AM, Fazendin JM, Rais-Bahrami S, Porterfield JR. Comparison of Perioperative Outcomes Between Single-Port and Multi-Port Robotic Adrenalectomy. Am Surg 2022:31348221075777. [DOI: 10.1177/00031348221075777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Single-port (SP) robotic surgery has been utilized in several surgical procedures. We aim to describe our institution’s approach and perioperative experience with SP robotic adrenalectomy and compare it to the traditional multi-port (MP) approach. Methods We retrospectively reviewed all patients who underwent robotic adrenalectomy by a single surgeon between March 2019 and March 2020. Patient demographic, perioperative factors, and pathologic outcomes were recorded and analyzed using t-tests, chi-square, or Fisher’s exact tests. Results Thirty-six patients underwent SP (n = 11) and MP (n = 25) robotic adrenalectomy. Age, body mass index, gender, operative time, major Clavien-Dindo complications, and margin status showed no differences. Patients undergoing SP adrenalectomy had a lower estimated blood loss (18.1 ± 13.0 vs 65.6 ± 95.0 cc, P = .02) and smaller lesion size (2.8 ± 1.3 vs 4.1 ± 1.8 cm, P = .04) compared to those undergoing MP. Conclusions SP adrenalectomy appears to be a feasible approach in select adrenal masses. Further studies are needed to establish its safety and cost effectiveness.
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Affiliation(s)
- Andrew M. Fang
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica M. Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John R. Porterfield
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Garden EB, Al-Alao O, Razdan S, Mullen GR, Florman S, Palese MA. Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System. JSLS 2021; 25:e2021.00062. [PMID: 34949909 PMCID: PMC8692076 DOI: 10.4293/jsls.2021.00062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The da Vinci SP® Surgical System received U.S. Food and Drug Administration approval for urological procedures in 2018. Here, we describe the first experience performing single-port robot-assisted donor nephrectomy (RADN) using the da Vinci SP® surgical system, present 90-day clinical outcomes, and discuss tips for operative success. METHODS Seven consecutive patients underwent single-port RADN at a single institution between September 1, 2020 and March 31, 2021. Surgery was performed through a single, 60 mm Pfannenstiel incision with a 12 mm periumbilical assistant port for suction and vascular stapling. Donor characteristics, operative details, 90-day donor clinical outcomes, and recipient renal function were retrospectively evaluated. RESULTS Four female and three male patients successfully underwent single-port RADN without conversion to standard multiport or open approach. Six cases were left-sided. Estimated blood loss for each procedure was ≤ 50 mL. Mean operative time, warm ischemia time, and extraction time were 218.3 minutes (standard deviation [SD]: 16.3 minutes), 5 minutes 4 seconds (SD: 56 seconds), and 3 minutes 37 seconds (SD: 38 seconds). Mean pre-operative creatinine and estimated glomerular filtration rate were 0.79 mg/dL and 107.3 mL/min/1.73m2, respectively. At six week's follow up, they were 1.22 mg/dL and 66.1 mL/min/1.73m2. Average pain score at 48 hours postoperatively was 1.7/10. There were no Clavien-Dindo grade ≥ III complications within 90 days. All recipients experienced immediate and sustained return of renal function post-transplant. CONCLUSION Single-port RADN is a technically feasible and safe procedure with the da Vinci SP® system and can confer acceptable functional and cosmetic outcomes. Future studies are needed to define long-term outcomes and compare with previously established techniques for donor nephrectomy.
