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Benn M, Hii W. Robotic-assisted laparoscopic resection of a pelvic solitary fibrous tumour causing distal ureteric compression. BMJ Case Rep 2024; 17:e260603. [PMID: 38964876 DOI: 10.1136/bcr-2024-260603] [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: 07/06/2024] Open
Abstract
This case report describes a male in his late 40s with a 4 cm pelvic mass compressing the left distal ureter, resulting in left hydroureteronephrosis. Biopsy of the mass was suggestive of a solitary fibrous tumour. The patient underwent a robotic-assisted laparoscopic excision of the left pelvic mass. Intraoperatively, the mass was found to be densely adhered to the ureter, necessitating a left distal ureterectomy and ureteric reimplantation. Subsequent histopathological analysis revealed the mass was a solitary fibrous tumour with no evidence of malignancy.
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Affiliation(s)
- Matthew Benn
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
- School of Medicine and Dentistry, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Wesley Hii
- Department of Urology, Ipswich Hospital, Ipswich, Queensland, Australia
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Gonzales A, Barbieri DF, Carbonell AM, Joseph A, Srinivasan D, Cha J. The compatibility of exoskeletons in perioperative environments and workflows: an analysis of surgical team members' perspectives and workflow simulation. ERGONOMICS 2024; 67:674-694. [PMID: 37478005 DOI: 10.1080/00140139.2023.2240045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/15/2023] [Indexed: 07/23/2023]
Abstract
Surgical team members in perioperative environments experience high physical demands. Interventions such as exoskeletons, external wearable devices that support users, have the potential to reduce these work-related physical demands. However, barriers such as workplace environment and task compatibility may limit exoskeleton implementation. This study gathered the perspectives of 33 surgical team members: 12 surgeons, four surgical residents, seven operating room (OR) nurses, seven surgical technicians (STs), two central processing technicians (CPTs), and one infection control nurse to understand their workplace compatibility. Team members were introduced to passive exoskeletons via demonstrations, after which surgical staff (OR nurses, STs, and CPTs) were led through a simulated workflow walkthrough where they completed tasks representative of their workday. Five themes emerged from the interviews (workflow, user needs, hindrances, motivation for intervention, and acceptance) with unique subthemes for each population. Overall, exoskeletons were largely compatible with the duties and workflow of surgical team members.
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Affiliation(s)
- Alec Gonzales
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | | | - Alfredo M Carbonell
- Department of Surgery, Prisma Health - Upstate, Greenville, South Carolina, USA
- University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, USA
| | - Anjali Joseph
- School of Architecture, Clemson University, Clemson, South Carolina, USA
| | - Divya Srinivasan
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Jackie Cha
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
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Chatterjee S, Das S, Ganguly K, Mandal D. Advancements in robotic surgery: innovations, challenges and future prospects. J Robot Surg 2024; 18:28. [PMID: 38231455 DOI: 10.1007/s11701-023-01801-w] [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: 10/17/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024]
Abstract
The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.
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Affiliation(s)
- Swastika Chatterjee
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | | | - Karabi Ganguly
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | - Dibyendu Mandal
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India.
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Bourgi A, Ayoub E, Merhej S, Souky J, Roupret M, Bruyère F. A comparison of perioperative outcomes of transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review. J Robot Surg 2023; 17:2563-2574. [PMID: 37596485 DOI: 10.1007/s11701-023-01685-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: 03/04/2022] [Accepted: 07/16/2023] [Indexed: 08/20/2023]
Abstract
RAPN can be carried out via a transperitoneal or retroperitoneal approach. The choice between the two approaches is open to debate and usually based on surgeon preference. The perioperative outcomes of transperitoneal robot-assisted partial nephrectomy versus retroperitoneal robot-assisted partial nephrectomy were compared. A systematic review of the literature was performed up to May 2020, using PubMed, Cochrane, Scopus and Ovid databases. Articles were selected according to a search strategy based on PRISMA criteria. Only studies comparing TRAPN with RRAPN were eligible for inclusion. Eleven studies were included in the quantitative synthesis. Baseline demographics (age, BMI, ASA, tumour size, and RENAL nephrometry score), intraoperative data (operative time, estimated blood loss, and warm ischaemia time) and postoperative outcomes (major complications according to Clavien-Dindo, length of hospital stay (LOS) and positive surgical margin rate) were recorded. A total of 3139 patients were included (2052 TRAPN vs. 1087 RRAPN). There was no significant difference in demographic variables (age, BMI), tumour size (p = 0.06) nor the nephrometry score (p = 0.20) between the two groups. Operative time (p = 0.02), estimated blood loss (p < 0.00001) and LOS (p < 0.00001) were significantly lower in the RRAPN group. No differences were found in major postoperative complications (Clavien-Dindo > 3; p = 0.37), warm ischaemia time (p = 0.37) or positive surgical margins (p = 0.13). Future researchers must attempt to achieve adequately powered, expertise based, multi-surgeon and multi-centric studies comparing TRAPN and RRAPN. RRAPN gives similar outcomes to TRAPN. RRAPN is associated with reduced operative time and LOS. Ideally, surgeons should be familiar and competent in both RAPN approaches and adopt a risk-stratified and patient-centred individualised approach, dependent on the tumour and patient characteristics. RAPN is feasible via two approaches. The retroperitoneal approach seems to be associated with a shorter operation time and hospital stay.
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Affiliation(s)
- Ali Bourgi
- Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France.
| | - Elias Ayoub
- Department of Urology, chu Poitiers, Poitiers, France
| | - Sleiman Merhej
- Department of Urology, Saint Joseph University, Damascus Road, PO-BOX: 17-5208, Beirut, Lebanon
| | - Josee Souky
- Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France
- Department of Urology, chu Poitiers, Poitiers, France
- Department of Urology, Saint Joseph University, Damascus Road, PO-BOX: 17-5208, Beirut, Lebanon
- Department of Urology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Morgan Roupret
- Department of Urology, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Franck Bruyère
- Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France
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Kallidonis P, Tatanis V, Peteinaris A, Katsakiori P, Gkeka K, Faitatziadis S, Vagionis A, Vrettos T, Stolzenburg JU, Liatsikos E. Robot-assisted pyeloplasty for ureteropelvic junction obstruction: initial experience with the novel avatera system. World J Urol 2023; 41:3155-3160. [PMID: 37668715 DOI: 10.1007/s00345-023-04586-7] [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: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE This pilot study was designed to interpret the technically specific features of the avatera robotic system and present our initial experience with this novel platform in robot-assisted pyeloplasty (RAP). METHODS A single-center prospective study was conducted including all patients who underwent RAP with the avatera robotic system from June 2022 to October 2022 in our Department. Transperitoneal robot-assisted dismembered pyeloplasty was performed in all cases. The trocar placement and the surgical technique were similar in all patients. The successful completion of the procedures, operation time (including draping, docking and console time), decrease in hemoglobin postoperatively, and presence of any complications were the study's primary endpoints. RESULTS In total, nine patients underwent RAP using the avatera system. All procedures were successfully completed. The draping of the robotic unit was completed in a median time of 10 min (range 7-15), while the median docking time was 17 min (range 10-24). The median console time was 88 min (range 78-116) and no complications were noticed. The median hemoglobin drop was calculated to 0.7 g/dL (range 0.4-1). During the mean follow-up of 9.33 ± 2.78 months, no late postoperative complications were noticed. CONCLUSION The early outcomes of the use of the novel avatera system in RAP are presented. All operations were successfully completed with safety and efficacy, without complications or significant blood loss.
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Affiliation(s)
| | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.
- Department of Urology, Medical University of Vienna, Vienna, Austria.
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
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Okhawere KE, Milky G, Razdan S, Shih IF, Li Y, Zuluaga L, Badani KK. One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study. BMC Health Serv Res 2023; 23:1099. [PMID: 37838666 PMCID: PMC10576279 DOI: 10.1186/s12913-023-10111-8] [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: 03/30/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVE Despite the wide-spread adoption of robotic-assisted surgery (RAS), the cost-benefit implications for partial (PN) and radical nephrectomy (RN) versus laparoscopic surgery (Lap) is not well established. We sought to examine the trend of adoption and 1-year healthcare expenditure of PN and RN, and compare 1-year expenditures of RAS versus Lap for PN and RN. PATIENTS AND METHODS This cohort study used the MerativeTM MarketScan® Databases between 2013 and 2020. A total of 5,353 patients with kidney cancer undergoing PN (2,980, 55.7%) or RN (2,373, 44.3%). We compared open-conversion, length of stay (LOS), index expenditure, 1-year healthcare expenditure and utilization, and missed work-days between RAS and Lap for PN and RN. RESULTS Adoption of PN increased overtime (47.0% to 55.8%), mainly driven by robotic PN increase. Among PN, RAS had lower open-conversion, shorter LOS and lower index expenditure than Lap. Among RN, RAS had shorter LOS, and similar open-conversion and index expenditures. During 1-year post-discharge, RAS had lower hospital outpatient visits (IRR = 0.92, 95% CI = 0.85, 0.99, p = 0.029) and office-based visits (IRR = 0.91, 95% CI = 0.86, 0.96, p = 0.002) for PN, translating to a 1-day less (95% CI = 0.25, 1.75, p = 0.008) missed from work for RAS. Following RN, RAS had lower 1-year readmission than Lap (O.R = 0.72, 95% CI = 0.55, 0.94, p = 0.018). RAS and Lap had comparable 1-year post-discharge expenditures for both PN (mean difference, MD = -$475, 95% CI = -$4362, $3412, p = 0.810) and RN (MD = -$4,204, 95% CI = -$13,837, $5430, p = 0.404). CONCLUSION At index surgery, RAS was associated with shorter LOS for both PN and RN, and lower open-conversion and expenditures for PN. RAS and Lap had comparable 1-year total expenditures, despite lower healthcare visits for RAS.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6Th Floor, New York City, NY, 10029, USA.
| | | | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6Th Floor, New York City, NY, 10029, USA
| | - I-Fan Shih
- Intuitive Surgical, Inc, Sunnyvale, CA, USA
| | - Yanli Li
- Intuitive Surgical, Inc, Sunnyvale, CA, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6Th Floor, New York City, NY, 10029, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6Th Floor, New York City, NY, 10029, USA
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Shuai H, Duan X, Wu T. Comparison of perioperative, oncologic, and functional outcomes between 3D and 2D laparoscopic radical prostatectomy: a systemic review and meta-analysis. Front Oncol 2023; 13:1249683. [PMID: 37795432 PMCID: PMC10546177 DOI: 10.3389/fonc.2023.1249683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
Objectives Literature regarding experience with 3D laparoscopy about prostatectomy has remained scanty, and this could be related to the rise of robotic assisted laparoscopic surgery. This study aimed to perform a systemic review and meta-analysis to evaluate the perioperative, functional, and oncologic outcomes between 3D and 2D laparoscopic radical prostatectomy (LRP). Methods We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that compared perioperative, functional, or oncologic outcomes of both 3D and 2D LRP. The Newcastle-Ottawa Scale (NOS) tool and Jadad scale were used to assess the risk of bias in the included studies. Review Manager 5.3 was used for the meta-analysis. Results Seven studies with a total of 542 patients were included in the analysis. Among them, two were RCTs. There was no difference between groups in terms of preoperative characteristics. Anastomosis time, hospital day, and overall complication rates were similar in 3D than 2D group. However, operative time [mean difference (MD) -36.96; 95% confidence interval [CI] -59.25 to -14.67; p = 0.001], blood loss (MD -83.5; 95% CI -123.05 to -43.94; p <0.0001), and days of drainage (MD -1.48; 95% CI -2.29 to -0.67; p = 0.0003) were lower in 3D LRP. 2D and 3D LRP showed similarity in the positive surgical margin (PSM) rate and biochemical recurrence (BCR) rate at 3, 6, and 12months postoperatively. Additionally, there was no significant differences in continence and potency recovery rate between two group except higher continence rate of 3D LRP at 3 months. Conclusion Current evidence shows that 3D LRP offers favorable outcomes compared with 2D LRP, including operative time, blood loss, days of drainage, and early continence. However, there was no conclusive evidence that 3D LRP was advantaged in terms of oncologic and functional outcomes (except for continence rate at 3 months). Systematic review registration The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023426403).
