1
|
Gkeka K, Kallidonis P, Peteinaris A, Katsakiori P, Tatanis V, Faitatziadis S, Spinos T, Vagionis A, Vrettos T, Stolzenburg JU, Liatsikos E. Robot-assisted radical prostatectomy using the avatera system™: a prospective pilot study. Minerva Urol Nephrol 2024; 76:52-59. [PMID: 38015550 DOI: 10.23736/s2724-6051.23.05545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Robot-assisted radical prostatectomy is a minimally invasive, safe procedure preferred in the management of localized prostate cancer. In this study, we present our initial experience with the avatera™ system (avateramedical GmbH, Jena, Germany) in robot-assisted radical prostatectomy. METHODS A total of fourteen patients underwent robot-assisted radical prostatectomy using this newly introduced system in our department from June 2022 to October 2022. The primary endpoints of the study were the time and the successful completion of the operation, the hemoglobin drop and the presence of complications. The pathologic tumor stage and the presence of positive surgical margins were also recorded. Follow-up of the patients for the functional outcomes over a period of 3 months took place. RESULTS The completion of all the surgeries was successful. The median draping and docking times were 9.5 minutes (7-13) and 10 minutes (5-40), respectively. The median console time was 103.5 minutes (90-121). No conversion to laparoscopic or open prostatectomy was necessary. The median hemoglobin drop was 1.95 g/dL (0.3-2.7), while positive surgical margins were present in two patients postoperatively. No major complications or need for transfusion were noticed. Six months after the procedure, 78.6% of the participants were continent while 77.7% of the nerve-sparing patients reported erections adequate for intercourse. CONCLUSIONS All the operations were completed successfully without major complications or significant blood loss. The functional outcomes were acceptable according to the literature. Based on the early outcomes, robot-assisted radical prostatectomy with the avatera™ system (avateramedical GmbH) could be considered feasible, safe, and efficient.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Theofanis Vrettos
- Intensive Care Unit, Department of Anesthesiology, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece -
- Department of Urology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
2
|
Elliott N, Pahouja G, Felice M, Capoccia E, Patel PM, Blanco Martinez E, Aiwerioghene E, Gorbonos A. Transition from standard robotic prostatectomy to Retzius-sparing prostatectomy: feasibility and early outcomes. J Robot Surg 2023; 17:2035-2040. [PMID: 37142888 DOI: 10.1007/s11701-023-01596-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Retzius-sparing robotic-assisted radical prostatectomy (rsRARP) has gained popularity due to superior early continence outcomes compared to standard robotic prostatectomy (sRARP). We evaluate the results of a single surgeon who transitioned from sRARP to rsRARP and compare oncologic and functional outcomes. METHODS We retrospectively reviewed all prostatectomies performed by a single surgeon between June 2018 and October 2020. Perioperative, oncologic, and functional data were collected and analyzed. Patients who underwent sRARP were compared with those who underwent rsRARP. RESULTS Both groups contained 37 consecutive patients each. Preoperative patient characteristics and biopsy results were similar between the two groups. Perioperative outcomes were significant for longer operative room time and higher proportion of T3 tumors in the rsRARP group. Thirty-day complication and readmission rates were similar between groups. There was no difference in early oncologic outcomes, including positive surgical margin rate, biochemical recurrence, and need for adjuvant or salvage treatments. The time to urinary continence and immediate continence rate was superior in the rsRARP group. CONCLUSIONS The Retzius-sparing approach can be safely adopted by surgeons experienced in sRARP without compromising early oncologic outcomes and with the benefit of improved early continence recovery.
Collapse
|
3
|
Tappero S, Vecchio E, Palagonia E, Longoni M, Martiriggiano M, Granelli G, Olivero A, Secco S, Bocciardi AM, Galfano A, Dell'Oglio P. Retzius-sparing robot-assisted radical prostatectomy after previous trans-urethral resection of the prostate: Assessment of functional and oncological outcomes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1524-1535. [PMID: 37012110 DOI: 10.1016/j.ejso.2023.03.218] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND no data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP), in patients previously treated with trans-urethral resection of the prostate (p-TURP), for benign prostate obstruction. Our study addressed the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR), as well as peri-operative outcomes and surgical margins, after RS-RARP. METHODS all patients treated with RS-RARP for prostate cancer at a single high-volume European institution, between 2010 and 2021, were identified and stratified according to p-TURP status. Logistic, Poisson and Cox regression models were performed. RESULTS Of 1386 RS-RARP patients, 99 (7%) had history of p-TURP. Between p-TURP and no-TURP patients no differences were detected regarding both intra- and post-operative complications (p values = 0.9). The rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients (p < 0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP vs no-TURP patients (p < 0.001). At multivariable logistic and Cox regression models, p-TURP was independently associated, respectively, with lower immediate (odds ratio [OR]: 0.32, p < 0.001) and 12-months UCR (hazard ratio: 0.54, p < 0.001). At multivariable Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p < 0.001) but not longer length of stay or time to catheter removal (p values > 0.05). Positive surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p = 0.1), which translated in a non-statistically significant multivariable OR of 1.14 (p = 0.6). CONCLUSIONS p-TURP does not increase surgical morbidity but portends longer operative time and worse urinary continence after RS-RARP.