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Affiliation(s)
- Evan B Garden
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Osama Al-Alao
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Gregory R Mullen
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Sander Florman
- The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
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12
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Tyson M, Andrews P, Cheney S, Humphreys M. Single Incision Robotic Cystectomy and Hybrid Orthotopic Neobladder Reconstruction: A Step by Step Description. Urology 2021; 156:285-288. [PMID: 34274390 DOI: 10.1016/j.urology.2021.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/17/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a new technique for single incision robotic cystectomy and Studer-type ileal neobladder using the single-port (SP) da Vinci SP robotic platform. METHODS In April 2021, a 71 year-old patient underwent a single incision robotic cystectomy and orthotopic Studer-type ileal neobladder using the single-port da Vinci SP robotic platform for cT2, cN0 urothelial carcinoma of the bladder. He was not a candidate for neoadjuvant cisplatin-based combination chemotherapy and declined participation in a clinical trial. RESULTS Total operative time was 554 minutes and estimated blood loss was 250 cc. He was discharged on postoperative day six without developing any Clavien complications. He underwent adjuvant chemotherapy for node-positive disease and follow-up through June 2021 was notable for the absence of any significant complications or readmissions. We provide a comprehensive discussion of the required instrumentation, a description of the technique with illustrations, and discuss the advantages and disadvantages of this technology as it pertains to cystectomy and urinary diversion. CONCLUSION We make no claim regarding the superiority of this technique over others, only that it is technically feasible and that the approach holds promise.
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Affiliation(s)
- Mark Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ.
| | - Paul Andrews
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
| | - Scott Cheney
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
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13
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Abstract
PURPOSE OF REVIEW Nephron-sparing partial nephrectomy is the state of the art for localized small renal mass and it is gaining attention also for more advanced cases. In the present narrative review, we discuss the new developments that have occurred in the advancement of this approach over the past few years. RECENT FINDINGS Off-clamp, selective/superselective clamp and early-unclamping techniques are safe and feasible approaches, with potentially superior functional outcomes, and noninferior complications rate and oncological outcomes, when compared with main artery clamping. Renorrhaphy must preserve the physiological vascularization of residual parenchyma. Running sutures, particularly using barbed wires, shorten the operating and ischemia times. A further advantage could derive from avoiding a double-layer suture. Transperitoneal robot-assisted partial nephrectomy (RAPN) and retroperitoneal RAPN can be considered equivalent in terms of perioperative morbidity, functional and oncologic outcomes, regardless of tumor's location, thus the choice of the approach should be driven by the surgeon's expertise. Future improvements should be introduced by the single-port robotic surgery, which seems to be safe and feasibly also in an off-clamp manner. SUMMARY Significant advances have recently been achieved in nephron-sparing surgery technique. However, future studies with standardized reporting of these new techniques are needed to assess the real impact of them on early and long-term functional outcomes.
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14
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Minimizing minimally invasive surgery: Current status of the single-port robotic surgery in Urology. Actas Urol Esp 2021; 45:345-352. [PMID: 34088433 DOI: 10.1016/j.acuroe.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The novel da Vinci Single-Port (SP) robotic platform received the US FDA approval in 2018. The device, specifically conceived for single-site approach, is pushing through the limits of minimally invasive surgery. We sought to provide a comprehensive overview of the current status of the clinical experiences accomplished by the da Vinci SP in urology, and to discuss future perspectives. METHODS A non-systematic literature review was performed focusing on single port articles in urological surgery using Medline/PubMed and Embase search electronic engines. The authors analyzed findings and a brief report of the clinical experience for surgical procedures completed by the SP platform was described. RESULTS The current data available from single-port robotic established the safety and feasibility of urologic procedures using this novel platform. However, the results come from single-center case series, small cohorts and retrospective studies that need to be cautiously interpreted. Additional evidence is required to determine the asset of the SP platform in the urological community. CONCLUSIONS The SP robotic system opens new frontiers on the surgical scenery facilitating the completion of urological surgeries through a single incision. Further comparative studies will be required to assess perioperative and long-term oncological and functional outcomes among SP, multi-arm robotic and open approaches.