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Affiliation(s)
- Hui Shuai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xi Duan
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Soputro NA, Olivares R. Current urological applications of the Hugo™ RAS system. World J Urol 2023; 41:2555-2561. [PMID: 37515649 DOI: 10.1007/s00345-023-04538-1] [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: 06/02/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023] Open
Abstract
PURPOSE To provide an update on the diverse, contemporary urological applications of the Hugo™ RAS system. METHODS A comprehensive literature review was performed to identify studies that described the clinical applications of the Hugo™ RAS system in Urology. The Hugo™ RAS is a new multi-modular robotic platform created by Medtronic, which offered new innovations, including an open surgical console and individual modular and extendable robotic arms that come in their own movable platforms. Since obtaining regulatory approval in Europe in October 2021, the novel platform has been increasingly used in various urologic and gynecologic procedures. RESULTS A total of 10 studies were included, which involved 176 patients who underwent varying urological procedures. These included radical and simple prostatectomy, partial nephrectomy, radical and simple nephrectomy, ureterolithotomy, ureteral reimplant, pyeloplasty, and adrenalectomy. The different docking configurations, operating room set-ups, and early perioperative outcomes were described for the respective procedure. CONCLUSION Based on the existing literature, the Hugo™ RAS system can be safely and effectively utilized for various urological procedures. The novel technology provided additional value in enriching the repertoire of urological minimally invasive surgical options. Further research with larger cohort of patients will be required to better refine the operating techniques and understand the perioperative outcomes of the Hugo™ RAS, especially when compared to other robotic surgical platforms.
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Affiliation(s)
- Nicolas A Soputro
- Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Glickman Tower, Cleveland, OH, Q10-218, USA
| | - Rubén Olivares
- Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Glickman Tower, Cleveland, OH, Q10-218, USA.
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Li KP, Chen SY, Wang CY, Yang L. Comparison between minimally invasive partial nephrectomy and open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis. Int J Surg 2023; 109:1769-1782. [PMID: 37094827 PMCID: PMC10389432 DOI: 10.1097/js9.0000000000000397] [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: 11/07/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The present study aimed to conduct a pooled analysis to compare the efficacy and safety of minimally invasive partial nephrectomy (MIPN) with open partial nephrectomy (OPN) in patients with complex renal tumors (defined as PADUA or RENAL score ≥7). METHODS The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, Supplemental Digital Content 1, http://links.lww.com/JS9/A394 . We conducted a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases until October 2022. MIPN and OPN-controlled trials for complex renal tumors were included. The primary outcomes were perioperative results, complications, renal function, and oncologic outcomes. RESULTS A total of 2405 patients were included in 13 studies. MIPN outperformed OPN in terms of hospital stay [weighted mean difference (WMD) -1.84 days, 95% CI -2.35 to -1.33; P <0.00001], blood loss (WMD -52.42 ml, 95% CI -71.43 to -33.41; P <0.00001), transfusion rates [odds ratio (OR) 0.34, 95% CI 0.17-0.67; P =0.002], major complications (OR 0.59, 95% CI 0.40-0.86; P =0.007) and overall complications (OR 0.43, 95% CI 0.31-0.59; P <0.0001), while operative time, warm ischemia time, conversion to radical nephrectomy rates, estimated glomerular decline, positive surgical margins, local recurrence, overall survival, recurrence-free survival, and cancer-specific survival were not significantly different. CONCLUSIONS The present study demonstrated that MIPN was associated with a shorter length of hospital stay, less blood loss, and fewer complications in treating complex renal tumors. MIPN may be considered a better treatment for patients with complex tumors when technically feasible.
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Affiliation(s)
| | | | | | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
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Moretto S, Gandi C, Bientinesi R, Totaro A, Marino F, Gavi F, Russo A, Aceto P, Pierconti F, Bassi P, Sacco E. Robotic versus Open Pyeloplasty: Perioperative and Functional Outcomes. J Clin Med 2023; 12:jcm12072538. [PMID: 37048622 PMCID: PMC10095392 DOI: 10.3390/jcm12072538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
We designed a retrospective study to assess the surgical and economic outcomes of robot-assisted laparoscopic pyeloplasty (RALP) compared with open pyeloplasty (OP), including consecutive patients suffering from ureteropelvic junction obstruction and operated on from January 2012 to January 2022 at a single center. Preoperative, intraoperative, and postoperative outcomes, including costs, were comparatively analyzed. The primary outcome was 3-month success, defined as symptom resolution and no obstruction upon diuretic renal scintigraphy. Overall, 91 patients were included (48 OP and 43 RALP). The success rate at 3 months was 93.0% and 83.3% in the RALP and OP group, respectively (p = 0.178), and the results remained stable at the last follow-up (35.4 ± 22.8 months and 56.0 ± 28.1 months, respectively). Intraoperative blood loss (p < 0.001), need for postoperative analgesics (p = 0.019) and antibiotics (p = 0.004), and early postoperative complication rate (p = 0.009) were significantly lower in the RALP group. None of the assessed variables were a predictor for failure. The mean total direct cost per surgical procedure and related hospital stay was 2373 € higher in the RALP group. RALP is an effective and safe treatment for ureteropelvic junction obstruction; however, further studies are needed to evaluate the cost-effectiveness of RALP, accounting for indirect costs and cost-saving with new surgical platforms.
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Gkeka K, Tsaturyan A, Faitatziadis S, Peteinaris A, Anaplioti E, Pagonis K, Vagionis A, Tatanis V, Vrettos T, Kallidonis P, Liatsikos E. Robot-Assisted Radical Nephrectomy Using the Novel Avatera Robotic Surgical System: A Feasibility Study in a Porcine Model. J Endourol 2023; 37:273-278. [PMID: 36274228 DOI: 10.1089/end.2022.0596] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate the feasibility and intraoperative technical parameters of the new robot-assisted surgical system Avatera by performing bilateral nephrectomy in a live porcine model. Materials and Methods: Six pigs underwent bilateral robot-assisted radical nephrectomy using the Avatera robotic system (RS). The operations were performed by experienced open (Group 1) and laparoscopic (Group 2) surgeons. The operating time, docking time, set-up time, and console time were evaluated. Data regarding intraoperative complications (major or not), injury of adjacent organs, and technical difficulties during the operation were also recorded. Results: Robot-assisted bilateral nephrectomy was completed effectively in all sample pigs. The docking time and set-up time were similar among the two groups, whereas the console time and operating time were significantly longer for the open surgeon group. Two intraoperative minor complications occurred in the open surgeon's group. An inadvertent damage of the renal vein occurred in two cases and the bleeding was controlled effectively. Other than the initial two cases, the estimated blood loss was <50 mL in both groups. Injury of the adjacent organs was not noticed. Conclusions: The study demonstrated that radical nephrectomy using the Avatera robotic surgical system is technically feasible, safe, and valid in pigs. Our results warrant the application of the Avatera RS in other urologic procedures, collecting data for further clinical trials.
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Affiliation(s)
- Kristiana Gkeka
- Department of Urology and University of Patras, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology and University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology and University of Patras, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria
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Zahid A, Ayyan M, Farooq M, Cheema HA, Shahid A, Naeem F, Ilyas MA, Sohail S. Robotic surgery in comparison to the open and laparoscopic approaches in the field of urology: a systematic review. J Robot Surg 2023; 17:11-29. [PMID: 35526260 DOI: 10.1007/s11701-022-01416-7] [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: 02/14/2022] [Accepted: 04/19/2022] [Indexed: 11/28/2022]
Abstract
To establish the feasibility of robotic surgical procedures in urology in terms of the applications, merits, and demerits as well as the postoperative and oncological outcomes while comparing it with the conventional approaches. A systematic search of electronic databases was performed to identify Randomized Controlled Trials and Cohort studies on Robot-Assisted urological surgical procedures in comparison with the conventional methods. The quality assessment of included studies was performed using the Newcastle-Ottawa Scale and the revised Cochrane "Risk of Bias" tool. A qualitative narrative synthesis of the data extracted from the studies was performed and presented in tabulated form. After screening, 39 studies were included in our review (7 Randomized Controlled Trials and 32 Cohort studies). Robot-Assisted Prostatectomy appears to be associated with lower estimated blood loss and shorter length of hospital stay. For Robot-Assisted Cystectomy, the results suggest longer operative time and fewer complications. Robot-Assisted Radical Nephrectomy was found to be associated with fewer perioperative complications and longer mean operative time while Robot-Assisted Partial Nephrectomy was associated with less positive surgical margins and reduced need for postoperative analgesia. The mean operative time was longer while the length of stay was shorter for the robotic approach in inguinal lymphadenectomy and ureteral reimplantation. The feasibility of Robot-Assisted surgery varied for different outcome measures as well as for different procedures. Some common advantages were a shorter length of stay, lesser blood loss, and fewer complications while the drawbacks included longer operative time.Study protocol PROSPERO database (Registration Number: CRD42021256623).
