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May M, Gilfrich C, Bründl J, Ubrig B, Wagner JR, Gloger S, Student V, Merseburger AS, Thomas C, Brookman-May SD, Wolff I. Impact of Peritoneal Interposition Flap on Patients Undergoing Robot-assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2024; 10:80-89. [PMID: 37541915 DOI: 10.1016/j.euf.2023.07.007] [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: 06/03/2023] [Revised: 07/02/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
CONTEXT Symptomatic lymphocele (sLC) occurs at a frequency of 2-10% after robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND). Construction of bilateral peritoneal interposition flaps (PIFs) subsequent to completion of RARP + PLND has been introduced to reduce the risk of lymphocele, and was initially evaluated on the basis of retrospective studies. OBJECTIVE To conduct a systematic review and meta-analysis of only randomized controlled trials (RCTs) evaluating the impact of PIF on the rate of sLC (primary endpoint) and of overall lymphocele (oLC) and Clavien-Dindo grade ≥3 complications (secondary endpoints) to provide the best available evidence. EVIDENCE ACQUISITION In accordance with the Preferred Reporting Items for Meta-Analyses statement for observational studies in epidemiology, a systematic literature search using the MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE databases up to February 3, 2023 was performed to identify RCTs. The risk of bias (RoB) was assessed using the revised Cochrane RoB tool for randomized trials. Meta-analysis used random-effect models to examine the impact of PIF on the primary and secondary endpoints. EVIDENCE SYNTHESIS Four RCTs comparing outcomes for patients undergoing RARP + PLND with or without PIF were identified: PIANOFORTE, PerFix, ProLy, and PLUS. PIF was associated with odds ratios of 0.46 (95% confidence interval [CI] 0.23-0.93) for sLC, 0.51 (95% CI 0.38-0.68) for oLC, and 0.41 (95% CI 0.21-0.83) for Clavien-Dindo grade ≥3 complications. Functional impairment resulting from PIF construction was not observed. Heterogeneity was low to moderate, and RoB was low. CONCLUSIONS PIF should be performed in patients undergoing RARP and simultaneous PLND to prevent or reduce postoperative sLC. PATIENT SUMMARY A significant proportion of patients undergoing prostate cancer surgery have regional lymph nodes removed. This part of the surgery is associated with a risk of postoperative lymph collections (lymphocele). The risk of lymphocele can be halved via a complication-free surgical modification called a peritoneal interposition flap.
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Affiliation(s)
- Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany.
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Burkhard Ubrig
- Center for Minimally Invasive and Robotic Urology, Augusta Hospital Bochum, Witten/Herdecke University, Bochum, Germany
| | - Joseph R Wagner
- Urology Division, Hartford Healthcare Medical Group, Hartford Hospital, Hartford, CT, USA
| | - Simon Gloger
- Center for Minimally Invasive and Robotic Urology, Augusta Hospital Bochum, Witten/Herdecke University, Bochum, Germany
| | - Vladimir Student
- Department of Urology, University Hospital Olomouc, Olomouc, Czechia
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, University Hospital of the Technical University of Dresden, Dresden, Germany
| | - Sabine D Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University, Munich, Germany; Janssen Pharma Research and Development, Spring House, PA, USA
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
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Kim JE, Kaldany A, Lichtbroun B, Singer EA, Jang TL, Ghodoussipour S, Kim MM, Kim IY. Single-Port Robotic Radical Prostatectomy: Short-Term Outcomes and Learning Curve. J Endourol 2022; 36:1285-1289. [PMID: 35906798 PMCID: PMC9587764 DOI: 10.1089/end.2021.0885] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objective: In 2018, the U.S. Food and Drug Administration approved the da Vinci single-port (SP) system, in which four instruments are still utilized, but enter through a single-site access trocar. Herein, we report the largest case series for SP robot-assisted radical prostatectomy (RARP) to date. Our primary aim is to analyze the perioperative and short-term outcomes of this procedure. Our secondary aim is an assessment of the learning curve with this new platform. Methods: A total of 157 patients underwent SP RARP by two surgeons who have completed >3000 multiport robotic surgeries collectively. Institutional Review Board-approved prospectively collected data were used. Basic demographic preoperative variables and perioperative outcomes were analyzed. Results: Median patient age and prostate-specific antigen was 63 years and 6.3 ng/mL before treatment (interquartile range [IQR] 4.7-8.2 ng/mL). Average prostate weight was 47 g. The median operating time was 195 minutes (IQR 165-221.25 minutes) with a median estimated blood loss of 100 mL (IQR 100-200 mL). Surgeon 1's operating time stabilized around case #56, and Surgeon 2 around case #26. Surgeon 2 used the transperitoneal approach for the first 7 cases. There were no intraoperative complications. There were six total postoperative complications (3.8%) and four (2.5%) were Clavien-Dindo scale ≥IIIa. One hundred ten patients went home same day, 45 stayed 1 night at the hospital, with only 2 patients requiring stay in the hospital for more than 1 night (70%, 29%, and 1% respectively). With the median follow-up period of 9 months, rates of biochemical recurrence, pad-free, and potency preservation were 8.3%, 82.5%, and 64.4%, respectively. Conclusions: This case series confirms the safety and efficacy of SP RARP with acceptable short-term outcomes. There is a significant learning curve for this new modality. Shorter hospital stay appears to be an early benefit of the SP platform.
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Affiliation(s)
- Juliana E. Kim
- Division of Urology, Department of Surgery, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Alain Kaldany
- Division of Urology, Department of Surgery, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Benjamin Lichtbroun
- Division of Urology, Department of Surgery, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Eric A. Singer
- Division of Urology, Department of Surgery, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Thomas L. Jang
- Division of Urology, Department of Surgery, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Saum Ghodoussipour
- Division of Urology, Department of Surgery, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Moses M. Kim
- Orange County Urology Associates, Hoag Hospital, Irvine, California, USA
| | - Isaac Y. Kim
- Division of Urology, Department of Surgery, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
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