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15
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Francavilla S, Abern MR, Dobbs RW, Vigneswaran HT, Talamini S, Antonelli A, Simeone C, Crivellaro S. Single-Port robot assisted partial nephrectomy: initial experience and technique with the da Vinci Single-Port platform (IDEAL Phase 1). Minerva Urol Nephrol 2021; 74:216-224. [PMID: 33769009 DOI: 10.23736/s2724-6051.21.03919-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To evaluate the safety and feasibility of robotic-assisted laparoscopic partial nephrectomy (RAPN) performed using the da Vinci Single-Port (SP) platform. METHODS A retrospective review was conducted from December 2018 to December 2019 of 14 consecutive patients with localized renal cancer who underwent SP robot-assisted partial nephrectomy at a single institution. The procedures were performed by 2 experienced robotic surgeons, reproducing the steps of the standard multiport robotic approach to partial nephrectomy. A transperitoneal approach was utilized with a 2.5 cm para-rectus incision with one assistant 12 mm laparoscopic port. RESULTS No conversions to open or laparoscopic surgery occurred and no additional laparoscopic assistant ports were required. The median total operative time was 202 (162-231) minutes and the median total room time was 258 (215-295) minutes. The warm ischemia time averaged 20 minutes ± 8 minutes. 2 patients required angioembolization due to postoperative acute bleeding (Clavien-Dindo Grade 3a complication). Trifecta outcome (<25 min warm ischemia, no perioperative complications and negative margins) was achieved in 79% of patients. In one case, a positive margin was present. The median length of stay was of 1 day (Interquartile Range 1-2) with a median pain score on postoperative day 1 of 3.5 (Interquartile Range 2.4-5). 1/14 (7%) patient needed narcotic use at one week from discharge. At a median follow up of 5.0 (4.0-8.0) months, no patients have had evidence of disease recurrence. CONCLUSIONS In this initial cohort, considering the introduction of a new technology, we observed satisfactory outcomes for several key perioperative variables including operative time, warm ischemia time, surgical margins, hospital stay, pain requirements in patients undergoing RAPN with the SP platform. For experienced robotic surgeons, RAPN with the SP platform is a safe and feasible approach for single site partial nephrectomy.
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Affiliation(s)
- Simone Francavilla
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA - .,Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy - .,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy -
| | - Michael R Abern
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan W Dobbs
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Hari T Vigneswaran
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan Talamini
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Alessandro Antonelli
- Urology Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, Azienda Ospedaliero Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | | | - Simone Crivellaro
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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16
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Garisto J, Bertolo R, Reese S, Bove P, Kaouk J. Minimizing minimally invasive surgery: Current status of the single-port robotic surgery in Urology. Actas Urol Esp 2021. [PMID: 33612358 DOI: 10.1016/j.acuro.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The novel da Vinci Single-Port (SP) robotic platform received the US FDA approval in 2018. The device, specifically conceived for single-site approach, is pushing through the limits of minimally invasive surgery. We sought to provide a comprehensive overview of the current status of the clinical experiences accomplished by the da Vinci SP in urology, and to discuss future perspectives. METHODS A non-systematic literature review was performed focusing on single port articles in urological surgery using Medline/PubMed and Embase search electronic engines. The authors analyzed findings and a brief report of the clinical experience for surgical procedures completed by the SP platform was described. RESULTS The current data available from single-port robotic established the safety and feasibility of urologic procedures using this novel platform. However, the results come from single-center case series, small cohorts and retrospective studies that need to be cautiously interpreted. Additional evidence is required to determine the asset of the SP platform in the urological community. CONCLUSIONS The SP robotic system opens new frontiers on the surgical scenery facilitating the completion of urological surgeries through a single incision. Further comparative studies will be required to assess perioperative and long-term oncological and functional outcomes among SP, multi-arm robotic and open approaches.
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17
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Lenfant L, Aminsharifi A, Kim S, Kaouk J. Predictive factors of postoperative complications and hospital readmission after implementation of the single-port robotic platform: A single-center and single-surgeon experience. Int J Urol 2021; 28:530-537. [PMID: 33527543 DOI: 10.1111/iju.14503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/20/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To measure the incidence, and identify potential risk factors of conversion, postoperative complication and readmission for patients treated with urological robotic single-port surgery. METHODS All consecutive urological surgery procedures carried out with the single-port robotic platform by the same surgeon in a single institution between September 2018 and March 2020 were included in this retrospective analysis. Demographic data, main perioperative outcomes and information related to the surgical technique were gathered and analyzed. A logistic regression model was used to assess predictive factors for any grade and high-grade (e.g. Clavien grade ≥3) postoperative complications, as well as predictive factors for readmission. RESULTS Analysis included 221 patients, of whom 194 (88%) underwent pelvic surgery and 27 (12.2%) underwent upper urinary tract surgery. Only one patient was converted to open surgery in the entire cohort. A total of 40 patients (18.1%) experienced postoperative complications, with grade ≥3 postoperative complications in 7.6% of the entire cohort. On multivariable analysis, the factors significantly associated with the risk of postoperative complication of any grade were diabetes (P < 0.001), perineal approach (P < 0.01) and postoperative pain management with opioids (P = 0.01). Only diabetes (P = 0.03) predicted a grade ≥3 complication. Overall, 17 patients (7.7%) were readmitted during the 3 months after surgery. A body mass index >30 kg/m2 was the only identified predictor of readmission (P = 0.01). CONCLUSION A wide range of pelvic, extraperitoneal and upper-tract urological procedures can be carried out using the robotic single-port platform with a minimal conversion rate and low complication or readmission rate.