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Affiliation(s)
- Afra Zahid
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Ayyan
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan.
| | - Minaam Farooq
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Huzaifa Ahmad Cheema
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Abia Shahid
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Faiza Naeem
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Shehreen Sohail
- Department of Life Sciences, University of Central Punjab, Lahore, Pakistan
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Brassetti A, Anceschi U, Bove AM, Prata F, Costantini M, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Torregiani G, Covotta M, Gallucci M, Simone G. Purely Off-Clamp Laparoscopic Partial Nephrectomy Stands the Test of Time: 15 Years Functional and Oncologic Outcomes from a Single Center Experience. Curr Oncol 2023; 30:1196-1205. [PMID: 36661741 PMCID: PMC9858317 DOI: 10.3390/curroncol30010092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Nephron-sparing surgery represents the gold standard treatment for organ-confined renal tumors. We present 15-years of outcomes after off-clamp laparoscopic partial nephrectomy (ocLPN). METHODS a retrospective analysis was performed on patients who underwent ocLPN between May 2001 and December 2005. Baseline demographic, clinical, pathologic, surgical, functional and survival data were collected. The Kaplan-Meier method evaluated group-specific oncologic outcomes at 5, 10 and 15 years and the log rank test assessed differences between groups. The same analysis investigated the probabilities of developing a significant renal function impairment (sRFI) and achieving ROMeS. Cox analyses identified predictors of this latter tricomposite outcome. RESULTS We included 63 patients whose median tumor size was 3 cm (IQR:2-4). At 15 years, the chances of developing local recurrence, metachronous renal cancers or distant metastases were 2 ± 2%, 23 ± 6% and 17 ± 5%, respectively. Consequently, disease-free, cancer-specific and overall-survival probabilities were 68 ± 6%, 90 ± 4% and 72 ± 6%. MCRSS and UCISS well predicted oncologic outcomes. Overall, nine (14%) patients experienced an sRFI and 33 (52%) achieved ROMeS. Age (HR: 1.046; p = 0.033) and malignant histology (low-risk cancers HR: 3.233, p = 0.048) (intermediate/high risk cancers HR: 5.721, p = 0.023) were independent predictors of ROMeS non-achievement. CONCLUSIONS At 15 years from ocLPN, most of patients will experience both excellent functional and oncologic outcomes.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Manuela Costantini
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
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Monfared S, Athanasiadis DI, Umana L, Hernandez E, Asadi H, Colgate CL, Yu D, Stefanidis D. A comparison of laparoscopic and robotic ergonomic risk. Surg Endosc 2022; 36:8397-8402. [PMID: 35182219 DOI: 10.1007/s00464-022-09105-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Work related injuries in minimally invasive surgery (MIS) are common because of the strains placed on the surgeon's or assistant's body. The objective of this study was to compare specific ergonomic risks among surgeons and surgical trainees performing robotic and laparoscopic procedures. MATERIALS AND METHODS Ergonomic data and discomfort questionnaires were recorded from surgeons and trainees (fellows/residents) for both robotic and laparoscopic procedures. Perceived discomfort questionnaires were recorded pre/postoperatively. Intraoperatively, biomechanical loads were captured using motion tracking sensors and electromyography (EMG) sensors. Perceived discomfort, body position and muscle activity were compared between robotic and laparoscopic procedures using a linear regression model. RESULTS Twenty surgeons and surgical trainees performed 29 robotic and 48 laparoscopic procedures. Postoperatively, increases in right finger numbness and right shoulder stiffness and surgeon irritability were noted after laparoscopy and increased back stiffness after robotic surgery. Further, the laparoscopic group saw increases in right hand/shoulder pain (OR 0.8; p = 0.032) and left hand/shoulder pain (0.22; p < 0.001) compared to robotic. Right deltoid and trapezius excessive muscle activity were significantly higher in laparoscopic operations compared to robotic. Demanding and static positioning was similar between the two groups except there was significantly more static neck position required for robotic operations. CONCLUSION Robotic assisted surgeries led to lower postoperative discomfort and muscle strain in both upper extremities, particularly dominant side of the surgeon, but increased static neck positioning with subjective back stiffness compared with laparoscopy. These recognized ergonomic differences between the two platforms can be used to raise surgeon awareness of their intraoperative posture and to develop targeted physical and occupational therapy interventions to decrease surgeon WMSDs and increase surgeon longevity.
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Affiliation(s)
- Sara Monfared
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dimitrios I Athanasiadis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Luke Umana
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Edward Hernandez
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Cameron L Colgate
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Denny Yu
- Purdue University, West Lafayette, IN, USA
| | - Dimitrios Stefanidis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Pahouja G, Sweigert SE, Sweigert PJ, Gorbonos A, Patel HD, Gupta GN. Does size matter? Comparing robotic versus open radical nephrectomy for very large renal masses. Urol Oncol 2022; 40:456.e1-456.e7. [PMID: 35667982 DOI: 10.1016/j.urolonc.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/23/2022] [Accepted: 05/07/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION We evaluated perioperative and mortality outcomes of robotic-assisted radical nephrectomy (RRN) vs. open radical nephrectomy (ORN) for very large renal cell carcinomas (RCC). MATERIALS AND METHODS Adult patients with non-metastatic RCC >10 cm in size (pT2b) were identified from the National Cancer Database (2010-2017). Mixed-effects multivariable logistic regression adjusting for patient, tumor, and facility characteristics were used to evaluate rates of positive margin, prolonged length of stay (LOS) (>75th percentile), 30-day readmission, and 30-day and 90-day mortality for RRN vs. ORN. Overall survival (OS) was evaluated using the Kaplan-Meier method and adjusted Cox proportional hazard modeling. RESULTS Of the 2,977 patients who underwent radical nephrectomy, 492 (16.5%) underwent RRN. Factors associated with RRN included male gender, metro or urban locations, academic facilities, Charlson-Deyo score >2, private or Medicaid insurance, and surgery in a later year (all P < 0.05). Tumors ≥15.1cm in size were associated with a higher rate of conversion to open surgery (P < 0.001). ORN was associated with increased median postoperative LOS (4d [interquartile range; IQR 3-6] vs. 3d, [IQR 2-4]; P < 0.01). RRN demonstrated no significant difference in the risk of positive margin, 30-day readmission, 30-day mortality, or 90-day mortality. RRN was associated with a decreased risk of prolonged LOS (OR 0.38; 95%CI [0.28-0.53]). There was no difference in long-term OS observed in patients treated with ORN vs. RRN. CONCLUSIONS Very large, non-metastatic RCC can be safely and effectively treated with RRN. Rates of conversion to open were higher for tumors ≥15.1 cm. RRN has comparable long-term OS and improved LOS compared to ORN.
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Affiliation(s)
- Gaurav Pahouja
- Department of Urology, Loyola University Medical Center, Maywood, IL.
| | - Sarah E Sweigert
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | | | - Alex Gorbonos
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL; Department of Radiology, Loyola University Medical Center, Maywood, IL
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16
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Song C, Cheng L, Li Y, Kreaden U, Snyder SR. Systematic literature review of cost-effectiveness analyses of robotic-assisted radical prostatectomy for localised prostate cancer. BMJ Open 2022; 12:e058394. [PMID: 36127082 PMCID: PMC9490571 DOI: 10.1136/bmjopen-2021-058394] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Review and assess cost-effectiveness studies of robotic-assisted radical prostatectomy (RARP) for localised prostate cancer compared with open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). DESIGN Systematic review. SETTING PubMed, Embase, Scopus, International HTA database, the Centre for Reviews and Dissemination database and various HTA websites were searched (January 2005 to March 2021) to identify the eligible cost-effectiveness studies. PARTICIPANTS Cost-effectiveness, cost-utility, or cost-minimization analyses examining RARP versus ORP or LRP were included in this systematic review. INTERVENTIONS Different surgical approaches to treat localized prostate cancer: RARP compared with ORP and LRP. PRIMARY AND SECONDARY OUTCOME MEASURES A structured narrative synthesis was developed to summarize results of cost, effectiveness, and cost-effectiveness results (eg, incremental cost-effectiveness ratio [ICER]). Study quality was assessed using the Consensus on Health Economic Criteria Extended checklist. Application of medical device features were evaluated. RESULTS Twelve studies met inclusion criteria, 11 of which were cost-utility analyses. Higher quality-adjusted life-years and higher costs were observed with RARP compared with ORP or LRP in 11 studies (91%). Among four studies comparing RARP with LRP, three reported RARP was dominant or cost-effective. Among ten studies comparing RARP with ORP, RARP was more cost-effective in five, not cost-effective in two, and inconclusive in three studies. Studies with longer time horizons tended to report favorable cost-effectiveness results for RARP. Nine studies (75%) were rated of moderate or good quality. Recommended medical device features were addressed to varying degrees within the literature as follows: capital investment included in most studies, dynamic pricing considered in about half, and learning curve and incremental innovation were poorly addressed. CONCLUSIONS Despite study heterogeneity, RARP was more costly and effective compared with ORP and LRP in most studies and likely to be more cost-effective, particularly over a multiple year or lifetime time horizon. Further cost-effectiveness analyses for RARP that more thoroughly consider medical device features and use an appropriate time horizon are needed. PROSPERO REGISTRATION NUMBER CRD42021246811.
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Affiliation(s)
- Chao Song
- Global Health Economics and Outcome Research, Intuitive Surgical, Atlanta, GA, USA
| | - Lucia Cheng
- Global Health Economics and Outcome Research, Intuitive Surgical, Sunnyvale, CA, USA
| | - Yanli Li
- Global Health Economics and Outcome Research, Intuitive Surgical, Sunnyvale, CA, USA
| | - Usha Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical, Sunnyvale, CA, USA
| | - Susan R Snyder
- Georgia State University School of Public Health, Atlanta, Georgia, USA
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Okhawere KE, Milky G, Shih IF, Li Y, Badani KK. Comparison of 1-Year Health Care Expenditures and Utilization Following Minimally Invasive vs Open Nephrectomy. JAMA Netw Open 2022; 5:e2231885. [PMID: 36112376 PMCID: PMC9482061 DOI: 10.1001/jamanetworkopen.2022.31885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Given the widespread adoption and clinical benefits of minimally invasive surgery approaches (MIS) in partial nephrectomy (PN) and radical nephrectomy (RN), assessment of long-term cost implications is relevant. OBJECTIVE To compare health care utilization and expenditures within 1 year after MIS and open surgery (OS). DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using a US commercial claims database between 2013 and 2018. A total of 5104 patients aged 18 to 64 years who underwent PN or RN for kidney cancer and were continuously insured for 180 days before and 365 days after surgery were identified. An inverse probability of treatment weighting analysis was performed to examine differences in costs and use of health care services. EXPOSURES Surgical approach (MIS or OS). MAIN OUTCOMES AND MEASURES Outcomes assessed included 1-year total health care expenditure, health care utilizations, and estimated days missed from work. RESULTS Of the 5104 patients, 2639 had PN (2008 MIS vs 631 OS) and 2465 had RN (1816 MIS vs 649 OS) and most were male (PN: 1657 [62.8%]; RN: 399 [63.1%]) and between 55 and 64 years of age (PN: 1034 [51.3%]; RN: 320 [55.7%]). Patients who underwent MIS had lower index hospital length of stay compared with OS (mean [95% CI] for PN: 2.45 [2.37-2.53] vs 3.78 [3.60-3.97] days; P < .001; for RN: 2.82 [2.73-2.91] vs 4.62 [4.41-4.83] days; P < .001), and lower index expenditure for RN ($28 999 [$28 243-$29 796] vs $31 977 [$30 729-$33 329]; P < .001). For PN, index expenditure was lower for OS than MIS (mean [95% CI], $27 480 [$26 263-$28 753] vs $30 380 [$29614-$31 167]; P < .001). Patients with MIS had lower 1-year postdischarge readmission rate (PN: 15.1% vs 21.5%; odds ratio [OR], 0.65; 95% CI, 0.52-0.82; P < .001; RN: 15.6% vs 18.9%; OR, 0.79; 95% CI, 0.63-1.00; P = .05), and fewer hospital outpatient visits (mean [95% CI] for PN: 4.69 [4.48-4.90] vs 5.25 [4.84-5.66]; P = .01; RN: 5.50 [5.21-5.80] vs 6.71 [6.12-7.30]; P < .001) than those with OS. For RN, MIS was associated with 1.47 fewer missed workdays (95% CI, 0.57-2.38 days; P = .001). The reduction in health care use in MIS was associated with lower or similar total cumulative expenditures compared with OS (mean difference [95% CI] for PN: $331 [-$3250 to $3912]; P = .85; for RN: -$11 265 [-$17 065 to -$5465]; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, MIS was associated with lower or similar total cumulative expenditure than OS in the period 1 year after discharge from the index surgery. These findings suggest that downstream expenditures and resource utilization should be considered when evaluating surgical approach for nephrectomy.
