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Yamada Y, Ikeda M, Hirayama T, Murakami Y, Koguchi D, Matsuda D, Okuno N, Taoka Y, Utsunomiya T, Irie A, Matsumoto K, Iwamura M. Noninferior oncological outcomes in adults aged 80 years or older compared with younger patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma. Asia Pac J Clin Oncol 2022; 19:305-311. [DOI: 10.1111/ajco.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Yasufumi Yamada
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
- Department of Urology Sagamihara Kyodo Hospital Sagamihara Japan
| | - Masaomi Ikeda
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| | - Takahiro Hirayama
- Department of Urology Kitasato University Kitasato Institute Hospital Tokyo Japan
| | - Yasukiyo Murakami
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| | - Dai Koguchi
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| | | | - Norihiko Okuno
- Department of Urology Sagamihara Hospital Sagamihara Japan
| | - Yoshinori Taoka
- Department of Urology Kitasato University Medical Center Kitamoto Japan
| | | | - Akira Irie
- Department of Urology Kitasato University Kitasato Institute Hospital Tokyo Japan
| | - Kazumasa Matsumoto
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
| | - Masatsugu Iwamura
- Department of Urology Kitasato University School of Medicine Sagamihara Japan
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Renders T, Gijsbrechts S, Bijleveld K, van Loon F. Establishing changes in endotracheal cuff pressure with continuous monitoring in patients undergoing laparoscopic surgery in Trende- lenburg position. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background : After endotracheal intubation, the endotracheal cuff gets inflated to a sufficiently high pressure to prevent air leaking. Placing a patient in Trendelenburg position and establishing a pneumoperitoneum affects the endotracheal cuff pressure.
Objectives : Determine the impact of these factors on the endotracheal cuff pressure.
Design and setting : This prospective, observational study was conducted in the Catharina Hospital (Eindhoven, the Netherlands).
Methods : This study included adult patients undergoing laparoscopic surgery. A routine endotracheal tube was inserted, in which the cuff pressure was continuously monitored.
Main outcome measures : The outcome of interest was a change in endotracheal cuff pressure after establishment of a pneumoperitoneum and/ or placing a patient in a Trendelenburg position.
Results : 39 patients were included. Cuff pressures in- creased significantly from the moment of pneumo-peritoneum, placing a patient into a Trendelenburg position increased endotracheal cuff pressure and peak pressures even more. The highest endotracheal cuff pressure was 67 cm H2O, the highest registered peak pressure was 35 cm H2O.
Conclusion : Both endotracheal cuff pressure and peak pressure increased during laparoscopic surgical procedures with a pneumoperitoneum and the patient placed in Trendelenburg position. Measuring the endo-tracheal cuff pressure only after endotracheal intubation is insufficient and should be repeated during surgery on fixed moments.
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Zhu W, Xiong S, Fang D, Hao H, Zhang L, Xiong G, Yang K, Zhang P, Zhu H, Cai L, Li X, Zhou L. Minimally invasive ileal ureter replacement: Comparative analysis of robot-assisted laparoscopic versus conventional laparoscopic surgery. Int J Med Robot 2021; 17:e2230. [PMID: 33533169 DOI: 10.1002/rcs.2230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/22/2020] [Accepted: 01/15/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study is an initial comparative analysis of perioperative and intermediate-term functional outcomes between patients who underwent robot-assisted laparoscopic (RALS) or conventional laparoscopic surgery (LS). MATERIALS AND METHODS A total of 25 patients who underwent ileal ureter replacement (10 RALS and 15 LS) were followed by functional cine magnetic resonance urography (MRU) combined with a modified Whitaker test. Also, the characteristics, perioperative data and functional outcomes of the patients were compared. RESULTS The estimated blood loss, postoperative hospital stay and time to oral intake were significantly lower in the RALS group. At the median 14-month follow-up, all the patients showed improved renal function and were symptom-free, with no signs of leakage or stenosis observed by cine MRU combined with a modified Whitaker test. CONCLUSIONS RALS with an extracorporeal bowel resection is feasible and appears to be safe, with quick postoperative recovery and encouraging outcomes.
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Affiliation(s)
- Weijie Zhu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Dong Fang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Peng Zhang
- Department of Urology, Emergency General Hospital, Beijing, China
| | - Hongjian Zhu
- Department of Urology, Beijing Jiangong Hospital, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China
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Bansal D, Chaturvedi S, Maheshwari R, Kumar A. Role of laparoscopy in the era of robotic surgery in urology in developing countries. Indian J Urol 2021; 37:32-41. [PMID: 33850353 PMCID: PMC8033240 DOI: 10.4103/iju.iju_252_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/04/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023] Open
Abstract
With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.
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Affiliation(s)
- Devanshu Bansal
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Samit Chaturvedi
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Ruchir Maheshwari
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Anant Kumar
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
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Semaan A, El Helou E, Abi Tayeh G, Mjaess G, Abi Chebel J, Sarkis J. Pelvic lymph node dissection in prostate cancer: Laparoscopy is not dead. Actas Urol Esp 2020; 44:682-691. [PMID: 33069487 DOI: 10.1016/j.acuro.2020.06.013] [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: 04/03/2020] [Revised: 05/31/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Abstract
CONTEXT Pelvic lymph node dissection (PLND) in localized prostate cancer is feasible through an open, laparoscopic or robot-assisted approach. Data comparing the three approaches is sparse. OBJECTIVE To perform a review in order to compare the effectiveness of the different PLND approaches. ACQUISITION OF EVIDENCE A search was performed including the following words: ("pelvic lymph node dissection") OR ("pelvic lymphadenectomy") AND ("French"[Language] OR "English"[Language]) AND ("1990"[Date-Publication]: "3000"[Date-Publication]) AND prostatectomy[Title]). Twenty-nine articles were finally included in the qualitative synthesis. EVIDENCE SYNTHESIS Laparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with a relatively short operative time, minimal blood loss, lower level of pain, shorter hospital stay, and fewer perioperative complications when compared to an open approach. This technique is more cost-effective than a robot-assisted approach. CONCLUSION Concerning the treatment of localized prostate cancer, laparoscopic pelvic lymph node dissection should be learned and applied by urologists.
