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Ramacciotti LS, Kaneko M, Strauss D, Hershenhouse JS, Rodler S, Cai J, Liang G, Aron M, Duddalwar V, Cacciamani GE, Gill I, Abreu AL. The learning curve for transperineal MRI/TRUS fusion prostate biopsy: A prospective evaluation of a stepwise approach. Urol Oncol 2024:S1078-1439(24)00574-X. [PMID: 39179437 DOI: 10.1016/j.urolonc.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE To evaluate the learning curve of a transperineal (TP) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion prostate biopsy (PBx). MATERIALS AND METHODS Consecutive patients undergoing MRI followed by TP PBx from May/2017 to January/2023, were prospectively enrolled (IRB# HS-13-00663). All participants underwent MRI followed by 12 to 14 core systematic PBx (SB), with at least 2 additional targeted biopsy (TB) cores per PIRADS ≥3. The biopsies were performed transperineally using an organ tracking image-fusion system. The cohort was divided into chronological quintiles. An inflection point analysis was performed to determine proficiency. Operative time was defined from insertion to removal of the TRUS probe from the patient's rectum. Grade Group ≥2 defined clinically significant prostate cancer (CSPCa). Statistically significant if P < 0.05. RESULTS A total of 370 patients were included and divided into quintiles of 74 patients. MRI findings and PIRADS distribution were similar between quintiles (P = 0.08). The CSPCa detection with SB+TB was consistent across quintiles: PIRADS 1 and 2 (range, 0%-18%; P = 0.25); PIRADS 3 to 5 (range, 46%-70%; P = 0.12). The CSPCa detection on PIRADS 3 to 5 TB alone, for quintiles 1 to 5, was respectively 44%, 58%, 66%, 41%, and 53% (P = 0.08). The median operative time significantly decreased for PIRADS 1 and 2 (33 min to 13 min; P < 0.01) and PIRADS 3 to 5 (48 min to 19 min; P < 0.01), reaching a plateau after 156 cases. Complications were not significantly different across quintiles (range, 0-5.4%; P = 0.3). CONCLUSIONS The CSPCa detection remained consistently satisfactory throughout the learning curve of the Transperineal MRI/TRUS fusion prostate biopsy. However, the operative time significantly decreased with proficiency achieved after 156 cases.
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Affiliation(s)
- Lorenzo Storino Ramacciotti
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Masatomo Kaneko
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David Strauss
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jacob S Hershenhouse
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Severin Rodler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jie Cai
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Gangning Liang
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Manju Aron
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Vinay Duddalwar
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Inderbir Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Andre Luis Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Soputro NA, Chavali JS, Ferguson EL, Ramos-Carpinteyro R, Calvo RS, Nguyen J, Moschovas MC, Wilder S, Okhawere K, De La Rosa RS, Saini I, Peabody J, Badani KK, Rogers C, Joseph J, Nix J, Patel V, Stifelman M, Ahmed M, Crivellaro S, Kim M, Kaouk JH. Complications of single-port robot-assisted radical prostatectomy: multi-institutional analysis from the Single-Port Advanced Research Consortium (SPARC). BJU Int 2024; 134:54-62. [PMID: 37971182 DOI: 10.1111/bju.16228] [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: 11/19/2023]
Abstract
OBJECTIVE To evaluate the perioperative complications of single-port robot-assisted radical prostatectomy (SP-RARP). PATIENTS AND METHODS A retrospective review was performed on the prospectively maintained, Institutional Review Board-approved, multi-institutional Single-Port Advanced Research Consortium (SPARC) database. A total of 1103 patients were identified who underwent three different approaches of SP-RARP between 2019 and 2022 using the purpose-built SP robotic platform. In addition to baseline clinical, perioperative outcomes, this study comprehensively analysed for any evidence of intraoperative complication, as well as postoperative complication and readmission within 90 days of the respective surgery. RESULTS Of the 244, 712, and 147 patients who underwent transperitoneal, extraperitoneal, and transvesical SP-RARP, respectively, intraoperative complications were noted in five patients (0.4%), all of which occurred during the transperitoneal approach. Two patients had bowel serosal tears, two had posterior button-holing of the bladder necessitating repair, and one patient had an obturator nerve injury. Postoperative complications were noted in 143 patients (13%) with major complications (Clavien-Dindo Grade ≥III) only identified in 3.7% of the total cohort. The most common complications were lymphocele (3.9%), acute urinary retention (2%), and urinary tract infection (1.9%). The 90-day re-admission rate was 3.9%. CONCLUSION The SP-RARP is a safe and effective procedure with low complication and readmission rates regardless of the approach. These results are comparable to current multi-port RARP literature.