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Affiliation(s)
| | | | - I-Fan Shih
- Intuitive Surgical Inc, Sunnyvale, California
| | - Yanli Li
- Intuitive Surgical Inc, Sunnyvale, California
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18
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Kuo CC, Chen GH, Chang CH, Huang CY, Chen CH, Li CC, Wu WJ, Yu CC, Lo CW, Chen YT, Chen SH, Cheng PY, Hsueh T, Chiu AW, Lin PH, Tseng JS, Lin JT, Jiang YH, Wu CC, Lin WY, Huang HC, Chiang HS, Chiang BJ. Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy using the Taiwan upper urinary tract urothelial carcinoma database. Front Surg 2022; 9:934355. [PMID: 36117820 PMCID: PMC9475171 DOI: 10.3389/fsurg.2022.934355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTaiwan has a high incidence of upper tract urothelial carcinoma (UTUC). This study aimed to compare the surgical outcomes following transperitoneal hand-assisted laparoscopic nephroureterectomy (TP-HALNU) and transperitoneal pure laparoscopic nephroureterectomy (TP-LNU) from the Taiwan nationwide UTUC collaboration database using different parameters, including surgical volumes.Materials and methodsThe nationwide UTUC collaboration database includes 14 hospitals in Taiwan from the Taiwan Cancer Registry. We retrospectively reviewed the records of 622 patients who underwent laparoscopic nephroureterectomy between July 1988 and September 2020. In total, 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncological outcomes were compared.ResultsOf the 322 patients, 181 and 141 received TP-LNU and TP-HALNU, respectively. There were no differences in clinical and histopathological data between the two groups. No differences were observed in perioperative and postoperative complications. There were no significant differences in oncological outcomes between the two surgical approaches. In the multivariate analysis, the cohort showed that age ≥70 years, positive pathological lymph node metastasis, tumors located in the upper ureter, and male sex were predictive factors associated with an increased risk of adverse oncological outcomes. A surgical volume of ≥20 cases showed a trend toward favorable outcomes on cancer-specific survival [hazard ratio (HR) 0.154, p = 0.052] and marginal benefit for overall survival (HR 0.326, p = 0.019) in the multivariate analysis.ConclusionAlthough different approaches to transperitoneal laparoscopic nephroureterectomy showed no significant differences in surgical outcomes, age, sex, lymph node metastasis, and tumor in the upper ureter in the following period were predictive factors for oncological outcomes. Higher surgical volume did not impact disease-free survival and bladder recurrence-free survival but was associated with improved overall survival and cancer-specific survival. Exploration of unknown influencing factors is warranted.
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Affiliation(s)
- Chih-Chun Kuo
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Guang-Heng Chen
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- Department of Urology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Chin Yu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chi-Wen Lo
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yung-Tai Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shin-Hong Chen
- Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Pai-Yu Cheng
- Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei, Taiwan
| | - Thomas Y. Hsueh
- Division of Urology, Department of Surgery, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Allen W. Chiu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Han Lin
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan
- Mackay Medical College, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
- Chang Gung University of Science and Technology, Chia-Yi, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Che Huang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Han-Sun Chiang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- Correspondence: Bing-Juin Chiang ; Han-Sun Chiang
| | - Bing-Juin Chiang
- Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Correspondence: Bing-Juin Chiang ; Han-Sun Chiang
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19
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Clinical and oncological outcomes of open partial nephrectomy versus robot assisted partial nephrectomy over 15 years. J Robot Surg 2022; 17:519-526. [PMID: 35851947 DOI: 10.1007/s11701-022-01446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022]
Abstract
Partial nephrectomy (PN) is the gold standard surgical treatment for localized kidney cancer. The objective of our study was to compare clinical and perioperative outcomes of open partial nephrectomy (OPN) and robotic-assisted partial nephrectomy (RAPN). We retrospectively collected all patients who underwent PN for kidney cancer between 2007 and 2019 at two French academic urology departments. Clinical and perioperative outcomes and complications were compared between the OPN group and the RAPN group. Recurrence-free survival (RFS) and overall survival (OS) were compared using the log-rank test. We included 405 patients. The maximum follow-up time was 13.6 years in the OPN group and 7.1 years in the RAPN group. The OPN group was associated with more blood loss and longer hospital stay (respectively, 287 ml vs. 62.1 ml; p < 0.001 and 8.54 days vs. 4.96 days; p < 0.001). Ischemia time was shorter in the OPN group (11.4 min vs. 16.9 min; p < 0.001). The rate of complications during hospitalization and after discharge from hospital was higher in the OPN group (respectively, n = 51 vs. 30; p = 0.031 and n = 31 vs. 14; p < 0.001). RFS and OS were similar in both groups. In our study, RAPN has better perioperative outcomes with shorter hospital stay and less blood loss but also fewer early and late complications. However, we did not find any difference in terms of RFS and OS.
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20
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Labban M, Dasgupta P, Song C, Becker R, Li Y, Kreaden US, Trinh QD. Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK. JAMA Netw Open 2022; 5:e225740. [PMID: 35377424 PMCID: PMC8980901 DOI: 10.1001/jamanetworkopen.2022.5740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The cost-effectiveness of different surgical techniques for radical prostatectomy remains a subject of debate. Emergence of recent critical clinical data and changes in surgical equipment costs due to their shared use by different clinical specialties necessitate an updated cost-effectiveness analysis in a centralized, largely government-funded health care system such as the UK National Health Service (NHS). OBJECTIVE To compare robotic-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) and laparoscopic-assisted radical prostatectomy (LRP) using contemporary data on clinical outcomes, costs, and surgical volumes in the UK. DESIGN, SETTING, AND PARTICIPANTS This economic analysis used a Markov model developed to compare the cost-effectiveness of RARP, LRP, and ORP to treat localized prostate cancer. The model was constructed from the perspective of the UK NHS. The model simulated 65-year-old men who underwent radical prostatectomy for localized prostate cancer and were followed up for a 10-year period. Data were analyzed from May 1, 2020, to July 31, 2021. EXPOSURES Robotic-assisted radical prostatectomy, LRP, and ORP. MAIN OUTCOMES AND MEASURES Quality-adjusted life-years (QALYs), costs (direct medical costs and costs outside the NHS), and incremental cost-effectiveness ratios (ICERs). RESULTS Compared with LRP, RARP cost £1785 (US $2350) less and had 0.24 more QALYs gained; thus, RARP was a dominant option compared with LRP. Compared with ORP, RARP had 0.12 more QALYs gained but cost £526 (US $693) more during the 10-year time frame, resulting in an ICER of £4293 (US $5653)/QALY. Because the ICER was below the £30 000 (US $39 503) willingness-to-pay threshold, RARP was more cost-effective than ORP in the UK. The most sensitive variable influencing the cost-effectiveness of RARP was the lower risk of biochemical recurrence (BCR). Scenario analysis indicated RARP would remain more cost-effective than ORP as long as the BCR hazard ratios comparing RARP vs ORP were less than 0.99. CONCLUSIONS AND RELEVANCE These findings suggest that in the UK, RARP has an ICER lower than the willingness-to-pay threshold and thus is likely a cost-effective surgical treatment option for patients with localized prostate cancer compared with ORP and LRP. The results were mainly driven by the lower risk of BCR for RARP. These findings may differ in other health care settings where different thresholds and costs may apply.
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Affiliation(s)
- Muhieddine Labban
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prokar Dasgupta
- MRC (Medical Research Council) Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
| | - Chao Song
- Global Health Economics and Outcome Research, Intuitive Surgical Inc, Atlanta, Georgia
| | | | - Yanli Li
- Global Health Economics and Outcome Research, Intuitive Surgical Inc, Sunnyvale, California
| | - Usha Seshadri Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, California
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Ordell Sundelin M, Paltved C, Kingo PS, Blichert-Refsgaard L, Lindgren MS, Kjölhede H, Jensen JB. The transferability of the minimal invasive surgeon’s skills to open surgery. Scand J Urol 2022; 56:131-136. [DOI: 10.1080/21681805.2022.2030401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Maria Ordell Sundelin
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Corporate MidtSim, Central Denmark Region, Aarhus, Denmark
| | | | - Pernille Skjold Kingo
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Linea Blichert-Refsgaard
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Maria S. Lindgren
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Kjölhede
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Does type of robotic platform make a difference in the final cost of robotic-assisted radical prostatectomy? J Robot Surg 2022; 16:1329-1335. [PMID: 35089500 DOI: 10.1007/s11701-021-01359-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
This study evaluates the difference of robot-assisted radical prostatectomy (RARP) costs in patients with similar preoperative characteristics operated on using the da Vinci® SP and Xi robotic platforms. We performed a retrospective analysis on 71 consecutive patients with prostate cancer who underwent RARP with the SP robot between June 2019 and April 2020. Propensity score (PS) matching was performed and 71 patients were selected from a cohort of 875 who underwent RARP with the Xi robot in the same period. We divided the total expense per surgery into the cost of disposable materials, robotic instruments (initial purchasing cost divided by the number of "lives"), and operative room costs. Only variable costs are included in this study, as fixed costs do not vary between procedures and are the same for both cohorts. Fixed costs include anesthesia, pathology, surgeon, and hospitalization fees. The median total cost for SP-RARP was $5586 ($5360-$5982) USD and $4875 ($4661-$5093) USD with the XI for a median cost difference of $707 ($584-$832) (P < 0.001). The median cost of disposables for the SP was $1877 ($1588-$2193) USD and for the Xi $1527 ($1407-$1781) USD, P < 0.001. Non-disposable instruments cost per case (fixed cost) was $1610 and $1270 USD for the SP and Xi, respectively. The cost of radical prostatectomy in the SP cohort is higher than the Xi cohort. The greater price was primarily due to the increased cost of instruments and disposable materials. In our experience, the lack of GelPOINT and space maker is also crucial factors to decrease the SP total cost.
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Crocerossa F, Carbonara U, Cantiello F, Marchioni M, Ditonno P, Mir MC, Porpiglia F, Derweesh I, Hampton LJ, Damiano R, Autorino R. Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 2021; 80:428-439. [DOI: 10.1016/j.eururo.2020.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022]
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Vu E, Pratsinis M, Plasswilm L, Schmid HP, Panje C, Betschart P. Radiotherapy or Surgery? Comparative, Qualitative Assessment of Online Patient Education Materials on Prostate Cancer. Curr Oncol 2021; 28:3420-3429. [PMID: 34590594 PMCID: PMC8482178 DOI: 10.3390/curroncol28050296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
As multiple different treatment options are available for prostate cancer (PCa) and YouTube is commonly used as a source for medical information, we performed a systematic and comparative assessment of available videos guiding patients on their choice for the optimal treatment. An independent search for surgical therapy or radiotherapy of PCa on YouTube was performed and the 40 most viewed videos of both groups were analyzed. The validated DISCERN questionnaire and PEMAT were utilized to evaluate their quality and misinformation. The median overall quality of the videos was found to be low for surgery videos, while radiotherapy videos results reached a moderate quality. The median PEMAT understandability score was 60% (range 0-100%) for radiotherapy and 75% (range 40-100) for surgery videos. The radiotherapy videos contained less misinformation and were judged to be of higher quality. Summarized, the majority of the provided videos offer insufficient quality of content and are potentially subject to commercial bias without reports on possible conflict of interest. Thus, most of available videos on YouTube informing PCa patients about possible treatment methods are not suited for a balanced patient education or as a basis for the patient's decision.