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Affiliation(s)
- A Semaan
- Departamento de Urología, Hotel-Dieu de France, Beirut, Líbano; Facultad de Medicina, Universidad de Saint Joseph, Beirut, Líbano.
| | - E El Helou
- Departamento de Urología, Hotel-Dieu de France, Beirut, Líbano; Facultad de Medicina, Universidad de Saint Joseph, Beirut, Líbano
| | - G Abi Tayeh
- Departamento de Urología, Hotel-Dieu de France, Beirut, Líbano; Facultad de Medicina, Universidad de Saint Joseph, Beirut, Líbano
| | - G Mjaess
- Facultad de Medicina, Universidad de Saint Joseph, Beirut, Líbano
| | - J Abi Chebel
- Departamento de Urología, Hotel-Dieu de France, Beirut, Líbano; Facultad de Medicina, Universidad de Saint Joseph, Beirut, Líbano
| | - J Sarkis
- Departamento de Urología, Hotel-Dieu de France, Beirut, Líbano; Facultad de Medicina, Universidad de Saint Joseph, Beirut, Líbano
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Abstract
Just as laparoscopic surgery provided a giant leap in safety and recovery for patients over open surgery methods, robotic-assisted surgery (RAS) is doing the same to laparoscopic surgery. The first laparoscopic-RAS systems to be commercialized were the Intuitive Surgical, Inc. (Sunnyvale, CA, USA) da Vinci and the Computer Motion Zeus. These systems were similar in many aspects, which led to a patent dispute between the two companies. Before the dispute was settled in court, Intuitive Surgical bought Computer Motion, and thus owned critical patents for laparoscopic-RAS. Recently, the patents held by Intuitive Surgical have begun to expire, leading to many new laparoscopic-RAS systems being developed and entering the market. In this study, we review the newly commercialized and prototype laparoscopic-RAS systems. We compare the features of the imaging and display technology, surgeons console and patient cart of the reviewed RAS systems. We also briefly discuss the future directions of laparoscopic-RAS surgery. With new laparoscopic-RAS systems now commercially available we should see RAS being adopted more widely in surgical interventions and costs of procedures using RAS to decrease in the near future.
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Sforza S, Minervini A, Tellini R, Ji C, Bergamini C, Giordano A, Lu Q, Chen W, Zhang F, Ji H, Di Maida F, Prosperi P, Masieri L, Carini M, Valeri A, Guo H. Perioperative outcomes of robotic and laparoscopic adrenalectomy: a large international multicenter experience. Surg Endosc 2020; 35:1801-1807. [PMID: 32328826 DOI: 10.1007/s00464-020-07578-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of the study was to describe the surgical outcomes of a retrospective series of consecutive patients treated with laparoscopic and robotic approach for adrenal masses in two tertiary referral centers. METHODS We retrospectively gathered data of 477 patients submitted to adrenalectomy performed at two Institutions from March 2008 to February 2018 by six highly experienced surgeons. We excluded from the analysis 43 patients that had an open approach for tumors or for anesthetic contraindications to minimally invasive surgery (MIS). Patients were selected for surgery after a radiologic and an endocrinology work up. Preoperative, perioperative and postoperative data were recorded. RESULTS Overall, 477 patients were included in the study. The robotic and the laparoscopic group included 110 and 367 patients, respectively. The preoperative characteristics were similar in both groups except for ASA score with a median (IQR) of 3 and 2 in the robotic and in the laparoscopic group, respectively (p = 0.03). Tumor size of adrenal tumors treated robotically (4, IQR 2.6-6 cm) was significantly larger than those treated laparoscopically (3, IQR 2.3-4.1 cm) (p = 0.01). The intraoperative complication rates were similar between robotic and laparoscopic groups (6.3% and 6%, respectively). The postoperative complication rate was 5.4% for robotic group and similarly 3.5% for laparoscopic adrenalectomy strategy. We analyzed the tumor ≥ 6 cm, with 29 patients in the robotic group and 43 in the laparoscopic one, with an overall complication rate of 19.5%. At multivariable analyses tumor size (OR 1.287; CI 1.128-1.468; p < 0.001) was the only independent predictor of overall complication. CONCLUSION Adrenal tumors can be safely treated either by robotic or laparoscopic strategy. MIS seems to be feasible also in larger adrenal masses (≥ 6 cm). Tumor size represents the only predictive factors for overall complication.
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Affiliation(s)
- Simone Sforza
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy.
| | - Andrea Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Riccardo Tellini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Changwei Ji
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | | | | | - Qun Lu
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Wei Chen
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Feifei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Hao Ji
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Fabrizio Di Maida
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Paolo Prosperi
- Emergency Surgery Unit, Careggi Hospital, Florence, Italy
| | - Lorenzo Masieri
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Marco Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Valeri
- Emergency Surgery Unit, Careggi Hospital, Florence, Italy
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
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Abstract
Initially, robot-assisted surgery (RAS) was developed by the USA forces as a tele-surgery tool in order to perform procedures in war zones without endangering the surgeon [...]
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