Collapse
Affiliation(s)
- Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Enrico Vecchio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Erika Palagonia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Ospedale San Donato, Arezzo, Italy
| | - Mattia Longoni
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Martiriggiano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Giorgia Granelli
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
4
|
GALFANO A, TAPPERO S, EDEN C, DELL’OGLIO P, FRANSIS K, GUO H, KOWALCZYK K, LONGONI M, MADI R, RHA KH, SECCO S, QIU X, SAYYID R, BOCCIARDI AM. Multicentric experience in Retzius-sparing robot-assisted radical prostatectomy performed by expert surgeons for high-risk prostate cancer. Minerva Urol Nephrol 2022; 74:607-614. [DOI: 10.23736/s2724-6051.22.04857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
5
|
Koukourikis P, Alqahtani AA, Han WK, Rha KH. Pure single‐port retzius‐sparing robot‐assisted radical prostatectomy with the da Vinci SP: Initial experience and technique description. BJUI COMPASS 2022; 3:251-256. [PMID: 35492224 PMCID: PMC9045582 DOI: 10.1002/bco2.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/28/2021] [Indexed: 01/30/2023] Open
Affiliation(s)
- Periklis Koukourikis
- Department of Urology, Urological Science Institute Yonsei University College of Medicine Seoul South Korea
- Second Department of Urology, School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece
| | - Ali Abdullah Alqahtani
- Department of Urology, Urological Science Institute Yonsei University College of Medicine Seoul South Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute Yonsei University College of Medicine Seoul South Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute Yonsei University College of Medicine Seoul South Korea
| |
Collapse
|
6
|
Albisinni S, Dasnoy C, Diamand R, Mjaess G, Aoun F, Esperto F, Porpiglia F, Fiori C, Roumeguère T, DE Nunzio C. Systematic review comparing Anterior vs Retzius-sparing robotic assisted radical prostatectomy: can the approach really make a difference? Minerva Urol Nephrol 2021; 74:137-145. [PMID: 34714037 DOI: 10.23736/s2724-6051.21.04623-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Retzius-Sparing Robotic Assisted Radical Prostatectomy (RS-RARP) is a novel surgical approach to radical prostatectomy. Its pioneers have suggested an improved recovery of urinary continence, while maintaining adequate cancer control. Aim of this systematic review is to explore available data on RS-RALP and compare functional, oncologic and perioperative results of RS-RARP compared to anterior RARP. EVIDENCE ACQUISITION A search following PRISMA guidelines was performed including the combination of the following words: retzius AND sparing AND radical AND prostatectomy. 93 articles were identified and 13 were included in the systematic review, including 3 randomized controlled trials (RCT), 4 prospective studies and 6 retrospective studies. EVIDENCE SYNTHESIS All available randomized trials confirmed an improved immediate continence for RS-RARP, with rates ranging 51-71%, compared to 21-48% for anterior RARP. However, this advantage was progressively lost with no significant difference found after 6 months. Moreover, a prospective study found no discrepancy in terms of quality of life across the two techniques. Erectile function was difficult to compare, as patients had different baseline erectile function across studies and rate of neurovascular preservation was not comparable. Surgical approach remains controversial regarding positive margin rate, although related to the surgeon's experience and clinical stage. Biochemical recurrence-free survival appears similar between the two approaches. CONCLUSIONS RS-RARP improves early urinary continence recovery compared to anterior RARP, with this advantage being lost after 3 to 6 months. Erectile function and quality of life were however comparable between the two techniques. The results concerning the rate of positive margins remained controversial. Future studies with longer follow-up are needed to better assess oncologic outcomes.