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Affiliation(s)
- Erwin Vu
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland; (E.V.); (L.P.); (C.P.)
| | - Manolis Pratsinis
- Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland; (M.P.); (H.-P.S.)
| | - Ludwig Plasswilm
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland; (E.V.); (L.P.); (C.P.)
- Faculty of Medicine, University of Bern, 3008 Bern, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland; (M.P.); (H.-P.S.)
| | - Cédric Panje
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland; (E.V.); (L.P.); (C.P.)
- Faculty of Medicine, University of Bern, 3008 Bern, Switzerland
| | - Patrick Betschart
- Department of Urology, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland; (M.P.); (H.-P.S.)
- Correspondence: ; Tel.: +41-71-494-914-16
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25
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The Role of Cost-Effectiveness Analysis in Patient-Centered Cancer Care in the Era of Precision Medicine. Cancers (Basel) 2021; 13:cancers13174272. [PMID: 34503082 PMCID: PMC8428334 DOI: 10.3390/cancers13174272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Over the last few decades, changes in diagnostic and treatment paradigms have greatly advanced cancer care and improved outcomes [...].
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Liatsikos E, Tsaturyan A, Kyriazis I, Kallidonis P, Manolopoulos D, Magoutas A. Market potentials of robotic systems in medical science: analysis of the Avatera robotic system. World J Urol 2021; 40:283-289. [PMID: 34424374 PMCID: PMC8381715 DOI: 10.1007/s00345-021-03809-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the potential opportunities and possible competitiveness of Avatera robotic system (ARS) (Avateramedical, Germany), and perform predictive cost-analysis for its implementation and dissemination. MATERIAL AND METHODS Our study employed a projective quantitative research design. SWOT (strengths, weaknesses, opportunities, threats) analysis was used to map ARS internal competencies towards external contexts, and potential opportunities and risks in the robotic market. The ARS purchase and procedural costs were evaluated in two different scenarios. RESULTS In the first scenario, setting the purchase cost of the Avatera at around $1.3-1.5 million, a total $400 procedural cost reduction compared to the RAS performed with the da Vinci Xi can be calculated. In the second scenario, with a purchase cos of the ARS of $700.000-800.000 and considering a 5-year period with an annual ARS volume of 500 procedures, only an additional $300 will be attributed to the robot itself. Our projections revealed that for an effective competition the purchase cost of ARS should range between $700.000 and $800.000 during the initial phase of market entry. The marketing strategy of the ARS should be oriented towards countries without any robotic system in operational use, followed by countries where the competition intensity in the marketplace is low. CONCLUSION The introduction of new robotic systems will greatly affect and reshape the market of robotic surgery. The ARS has all the technical capacity ensuring the performance of high-quality surgical procedures. A fast spread and implementation of the ARS could be expected should the purchase and maintenance costs be kept low.
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Affiliation(s)
- Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece. .,Department of Urology, Medical University of Vienna, Vienna, Austria. .,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Arman Tsaturyan
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Iason Kyriazis
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Dimitris Manolopoulos
- School of Social Sciences, Hellenic Open University, Athens, Greece.,Department of Business Administration, Athens University of Economics and Business, Athens, Greece
| | - Anastasios Magoutas
- School of Social Sciences, Hellenic Open University, Athens, Greece.,General Department, National and Kapodistrian University of Athens, Athens, Greece
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27
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Fan S, Dai X, Yang K, Xiong S, Xiong G, Li Z, Cheng S, Li X, Meng C, Guan H, Huang Y, Mu L, Cui L, Zhou L, Li X. Robot-assisted pyeloplasty using a new robotic system, the KangDuo-Surgical Robot-01: a prospective, single-centre, single-arm clinical study. BJU Int 2021; 128:162-165. [PMID: 33725392 DOI: 10.1111/bju.15396] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Xiaofei Dai
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China.,Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Xinfei Li
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Hua Guan
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Yanbo Huang
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Li Mu
- Department of Operation Room, Peking University First Hospital, Beijing, China
| | - Liang Cui
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology Peking University, National Urological Cancer Center, Peking University, Beijing, China
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Gupta K, Omil-Lima D, Sheyn D, Shoag J. Temporal improvements in renal surgery outcomes across surgical approaches. Int Urol Nephrol 2021; 53:1311-1316. [PMID: 33591487 DOI: 10.1007/s11255-021-02811-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/08/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate patient outcomes in a contemporary cohort of patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN). METHODS The NSQIP database was used to identify patients undergoing PN or RN for renal neoplasms between 2010 and 2018. The SEER database was also queried to assess changes in tumor staging during the study period. Logistic regression was used to assess the independent relationship between surgery year and approach on postoperative complications. RESULTS Between 2010 and 2018, NSQIP captured 58,020 cases, including 26,745 (46%) PN and 31,275 (54%) RN. The proportion of PN increased annually, from 39.8% in 2010 to 48.7% in 2018. This rise in PN coincided with a decrease in the proportion of patients experiencing complications, irrespective of surgical approach (20.4% of total cases to 14.2% of total cases). While limited by a lack of information on tumor characteristics, multivariable analysis controlling for patient characteristics demonstrated that RN was associated with an increased risk of complications, OR 1.42 (95% CI 1.35-1.49). CONCLUSION Here, we report an 8.9% increase in the proportion of patients undergoing PN between 2010 and 2018, with no associated increase in perioperative morbidity/mortality. Given that there was no concurrent shift in stage or size of kidney tumors undergoing resection during the study period, these data therefore suggest markedly improved surgical technique and perioperative management nationally. Furthermore, the relative burden of complications has shifted from patients undergoing PN to those undergoing RN. Therefore PN, when technically feasible, should be increasingly considered.
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Affiliation(s)
- Karishma Gupta
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Danly Omil-Lima
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Sheyn
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jonathan Shoag
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, USA
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29
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Boga MS, Ates M. Retroperitoneal robot-assisted laparoscopic partial nephrectomy for posterior located renal tumours: Technique and early term outcomes. Int J Clin Pract 2021; 75:e13851. [PMID: 33237611 DOI: 10.1111/ijcp.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Traditionally, the trans-peritoneal approach is preferred for robot-assisted partial nephrectomy (RPN). However, retroperitoneal RPN (RP-RPN) has recently become widespread because of the advantages of easier access to the hilum, ease dissection of posterior tumours, and lower probability of intra-peritoneal organ injury. We aimed to present our initial experience of the RP-RPN series in posteriorly located renal tumours. METHODS Twenty-one patients were included in the study, who underwent RP-RPN by a single surgeon between July 2019 and January 2020. RP-RPN was carried out only in posteriorly located renal tumours with ischemic (on-clamp) or zero ischemic (off-clamp) techniques. Patients with solitary kidney and a history of previous retroperitoneal surgery in the lumbodorsal region were excluded from the study. RESULTS All cases completed without any operative complication and conversion to open or radical nephrectomy. Seven cases were completed as zero ischemic and 14 cases as ischemic technique. The mean operation time was 157.86 ± 64.24 minutes and estimated blood loss was 173.81 ± 136.84 mL. The mean warm ischemia time was 15.81 ± 12.42 minutes. Positive surgical margin observed in 4.8% of the patients. The mean length of stay was 3.33 ± 0.79 days. The mean estimated glomerular filtration rate (eGFR) change in the 3rd postoperative month was -3.71 ± 8.57 ml/min/1.73 m2 (4.6%). Mean follow-up period was 10.29 ± 4.86 months. New-onset stage 3-4 chronic kidney disease (eGFR < 60 m /min/1.73m2 ) was not observed during the follow-up period. CONCLUSION RP-RPN is a safe and feasible approach with acceptable oncological and functional results. We think that RP-RPN can be applied as an alternative to the trans-peritoneal approach for selected cases, especially in renal tumours with the posterior location.
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Affiliation(s)
- Mehmet Salih Boga
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mutlu Ates
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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Boga MS, Sönmez MG, Karamık K, Özsoy Ç, Aydın A, Savas M, Ateş M. Long-term outcomes of minimally invasive surgeries in partial nephrectomy. Robot or laparoscopy? Int J Clin Pract 2021; 75:e13757. [PMID: 33058376 DOI: 10.1111/ijcp.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To compare long-term oncological and renal functional outcomes of laparoscopic and robotic partial nephrectomy for small renal masses. METHODS A total of 103 patients who underwent laparoscopic (n = 31) and robotic (n = 72) partial nephrectomy between April 2015 and November 2018 were included in the study. Perioperative parameters, long-term oncological and functional outcomes were compared between the laparoscopic and robotic groups. RESULTS No significant differences were found in terms of age, tumour size, RENAL and PADUA scores, pre-operative estimated glomerular filtration rate (eGFR), and presence of chronic hypertension and diabetes (P = .479, P = .199, P = .120 and P = .073, P = .561, and P = .082 and P = .518, respectively). Only estimated blood loss was significantly higher in the laparoscopic group in operative parameters (158.23 ± 72.24 mL vs. 121.11 ± 72.17 mL; P = .019), but transfusion rates were similar between the groups (P = .33). In the laparoscopic group, two patients (6.5%) required conversion to open, while no conversion was needed in the robotic group (P = .89). There were no differences in terms of positive surgical margin and complication rates (P = .636 and P = .829, respectively). No significant differences were observed in eGFR changes and post-operative new-onset chronic kidney disease at 1 year after the surgery (P = .768, P = .614, respectively). The overall mean follow-up period was 36.07 ± 13.56 months (P = .007). During the follow-up period, no cancer-related death observed in both group and non-cancer-specific survival was 93.5% and 94.4% in laparoscopic and robotic groups, respectively (P = .859). CONCLUSIONS In this study, perioperative and long-term oncological and functional outcomes seems to be comparable between laparoscopic and robotic partial nephrectomies.
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Affiliation(s)
- Mehmet Salih Boga
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Giray Sönmez
- Department of Urology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Kaan Karamık
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Çağatay Özsoy
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Arif Aydın
- Department of Urology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Murat Savas
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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Zhu D, Shao X, Guo G, Zhang N, Shi T, Wang Y, Gu L. Comparison of Outcomes Between Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy: A Meta-Analysis Based on Comparative Studies. Front Oncol 2021; 10:592193. [PMID: 33489891 PMCID: PMC7819878 DOI: 10.3389/fonc.2020.592193] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background To compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN). Methods A literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were estimated using fixed-effect or random-effect model. Publication bias was evaluated with funnel plots. Only comparative studies with matched design or similar baseline characteristics were included. Results Eleven studies embracing 2,984 patients were included. There was no significant difference between the two groups regarding conversion to open (P = 0.44) or radical (P = 0.31) surgery, all complications (P = 0.06), major complications (P = 0.07), warm ischemia time (P = 0.73), positive surgical margin (P = 0.87), decline in eGFR (P = 0.42), CKD upstaging (P = 0.72), and total recurrence (P = 0.66). Patients undergoing TRPN had a significant higher minor complications (P = 0.04; OR: 1.39; 95% CI, 1.01–1.91), longer operative time (P < 0.001; WMD: 21.68; 95% CI, 11.61 to 31.76), more estimated blood loss (EBL, P = 0.002; WMD: 40.94; 95% CI, 14.87 to 67.01), longer length of hospital stay (LOS, P < 0.001; WMD: 0.86; 95% CI, 0.35 to 1.37). No obvious publication bias was identified. Conclusion RRPN is more favorable than TRPN in terms of less minor complications, shorter operative time, less EBL, and shorter LOS. Methodological limitations of the included studies should be considered while interpreting these results.