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Affiliation(s)
- Nicolas A Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaya Sai Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Indu Saini
- Mount Sinai Hospital, New York City, NY, USA
| | | | | | | | - Jean Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Nix
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vipul Patel
- Advent Health Medical Group Urology, Celebration, FL, USA
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack, NJ, USA
- Hackensack Meridien School of Medicine, Hackensack, NJ, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ, USA
- Hackensack Meridien School of Medicine, Hackensack, NJ, USA
| | | | - Moses Kim
- Orange County Urology Associates, Laguna Hills, CA, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Soputro NA, Kaouk J. Single-port robot-assisted radical prostatectomy. World J Urol 2024; 42:245. [PMID: 38643347 PMCID: PMC11032265 DOI: 10.1007/s00345-024-04914-5] [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: 06/26/2023] [Accepted: 09/01/2023] [Indexed: 04/22/2024] Open
Abstract
PURPOSE To provide a comprehensive update on the different techniques and outcomes of contemporary Single-Port (SP) Robotic Radical Prostatectomy (RARP) approaches. METHODS A literature review was performed to identify cohort studies that have utilized the purpose-built SP robotic platform (Intuitive Surgical Inc., Sunnyvale, California) for RARP. All published approaches of SP-RARP were included in our review. Baseline clinical, perioperative, and postoperative oncological and functional outcomes were collected from the included studies. RESULTS A total of 16 studies involving 1159 patients were identified. To date, five approaches of SP-RARP have been described, namely Transperitoneal, Extraperitoneal, Retzius-Sparing, Transperineal, and Transvesical. The surgical steps and clinical outcomes of the aforementioned approaches were discussed. While operating times were still faster in the Transperitoneal and Extraperitoneal cohorts, the novel and more regionalized Transvesical approach allowed for radical prostatectomy to be pursued in more patients with previous abdominal surgeries and contributed to significantly improved postoperative outcomes, including the earlier return of urinary continence and with most patients being discharged on the same day without any opioids. CONCLUSION Based on the existing literature, the introduction of SP-RARP not only enriched the repertoire of minimally-invasive surgical treatment options for prostate cancer but also provided the opportunity for urologists to develop new techniques that can improve perioperative outcomes and postoperative quality of life. Given the limited number of patients and heterogeneity in the patient selection and reporting of postoperative outcomes, further research remains necessary to better understand the different benefits and improve patient selection algorithms for the different techniques.
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Affiliation(s)
- Nicolas A Soputro
- Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Glickman Tower, Q10, Cleveland, OH, 44195, USA
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Glickman Tower, Q10, Cleveland, OH, 44195, USA.
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Mian AH, Tollefson MK, Shah P, Sharma V, Mian A, Thompson RH, Boorjian SA, Frank I, Khanna A. Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy. J Clin Med 2024; 13:359. [PMID: 38256493 PMCID: PMC10815957 DOI: 10.3390/jcm13020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.
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Affiliation(s)
- Abrar H. Mian
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ahmed Mian
- Urology Associates of Green Bay, Green Bay, WI 54301, USA
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Abhinav Khanna
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
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Franco A, Ditonno F, Manfredi C, Johnson AD, Mamgain A, Feldman-Schultz O, Feng CL, Pellegrino AA, Mir MC, Porpiglia F, Crivellaro S, De Nunzio C, Chow AK, Autorino R. Robot-assisted Surgery in the Field of Urology: The Most Pioneering Approaches 2015-2023. Res Rep Urol 2023; 15:453-470. [PMID: 37842031 PMCID: PMC10575039 DOI: 10.2147/rru.s386025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Robot-assisted surgery has emerged as a transformative technology, revolutionizing surgical approaches and techniques that decades ago could barely be imagined. The field of urology has taken charge in pioneering a new era of minimally invasive surgery with the ascent of robotic systems which offer enhanced visualization, precision, dexterity, and enabling surgeons to perform intricate maneuvers with improved accuracy. This has led to improved surgical outcomes, including reduced blood loss, lower complication rates, and faster patient recovery. The aim of our review is to present an evidence-based critical analysis on the most pioneering robotic urologic approaches described over the last eight years (2015-2023).
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, “Luigi Vanvitelli” University, Naples, Italy
| | | | | | | | - Carol L Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
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