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Affiliation(s)
- Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,CRG 5, Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière University Hospital, Urology, Sorbonne University, Paris, France
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Covas Moschovas M, Bhat S, Rogers T, Thiel D, Onol F, Roof S, Sighinolfi MC, Rocco B, Patel V. Applications of the da Vinci single port (SP) robotic platform in urology: a systematic literature review. Minerva Urol Nephrol 2020; 73:6-16. [PMID: 32993277 DOI: 10.23736/s2724-6051.20.03899-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Robotic surgical technology has evolved to include a new platform specifically designed for the single-port (SP) approach. Benefits of the da Vinci SP are still under investigation. This study aimed to review the urological literature since the first report of the use of the platform. EVIDENCE ACQUISITION We performed a systematic literature review of PubMed, Medline, and Web of Science databases on June 15, 2020 searching for all available articles of da Vinci SP use from December 2014 (date of the first clinical report of da Vinci SP in the urology) until June 1, 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. EVIDENCE SYNTHESIS A total of 43 articles were eligible for inclusion. Ten studies reported different surgeries and techniques on cadavers while the rest described the clinical experience of different groups. We divided our article and tables into preclinical experience with surgery on cadavers, radical prostatectomy (RP) approach, and multiple types of procedures described in the same study. CONCLUSIONS The application of da Vinci SP in urologic procedures after five years of the first clinical investigation is feasible and safe. Radical prostatectomy is the most common intervention performed with this robot. Some groups described benefits in terms of less postoperative pain and early discharge, especially with the extraperitoneal approach. However, further studies with larger sample sizes and longer follow-up are awaited.
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Affiliation(s)
| | - Seetharam Bhat
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Travis Rogers
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | - Fikret Onol
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Shannon Roof
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
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19
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Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes. J Robot Surg 2020; 15:293-298. [PMID: 32564222 DOI: 10.1007/s11701-020-01106-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022]
Abstract
The Intuitive Surgical DaVinci SP ("Single Port") robotic platform was approved in 2014, but, recently, there has been a dissemination of the technology with multiple urological procedures successfully adapted to this robot. There are some important differences from prior models. We aimed to share our early outcomes and lessons learned for performing successful single-port robotic-assisted partial nephrectomy (SP-RAPN). This study is a retrospective review of sequential SP-RAPN cases between 7/2019 and 3/2020. We extracted patient characteristics and early surgical outcomes. Surgical tips and tricks were recorded during these cases and compiled. SP-RAPN was successfully completed in 12 patients. Patients mean age was 57.8 ± 11.0 years and median ASA score was 2. Mean tumor size was 3.1 ± 2.2 cm. The average OR Time was 172 ± 41 min and EBL was 68 ± 75 mL. All cases had warm ischemia time < 25 min. Tumor pathology included 8 RCC (6 pT1a, 1 pT1b, 1 pT2a), 2 AML, and 2 oncocytoma. There were no complications. Our top surgical tips involved: (1) patient positioning, (2) port placement, (3) insufflation, (4) air docking, (5) assistant port placement, (6) dynamic arm control, (7) hilar clamping, (8) camera relocation, (9) tumor excision, and (10) extraction and port closure. SP-RAPN is safe and feasible in this series. There are advantages and disadvantages to this platform. As the technology matures and techniques evolve, SP-RAPN may become more appealing. Future studies should focus on long-term outcomes and cost-effectiveness of the SP system.
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