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Affiliation(s)
- Daqing Zhu
- Department of Urology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Xue Shao
- Department of Neurology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Gang Guo
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Nandong Zhang
- Department of Urology, Affiliated Hospital of Inner Mongolia University For Nationalities, Tongliao, China
| | - Taoping Shi
- Department of Urology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Yi Wang
- Department of Urology, The Second Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Liangyou Gu
- Department of Urology, Chinese PLA General Hospital, 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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Mantica G, Ambrosini F, Parodi S, Tappero S, Terrone C. Comparison of Safety, Efficacy and Outcomes of Robot Assisted Laparoscopic Pyeloplasty vs Conventional Laparoscopy. Res Rep Urol 2020; 12:555-562. [PMID: 33204662 PMCID: PMC7667144 DOI: 10.2147/rru.s238823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 12/31/2022] Open
Abstract
Pyeloplasty is considered the gold standard for the management of ureteropelvic junction obstruction in cases of flank pain, recurrent stone formation or infection, and deteriorating renal function. Over the last two decades, minimally invasive techniques such as robotic (RALP) and laparoscopic pyeloplasty (LP) have become increasingly popular and have been moderately replacing the open approach. This paper aims to provide a comprehensive up-to-date review on safety, efficacy and outcomes regarding robotic repair of UPJO compared to the conventional laparoscopic procedure. RALP represents a viable and innovative alternative to conventional LP with a comparable success and complication rate both in adult and in paediatric fields. The robotic approach seems to add further technical advantages when compared to conventional LP but sustains a higher costs. Currently, the choice to adopt one of the different minimally invasive approaches depends on the surgeon's preference or experience, and on institutional availability.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Francesca Ambrosini
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Stefano Parodi
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Stefano Tappero
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
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Labban M, Bulbul M, Wazzan W, Khauli R, El Hajj A. Robot-assisted radical prostatectomy in the Middle East: A report on the perioperative outcomes from a tertiary care centre in Lebanon. Arab J Urol 2020; 19:152-158. [PMID: 34104490 PMCID: PMC8158259 DOI: 10.1080/2090598x.2020.1814184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To report on the surgical, oncological and early functional outcomes of robot-assisted radical prostatectomy (RARP) at our tertiary care centre, as there is a scarcity of reports on outcomes of robotic surgery from the Middle East. Patients and methods We reviewed the electronic health records for patients undergoing RARP between 2013 and 2019 at the American University of Beirut Medical Center. We collected patients’ demographics and preoperative oncological factors including prostate-specific antigen (PSA), clinical oncological stage, and World Health Organization (WHO) grade. PSA persistence, biochemical recurrence (BCR) and positive surgical margin (PSM) were reported. Complications were categorised by Clavien–Dindo grade. Moreover, the postoperative oncological outcomes including the rates of adjuvant and salvage androgen-deprivation therapy (ADT) and external-beam radiation therapy (EBRT), chemotherapy, and metastasis were reported. Additionally continence and potency results were retrieved. Results For the designated period, 250 patients underwent RARP of which 182 (72.8%) underwent lymph node dissection. The median (interquartile range) anaesthesia time was 330 (285–371) min and the estimated blood loss was 200 (200–300) mL. The overall complication rate was 8%, with 2% Clavien–Dindo Grade III–IV complications. The PSM and BCR rates were 21.6% and 6.4%, respectively. Adjuvant ADT and EBRT was administered to 7.2% of the patients. Functional data was available for 112 patients. Continence was 68%, 82% and 97% of the patients at 3, 6 and 12 months, respectively. For 65 patients who had bilateral nerve sparing potency was 37%, 60% and 83% at 3, 6 and 12 months, respectively. Conclusion This is the largest RARP series from the Middle East. The surgical, oncological and functional outcomes are consistent with those published in the literature. This confirms the safety and efficacy of applying robotic technology in our region during the implementation phase. Abbreviations: ADT: androgen-deprivation therapy; AJCC: American Joint Committee on Cancer; AUBMC: American University of Beirut Medical Center; BCR: biochemical recurrence; CPT: Current Procedural Terminology; EBRT external beam radiation therapy; IQR, interquartile ranges; LOS: length of stay; PLND: pelvic lymph node dissection; PSM: positive surgical margin; (O)(RA)RP, (open) (robot-assisted) radical prostatectomy
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Affiliation(s)
- Muhieddine Labban
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Wassim Wazzan
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Raja Khauli
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Albert El Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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Mazzone E, Mistretta FA, Knipper S, Tian Z, Larcher A, Widmer H, Zorn K, Capitanio U, Graefen M, Montorsi F, Shariat SF, Saad F, Briganti A, Karakiewicz PI. Contemporary National Assessment of Robot-Assisted Surgery Rates and Total Hospital Charges for Major Surgical Uro-Oncological Procedures in the United States. J Endourol 2020; 33:438-447. [PMID: 30931607 DOI: 10.1089/end.2018.0840] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: The role of robot assistance is increasingly gaining importance among all major surgical uro-oncological procedures (MSUPs). However, contemporary analyses showed that total hospital charges (THCGs) related to robot-assisted procedures exceed those of open procedures. Based on increasing familiarity with robot-assisted surgery, we postulated that THCGs may have decreased over the past half-decade. Thus, we tested contemporary trends and THCGs related to robot-assisted vs nonrobot-assisted MSUPs. Materials and Methods: Within the National Inpatient Sample database (2009-2015), we identified patients who underwent robot-assisted vs nonrobot-assisted (open or laparoscopic) MSUPs, which included radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN), and radical cystectomy (RC). Rates of robot-assisted MSUPs were evaluated using estimated annual percentage changes (EAPCs) analyses. The t-test was used to examine statistically significant differences between mean THCGs according to either robot-assisted or nonrobot-assisted approach. Finally, linear regression analyses were tested for annual variation in the mean THCGs. Results: Of 128,367 MSUPs, 47.7% were robot-assisted. Overall, robot-assisted surgery rates among MSUPs increased from 40.3% to 57.6% (EAPC: +6.3%, p < 0.001) between 2009 and 2015. The mean THCGs for robot-assisted RP, RN, PN, and RC were $13,799, $18,789, $16,574, and $33,575, respectively. The observed mean THCGs differences between robot-assisted and nonrobot-assisted MSUPs were +$1594, +$1592, and +$1829 for RP, RN, and RC, respectively (all p < 0.05). Conversely, no statistically significant difference in the mean THCGs was reported between robot-assisted and nonrobot-assisted PN (+$367, p > 0.05). Finally, the annual observed mean THCGs linearly decreased for all robot-assisted MSUPs during the study period. Conclusions: Rates of robot-assisted MSUPs exponentially increased between 2009 and 2015. Although the mean THCGs decreased in a significant manner during the study period for all MSUPs, THCGs of robot-assisted RP, RN, and RC still exceed those of their respective nonrobot-assisted counterparts. Conversely, no differences in the mean THCGs were reported between robot-assisted vs nonrobot-assisted PN.
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Affiliation(s)
- Elio Mazzone
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco A Mistretta
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,3 Department of Urology, European Institute of Oncology, Milan, Italy
| | - Sophie Knipper
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,4 Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alessandro Larcher
- 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Hugues Widmer
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Kevin Zorn
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Umberto Capitanio
- 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Markus Graefen
- 4 Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Fred Saad
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Alberto Briganti
- 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW The goal of this paper was to identify areas of importance in modern urology education that are not currently emphasized in current urological curricula. RECENT FINDINGS We identified curricular deficits in robotic surgical simulation, transgender health, leadership, business management, and social media training. Few practicing urologists feel comfortable managing transgender-specific needs, and most training programs do not adequately address transgender health. Urology programs also do not sufficiently emphasize topics in leadership, business management, or appropriate social media usage. With respect to simulation, while it is currently included in the Accreditation Council for Graduate Medical Education (ACGME) program requirements, it is currently under-utilized for training in robotic surgery. It is important for urologists to receive adequate training for the modern practice landscape. Where knowledge gaps among early practicing urologists arise, programs should adapt their curricula to address them.
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Keating MF, Zhang J, Feider CL, Retailleau S, Reid R, Antaris A, Hart B, Tan G, Milner TE, Miller K, Eberlin LS. Integrating the MasSpec Pen to the da Vinci Surgical System for In Vivo Tissue Analysis during a Robotic Assisted Porcine Surgery. Anal Chem 2020; 92:11535-11542. [PMID: 32786489 DOI: 10.1021/acs.analchem.0c02037] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Minimally invasive robotic-assisted surgeries have been increasingly used as a first-line of treatment for patients undergoing oncologic surgeries. In-situ tissue identification is critical to guide tissue resection and assist decision-making. Traditional intraoperative histopathologic analysis of frozen tissue sections can be time-consuming and present logistical challenges which interrupt surgical workflows. We report the development and implementation of a laparoscopic, drop-in version of the MasSpec Pen device integrated into the da Vinci Xi Surgical system for in vivo tissue analysis in a robotic-assisted porcine surgery. We evaluated the performance of the drop-in MasSpec Pen during surgery by introducing the device into the animal upper gastrointestinal system and performing in vivo analyses of the stomach and liver, including charred and bloody tissues after electrocauterization. The molecular profiles obtained included ions tentatively identified as metabolites and lipids typically observed with MasSpec Pen analysis, without causing observable tissue damage. Statistical classifiers built to distinguish porcine liver and stomach tissues using the in vivo data yielded an overall tissue identification accuracy of 98% (n = 53 analyses). The results provide evidence that the drop-in MasSpec Pen developed can be used to acquire mass spectra in vivo during a robotic-assisted surgery and might be used as an in vivo tissue assessment tool to help guide surgical resections and streamline surgical workflows.