Collapse
Affiliation(s)
- Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium -
| | - Cyrielle Dasnoy
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Urology Department, Hôtel Dieu de France - Université Saint Joseph, Beyrouth, Lebanon
| | - Fouad Aoun
- Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium.,Urology Department, Hôtel Dieu de France - Université Saint Joseph, Beyrouth, Lebanon
| | | | - Francesco Porpiglia
- Division of Urology- San Luigi Hospital (Orbassano), Turin.,Department of Oncology, University of Turin, Turin, Italy
| | - Cristian Fiori
- Division of Urology- San Luigi Hospital (Orbassano), Turin.,Department of Oncology, University of Turin, Turin, Italy
| | - Thierry Roumeguère
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium.,Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Cosimo DE Nunzio
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
| |
Collapse
|
7
|
Yee CH, Liu AQ, Chiu PKF, Teoh JYC, Hou SSM, Ng CF. A propensity score-matching study on retzius-sparing robotic-assisted radical prostatectomy: Evidence of continence advantage in the early learning curve. Asian J Surg 2021; 45:1403-1407. [PMID: 34690053 DOI: 10.1016/j.asjsur.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/07/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the outcome of retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) compared with conventional RARP in the early learning curve. METHODS Consecutive patients with prostate cancer who underwent RS-RARP were included to compare against conventional RARP of the same period. Propensity-score matching was performed based on age, prostate size, nerve-sparing approach, and final pathological risk categories. All patients were re-admitted to undergo trial without Foley catheter from post-operative day 7-10. Clinical follow-up was performed with monitoring of continence (day 0, 3 months, and the latest continence during the study period) and surveillance of PSA level. RESULTS Between July 2017 and August 2019, 24 consecutive patients received RS-RARP in our centre. Propensity score matching was performed with the best matched 24 controls receiving conventional RARP. Overall median follow-up duration was 15.5 months. A majority of the patients belonged to the intermediate-risk group, with most of them harbouring pT2 disease (RS-RARP: 87.5%; conventional RARP: 79.2%). More patients in RS-RARP group achieved day-0 continence (33.3% vs 0%, p = 0.002) and 3-month continence (66.7% vs 12.5%, p = 0.001). During the whole study period, more RS-RARP achieved continence with 0 pad (91.7% vs 66.7%, p = 0.033). The mean months to continence is shorter in RS-RARP group (4.0 months vs 13.6 months, p = 0.002). No statistically significant differences between the two groups with respect to surgical margins, post-operative PSA detection, and the use of adjuvant radiotherapy. CONCLUSIONS RS-RARP showed better continence rates when compared to conventional RARP even during the learning curve phase.
Collapse
Affiliation(s)
- Chi Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Alex Q Liu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Peter K F Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Simon S M Hou
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chi Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
8
|
Galfano A, Secco S, Dell'Oglio P, Rha K, Eden C, Fransis K, Sooriakumaran P, De La Muela PS, Kowalczyk K, Miyagawa T, Assenmacher C, Matsubara A, Chiu KY, Boylu U, Lee H, Bocciardi AM. Retzius-sparing robot-assisted radical prostatectomy: early learning curve experience in three continents. BJU Int 2020; 127:412-417. [PMID: 32745367 DOI: 10.1111/bju.15196] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the effect of surgical experience on peri-operative, functional and oncological outcomes during the first 50 Retzius-sparing robot-assisted radical prostatectomy (RsRARP) cases performed by surgeons naïve to this novel approach. MATERIALS AND METHODS We retrospectively evaluated the initial cases operated by 14 surgeons in 12 different international centres. Pre-, peri- and postoperative features of the first 50 patients operated by each surgeon in all the participating centres were collected. The effect of surgical experience on peri-operative, functional and oncological outcomes was firstly evaluated after stratification by level of surgical experience (initial [≤25 cases] and expert [>25 cases]) and after using locally weighted scatterplot smoothing to graphically explore the relationship between surgical experience and the outcomes of interest. RESULTS We evaluated 626 patients. The median follow-up was 13 months in the initial group and 9 months in the expert group (P = 0.002). Preoperative features overlapped between the two groups. Shorter console time (140 vs 120 min; P = 0.001) and a trend towards lower complications rates (13 vs 5.5%; P = 0.038) were observed in the expert group. The relationship between surgical experience and console time, immediate urinary continence recovery and Clavien-Dindo grade ≥2 complications was linear, without reaching a plateau, after 50 cases. Conversely, a non-linear relationship was observed between surgical experience and positive surgical margins (PSMs). CONCLUSIONS In this first report of a multicentre experience of RsRARP during the learning curve, we found that console time, immediate urinary continence recovery and postoperative complications are optimal from the beginning and further quickly improve during the learning process, while PSM rates did not clearly improve over the first 50 cases.
Collapse
Affiliation(s)
| | | | | | - Koon Rha
- Urology, Yonsei University, Seoul, Korea
| | | | - Karen Fransis
- Urology, UZA - University Hospital, Antwerp, Belgium
| | | | | | - Keith Kowalczyk
- Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Tomoaki Miyagawa
- Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | | | | | - Kun-Yuan Chiu
- Urology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ugur Boylu
- Urology, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Harry Lee
- Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | | |
Collapse
|