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Affiliation(s)
- Michael F Keating
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78751, United States
| | - Jialing Zhang
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78751, United States
| | - Clara L Feider
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78751, United States
| | | | - Robert Reid
- Intuitive Surgical, Sunnyvale, California 94086, United States
| | | | - Bradley Hart
- Thermo Fisher Scientific, San Jose, California 95134, United States
| | - Gina Tan
- Thermo Fisher Scientific, San Jose, California 95134, United States
| | - Thomas E Milner
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas 78751, United States
| | - Kyle Miller
- Intuitive Surgical, Sunnyvale, California 94086, United States
| | - Livia S Eberlin
- Department of Chemistry, The University of Texas at Austin, Austin, Texas 78751, United States
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Min BH, Oh TK, Song IA, Jeon YT. Comparison of the effects of sugammadex and neostigmine on hospital stay in robot-assisted laparoscopic prostatectomy: a retrospective study. BMC Anesthesiol 2020; 20:178. [PMID: 32693776 PMCID: PMC7372771 DOI: 10.1186/s12871-020-01088-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sugammadex reduces postoperative complications. We sought to determine whether it could reduce the length of hospital stay, post-anesthetic recovery time, unplanned readmission, and charges for patients who underwent robot-assisted laparoscopic prostatectomy (RALP) when compared to neostigmine. METHODS This was a retrospective observational study of patients who underwent RALP between July 2012 and July 2017, in whom rocuronium was used as a neuromuscular blocker. The primary outcome was the length of hospital stay after surgery in patients who underwent reversal with sugammadex when compared to those who underwent reversal with neostigmine. The secondary outcomes were post-anesthetic recovery time, hospital charges, and unplanned readmission within 30 days after RALP. RESULTS In total, 1430 patients were enrolled. Using a generalized linear model in a propensity score-matched cohort, sugammadex use was associated with a 6% decrease in the length of hospital stay (mean: sugammadex 7.7 days vs. neostigmine 8.2 days; odds ratio [OR] 0.94, 95% confidence interval [CI] [0.89, 0.98], P = 0.008) and an 8% decrease in post-anesthetic recovery time (mean: sugammadex 36.7 min vs. neostigmine 40.2 min; OR 0.92, 95% CI [0.90, 0.94], P < 0.001) as compared to neostigmine use; however, it did not reduce the 30-day unplanned readmission rate (P = 0.288). The anesthesia charges were higher in the sugammadex group than in the neostigmine group (P < 0.001); however, there were no significant differences between the groups in terms of postoperative net charges (P = 0.061) and total charges (P = 0.100). CONCLUSIONS Compared to the reversal of rocuronium effects with neostigmine, reversal with sugammadex after RALP was associated with a shorter hospital stay and post-anesthetic recovery time, and was not associated with 30-day unplanned readmission rates and net charges.
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Affiliation(s)
- Byung-Hun Min
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.,Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
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Urish KL, Qin Y, Salka B, Li BY, Borza T, Sessine M, Kirk P, Hollenbeck BK, Helm JE, Lavieri MS, Skolarus TA, Jacobs BL. Comparison of readmission and early revision rates as a quality metric in total knee arthroplasty using the Nationwide Readmission Database. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:687. [PMID: 32617307 PMCID: PMC7327322 DOI: 10.21037/atm-19-3463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background After release of the Comprehensive Care for Joint Replacement bundle, there has been increased emphasis on reducing readmission rates for total knee arthroplasty (TKA). The potential for a separate, clinically-relevant metric, TKA revision rates within a year following surgery, has not been fully explored. Based on this, we compared rates and payments for TKA readmission and revision procedures as metrics for improving quality and cost. Methods We utilized the 2013 Nationwide Readmission Database (NRD) to examine national readmission and revision rates, the reasons for revision procedures, and associated costs for elective TKA procedures. As data are not linked across years, we examined revision rates for TKA completed in the month of January by capturing revision procedures in the subsequent following 11-month period to approximate a 1-year revision rate. Diagnosis and procedure codes for revision procedures were collected. Average readmission and revision procedure costs were then calculated, and the cost distributed across the entire TKA population. Results We identified 20,851 patients having TKA surgery. The mean unadjusted 30- and 90-day TKA readmission rates were 3.4% and 5.8%, respectively. In contrast, the mean unadjusted 3-month and approximate 1-year reoperation rates were 1.0% and 1.6%, respectively. The most common cause for revision was periprosthetic joint infection, which accounting for 62% of all reported revision procedures. The mean payment for 90-day readmission was roughly half ($10,589±$11,084) of the mean inpatient payment for single reoperation procedure at 90 days ($20,222±$17,799). Importantly, nearly half (46%) of all 90-day readmissions were associated with a reoperation event within the first year. Conclusions Readmission following TKA is associated with a 1-year reoperation in approximately half of patients. These reoperations represent a significant patient burden and have a higher per episode cost. Early reoperation may represent a more clinically relevant target for quality improvement and cost containment.
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Affiliation(s)
- Kenneth L Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Yongmei Qin
- Department of Urology, Division of Oncology, Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, MI, USA
| | - Bassel Salka
- Department of Urology, Division of Oncology, Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Y Li
- Department of Urology, Division of Oncology, Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, MI, USA
| | - Tudor Borza
- Department of Urology, University of Wisconsin School of Medicine and Public Health, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Michael Sessine
- Department of Urology, Division of Oncology, Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, MI, USA
| | - Peter Kirk
- Department of Urology, Division of Oncology, Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, MI, USA
| | - Brent K Hollenbeck
- Department of Urology, Division of Oncology, Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan E Helm
- Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Mariel S Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ted A Skolarus
- Department of Urology, Division of Oncology, Dow Division for Urologic Health Service Research, Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
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Three Different Ways of Treating Primary Hepatocellular Carcinoma at an Early Stage: A Prospective Comparative Study. Gastroenterol Res Pract 2020; 2020:7802498. [PMID: 32508913 PMCID: PMC7245688 DOI: 10.1155/2020/7802498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023] Open
Abstract
Primary hepatocellular carcinoma (PHC) is one of the most common malignancies in clinical practice. According to the "Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China," PHC, at an early stage, can be treated by surgical resection and ablation. Surgical resection basically consists of two ways; one is open hepatectomy (OH), and the other is laparoscopic hepatectomy (LH), which is a newly developed technique associated with advantages of open surgery. Ablation, also known as percutaneous thermal ablation using radiofrequency ablation (RFA) and microwave ablation (MWA), is a minimally invasive curative treatment for hepatocellular carcinoma. This preliminary report was aimed at evaluating the postoperative outcome of the patients undergoing these three therapeutic methods, respectively. The study analyzed the data of 95 patients who underwent LH, OH, or ablation between June 2018 and June 2019 at First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University. There were 20 patients in the ablation group, 35 patients in the OH group, and 40 patients in the LH group. Among the three groups, the postoperative short-term outcome was the best in the ablation group, suggesting that it was a safe and cheap way to treat PHC at an early stage.
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Desai A, Hudnall M, Weiner AB, Patel M, Cohen J, Gogana P, Sharifi R, Meeks JJ. Contemporary Comparison of Open to Robotic Prostatectomy at a Veteran's Affairs Hospital. Mil Med 2020; 184:e330-e337. [PMID: 30535336 DOI: 10.1093/milmed/usy352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/12/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Among veterans, prostate cancer is the most common malignancy and has a higher incidence compared to the rest of the nation. No study has compared the effectiveness of Robotic-assisted-laparoscopic radical prostatectomy (RALP) vs. open radical prostatectomy (ORP) in the Veteran's Affairs (VA) hospital setting during the adoption of RALP. METHODS Institutional Review Board approval was obtained. Retrospective review was completed on Veterans with prostate cancer who underwent ORP or RALP from March 2011 to January 2017 during the introduction of RALP at one VA hospital. Perioperative and functional outcomes between ORP and RALP were compared as well as between the initial 50 and final 53 RALPs. RESULTS Among 91 ORPs and 153 RALPs, RALP had significant reductions in blood transfusions [2(1.3%) vs. 44(40%), p < 0.001], length of stay [2 days(1-2) vs. 3 days(2-4), p < 0.001], Clavien grade >2 complications [1(0.7%) vs. 20 (22.0%), p < 0.001], urine leak [2(1.3%) vs. 11 (12.1%), p < 0.001], and ICU readmissions [0(0%) vs. 3(3.3%), p < 0.001]. There were no significant differences in positive margin status or functional outcomes. Compared to the first 50 cases, the last 53 RALPs demonstrated a shorter operative time (349 vs. 292 min, p < 0.001), lower EBL (300 vs. 150 mL, p < 0.001), more frequent 1-day length of stay (34% vs. 60%, p = 0.02), and fewer composite adverse events (82% vs. 51%, p = 0.004). Operative time for the final 53 RALPs (292 minutes) was shorter than that of ORP (325 minutes, p = 0.013). CONCLUSIONS During the introduction of RALP at one VA hospital, RALP was associated with several improved parameters compared to ORP and similar operative times were noted after the first 100 cases of RALPs. RALP is safe to introduce in a VA setting without compromising outcomes.
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Affiliation(s)
- Anuj Desai
- Department of Urology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL
| | - Matthew Hudnall
- Department of Urology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL
| | - Adam B Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL
| | - Mehul Patel
- Department of Urology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL
| | - Jason Cohen
- Department of Urology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL
| | - Pooja Gogana
- Department of Urology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL.,Department of Surgery, Jesse Brown VA Hospital, 820 S Damen Ave, Chicago, IL
| | - Roohallah Sharifi
- Department of Surgery, Jesse Brown VA Hospital, 820 S Damen Ave, Chicago, IL
| | - Joshua J Meeks
- Department of Urology, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL.,Department of Surgery, Jesse Brown VA Hospital, 820 S Damen Ave, Chicago, IL
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Kozminski DJ, Cerf MJ, Feustel PJ, Kogan BA. Robot set-up time in urologic surgery: an opportunity for quality improvement. J Robot Surg 2020; 14:745-752. [PMID: 32040816 DOI: 10.1007/s11701-020-01049-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Robotic-assisted techniques are widespread in urology. However, prolonged preparation time for robotic cases hinders operating room (OR) efficiency and frustrates robotic surgeons. Pre-operative times are an opportunity for quality improvement (QI) and enhancing OR throughput. We have previously shown that pre-operative times in robotic cases are highly variable and that increasing patient complexity was associated with longer times. Our objective was to characterize set-up times in robotic urology cases and to determine whether prolongation was due to robot set-up, in particular. MATERIALS AND METHODS Patients undergoing robotic-assisted urology procedures at our academic institution had routine peri-operative collection of demographic data and OR time stamps. Following IRB approval, we retrospectively reviewed set-up times from an OR database. Multivariable analysis was used to assess the influence of independent patient variables-gender (M/F), smoking history, age, BMI, American Society of Anesthesiologists (ASA) Physical Status Classification, and Charlson Comorbidity Index (CCI)-on robot set-up times. Institutional factors including procedure, surgeon, and case year were also assessed. RESULTS A total of 808 patients undergoing 816 robotic-assisted procedures from 2013 to 2018 met inclusion criteria. Robot set-up times varied only by gender (F > M) but not by general patient complexity. Age, BMI, smoking status, ASA, and CCI did not play a role in prolonging robot set-up times. There was marked variability of robot set-up times, even within procedure type. Robot set-up times generally improved over time for a given surgeon. CONCLUSIONS Robot set-up time is not affected by patient complexity, in contrast to pre-operative time. It is affected by procedure type and does improve with experience. There is wide variability of robot set-up times and this is an important target for surgical QI.
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Affiliation(s)
- David J Kozminski
- Division of Urology, Department of Surgery, Albany Medical College, Albany Medical Center, Albany, NY, USA.
| | - Matthieu J Cerf
- Health Data Analytics Group, Albany Medical Center, Albany, NY, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Barry A Kogan
- Division of Urology, Department of Surgery, Albany Medical College, Albany Medical Center, Albany, NY, USA
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Nabi J, Friedlander DF, Chen X, Cole AP, Hu JC, Kibel AS, Dasgupta P, Trinh QD. Assessment of Out-of-Pocket Costs for Robotic Cancer Surgery in US Adults. JAMA Netw Open 2020; 3:e1919185. [PMID: 31940036 PMCID: PMC6991257 DOI: 10.1001/jamanetworkopen.2019.19185] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Expensive technologies-including robotic surgery-experience rapid adoption without evidence of superior outcomes. Although previous studies have examined perioperative outcomes and costs, differences in out-of-pocket costs for patients undergoing robotic surgery are not well understood. OBJECTIVE To assess out-of-pocket costs and total payments for 5 types of common oncologic procedures that can be performed using an open or robotic approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective, cross-sectional, propensity score-weighted analysis was performed using deidentified insurance claims for 1.9 million enrollees from the MarketScan database from January 1, 2012, to December 31, 2017. The final study sample comprised 15 893 US adults aged 18 to 64 years who were enrolled in an employer-sponsored health plan. Patients underwent either an open or robotic radical prostatectomy, hysterectomy, partial colectomy, radical nephrectomy, or partial nephrectomy for a solid-organ malignant neoplasm. Statistical analysis was performed from December 18, 2018, to June 5, 2019. EXPOSURES Type of surgical procedure-robotic vs open. MAIN OUTCOMES AND MEASURES The primary outcome of interest was out-of-pocket costs associated with robotic and open surgery. The secondary outcome of interest was associated total payments. RESULTS Among 15 893 patients (11 102 men; mean [SD] age, 55.4 [6.6] years), 8260 underwent robotic and 7633 underwent open procedures; patients undergoing robotic hysterectomy were older than those undergoing open hysterectomy (mean [SD] age, 55.7 [6.7] vs 54.6 [7.2] years), and patients undergoing open radical nephrectomy had more comorbidities than those undergoing robotic radical nephrectomy (≥2 comorbidities, 658 of 861 [76.4%] vs 244 of 347 [70.3%]). After adjustment for baseline characteristics, the robotic approach was associated with lower out-of-pocket costs for all procedures: -$137.75 (95% CI, -$240.24 to -$38.63) for radical prostatectomy (P = .006); -$640.63 (95% CI, -$933.62 to -$368.79) for hysterectomy (P < .001); -$1140.54 (95% CI, -$1397.79 to -$896.54) for partial colectomy (P < .001); -$728.32 (95% CI, -$1126.90 to -$366.08) for radical nephrectomy (P < .001); and -$302.74 (95% CI, -$523.14 to -$97.10) for partial nephrectomy (P = .003). The robotic approach was similarly associated with lower adjusted total payments: -$3872.62 (95% CI, -$5385.49 to -$2399.04) for radical prostatectomy (P < .001); -$29 640.69 (95% CI, -$36 243.82 to -$23 465.94) for hysterectomy (P < .001); -$38 151.74 (95% CI, -$46 386.16 to -$30 346.22) for partial colectomy; (P < .001); -$33 394.15 (95% CI, -$42 603.03 to -$24 955.20) for radical nephrectomy (P < .001); and -$9162.52 (95% CI, -$12 728.33 to -$5781.99) for partial nephrectomy (P < .001). CONCLUSIONS AND RELEVANCE This study found significant variation in perioperative costs according to surgical technique for both patients (out-of-pocket costs) and payers (total payments); the robotic approach was associated with lower out-of-pocket costs for all studied oncologic procedures.
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Affiliation(s)
- Junaid Nabi
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David F. Friedlander
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xi Chen
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P. Cole
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Adam S. Kibel
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prokar Dasgupta
- Medical Research Council Centre for Transplantation, National Institute for Health Research Biomedical Research Centre, King’s College, London, United Kingdom
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Outcomes of robot-assisted transperitoneal pyeloplasty: Case series. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.638664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Uhlig A, Uhlig J, Trojan L, Hinterthaner M, von Hammerstein-Equord A, Strauss A. Surgical approaches for treatment of ureteropelvic junction obstruction - a systematic review and network meta-analysis. BMC Urol 2019; 19:112. [PMID: 31711468 PMCID: PMC6849262 DOI: 10.1186/s12894-019-0544-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 10/24/2019] [Indexed: 12/04/2022] Open
Abstract
Background Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. Methods A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. Results A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003). Conclusions Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.
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Affiliation(s)
- Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
| | - Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.,Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Lutz Trojan
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Arne Strauss
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
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Zeng L, Tian M, Chen SS, Ke YT, Geng L, Yang SL, Ye L. Short-term Outcomes of Laparoscopic vs. Open Hepatectomy for Primary Hepatocellular Carcinoma: A Prospective Comparative Study. Curr Med Sci 2019; 39:778-783. [PMID: 31612396 DOI: 10.1007/s11596-019-2105-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/03/2019] [Indexed: 02/06/2023]
Abstract
Laparoscopic hepatectomy (LH) is a newly developed technique associated with advantages as open surgery, but the study on outcome of liver function recovery was scarce. This preliminary report was aimed to comparatively assess the short-term outcomes between LH and open hepatectomy (OH) for primary hepatocellular carcinoma (PHC). This study retrospectively analyzed the demographic data and short-term outcomes of 81 patients who underwent LH or OH for the primary treatment of PHC between Oct. 2017 and May 2018 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (China). A total of 81 PHC patients who received major liver resection were enrolled. There were 38 (47%) patients in the LH group and 43 (53%) patients in the OH group. The operative time was significantly longer (373.53±173.38 vs. 225.43±55.08, P<0.01), and hospital stay (17.34±5.93 vs. 21.70±6.89, P=0.003), exhaust time (2.32±0.62 vs. 3.07±0.59, P<0.01) and defecation time (2.92±0.78 vs. 3.63±0.58, P<0.01) were significantly shorter in LH group than in OH group. The recovery of liver function was significantly faster in LH group, including higher serum albumin (P=0.002), higher ratio of albumin/globulin (P=0.029) and lower direct bilirubin (P=0.001) than in OH group. It is suggested that LH can serve as a fast recovery and cheap surgical procedure in the treatment of PHC, which is safe and feasible.
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Affiliation(s)
- Li Zeng
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Min Tian
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Si-Si Chen
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu-Ting Ke
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li Geng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Sheng-Li Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Lin Ye
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Sentell KT, Badani KK, Paulucci DJ, Hemal AK, Porter J, Eun DD, Bhandari A, Abaza R. A Single Overnight Stay After Robotic Partial Nephrectomy Does Not Increase Complications. J Endourol 2019; 33:1003-1008. [PMID: 31422698 DOI: 10.1089/end.2019.0218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: To evaluate the feasibility of postoperative day 1 (POD1) discharge after robotic partial nephrectomy (RPN) and to determine whether a protocol targeting a shorter length of stay (LOS) is associated with any difference in the rate of postoperative complications. Materials and Methods: We reviewed a prospectively maintained, multi-institutional database of patients who underwent RPN from September 2013 to September 2016. Three of the six participating surgeons used a protocol that targeted discharge on POD1, whereas three surgeons did not. Patient characteristics and postoperative complication rates between the two groups were compared. Results: A total of 665 patients were included, 455 of whom were treated by surgeons utilizing a POD1 discharge protocol, whereas 210 were not. The mean LOS for those in the POD1 protocol group was 1.13 days vs 2.02 days in the non-protocol group. Between groups, there were no differences in age (p = 0.098), body mass index (p = 0.164), tumor size (p = 0.502), or R.E.N.A.L. Nephrometry score (p = 0.974), but POD1 discharge protocol patients had higher age-adjusted Charlson comorbidity score (4 vs 2, p = 0.033), were less likely to have a hilar tumor (15.9% vs 23.1%, p = 0.03), and had a larger percent decrease in discharge estimated glomerular filtration rate (-15.9% vs -7.1%, p < 0.001). There were no differences in the rates of overall (p = 0.715), major (p = 0.164), medical (p = 0.089), or surgical complications (p = 0.301) or in complications by the Clavien-Dindo category (p = 0.13). Conclusion: Discharge on POD1 after RPN is feasible, reproducible by different surgeons, and not associated with an increased risk of postoperative complications.
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Affiliation(s)
- Katherine T Sentell
- OhioHealth Robotic Urologic and Cancer Surgery, Dublin Methodist Hospital, Dublin, Ohio
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David J Paulucci
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, Washington
| | - Daniel D Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Akshay Bhandari
- Division of Urology, Columbia University at Mount Sinai, Miami Beach, Florida
| | - Ronney Abaza
- OhioHealth Robotic Urologic and Cancer Surgery, Dublin Methodist Hospital, Dublin, Ohio
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Devos G, Muilwijk T, Raskin Y, Calderon V, Moris L, Van den Broeck T, Berghen C, De Meerleer G, Albersen M, Van Poppel H, Everaerts W, Joniau S. Comparison of Peri-operative and Early Oncological Outcomes of Robot-Assisted vs. Open Salvage Lymph Node Dissection in Recurrent Prostate Cancer. Front Oncol 2019; 9:781. [PMID: 31555579 PMCID: PMC6737006 DOI: 10.3389/fonc.2019.00781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/01/2019] [Indexed: 01/06/2023] Open
Abstract
Introduction: Salvage lymph node dissection (sLND) has been proposed as a treatment option for prostate cancer patients with lymph node (LN) recurrence following radical prostatectomy to delay or avoid palliative androgen deprivation therapy (ADT). Historically sLND has been performed using an open approach, with its associated morbidity. A limited number of studies have reported peri-operative outcomes following robot-assisted sLND. However, a direct comparison with the open approach has hitherto not yet been reported. This study investigates whether robot-assisted sLND is associated with better peri-operative outcomes compared to the open approach. Early oncological outcomes are also compared. Patients and methods: In this retrospective study, clinical data were collected from 60 patients undergoing open sLND between 2010-2016 and 30 patients undergoing robot-assisted sLND between 2016 and 2018 at our tertiary referral center. The primary objective of the study was to compare peri-operative outcomes (length of stay, estimated blood loss, operative time, intra-operative, and postoperative complications) and LN yield between both procedures. As secondary objective early oncological outcome [biochemical recurrence-free survival (BRFS) and clinical recurrence-free survival (CRFS)] was compared. Variables of interest were compared using the chi-squared test (categorical variables), two sample t-test, and Mann-Whitney U-test (continuous variables). To compare BRFS and CRFS, Kaplan-Meier analysis, and log-rank tests were performed. Results: Robotic sLND was associated with reduced blood loss (median 100 vs. 275cc; p < 0.0001) and shorter length of stay (median 2 vs. 7 days; p < 0.0001) compared to open sLND. Moreover, postoperative complications within 30 days after surgery were more prevalent in the open sLND group compared to the robotic group (41.6% vs. 20%, p = 0.04). No significant differences in LN yield (for each sLND template), BRFS, and CRFS were detected between both groups. Conclusion: Robot-assisted sLND is associated with significantly reduced peri-operative morbidity compared to open sLND. No difference in LN yield, BRFS and CRFS was seen between both groups. Modern imaging techniques underestimate the tumor burden and therefore, the surgical sLND template should not be limited to the positive spots on pre-operative imaging.
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Affiliation(s)
- Gaëtan Devos
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Yannic Raskin
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Victor Calderon
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | | | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Congnard D, Vincendeau S, Lahjaouzi A, Neau AC, Chaize C, Estèbe JP, Mathieu R, Beloeil H. Outpatient Robot-assisted Radical Prostatectomy: A Feasibility Study. Urology 2019; 128:16-22. [DOI: 10.1016/j.urology.2019.01.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 12/29/2022]
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