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Kamei J, Endo K, Yamazaki M, Sugihara T, Takaoka EI, Ando S, Kume H, Fujimura T. Lower bleeding volume contributes to decreasing surgical site infection in radical cystectomy: A propensity score-matched comparison of open versus robot-assisted radical cystectomy. Int J Urol 2024; 31:430-437. [PMID: 38173290 DOI: 10.1111/iju.15382] [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: 08/25/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To compare the incidence of surgical site infections (SSI) between robot-assisted and open radical cystectomies and investigate the risk factors for SSI after radical cystectomies. METHODS Consecutive patients who underwent radical cystectomy between July 2008 and December 2022 were retrospectively reviewed. The prevalence and characteristics of SSI after open and robot-assisted radical cystectomies were compared, and the risk factors for SSI were investigated using propensity score matching. RESULTS This study enrolled 231 patients (open: 145, robot-assisted: 86). In the robot-assisted group, urinary diversion was performed using an intracorporeal approach. SSI occurred in 34 (open: 28, robot-assisted: 6) patients, and the incidence was significantly lower in the robot-assisted group (19.3% vs. 7.0%, p = 0.007). After propensity score matching cohort (open: 34, robot-assisted: 34), increased bleeding volume, blood transfusion, and delayed postoperative oral feeding were significantly associated with SSI. Only increased bleeding volume remained a significant risk factor in the multivariate regression analysis (odds ratio, 1.13 [per 100 mL increase]; 95% confidence interval: 1.02-1.25; p = 0.001). The cutoff bleeding volume for predicting SSI was 1630 mL with an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.773, 0.73, and 0.75, respectively. CONCLUSIONS The incidence of SSI after robot-assisted radical cystectomy was significantly lower than that after the open procedure. However, decreased bleeding volume, which was significantly associated with robot-assisted procedures, was an independent and more significant factor for reducing SSI after radical cystectomy than the differences of the surgical procedure even after propensity score matching.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kaori Endo
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | - Toru Sugihara
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | - Satoshi Ando
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Haruki Kume
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Zukiwskyj M, Nicol A, Heathcote P. Incisional hernias following robotic-assisted laparoscopic prostatectomy: does the extraction site matter? J Robot Surg 2024; 18:61. [PMID: 38308726 DOI: 10.1007/s11701-023-01816-3] [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: 11/20/2023] [Accepted: 12/28/2023] [Indexed: 02/05/2024]
Abstract
The incidence of incisional hernia (IH) following robotic-assisted laparoscopic prostatectomy (RALP) varies widely within the literature (0.4-9.7%). Whilst small hernias may go unnoticed, the potential exists for bowel strangulation and subsequent emergency surgery. We suggest that the extraction site may influence the rate of IH. A retrospective chart review of a single surgeon RALP series was undertaken. One hundred charts were sampled, of which 69 had sufficient data to be analysed. Prior to July 2017, specimen extraction had been via the supra-umbilical port site. After this time, specimens were extracted via a Pfannenstiel incision. Of the 69 patients, 24 underwent RALP prior to July 2017. Three patients developed IH at the supra-umbilical port extended for extraction site in the pre-2017 group and three patients developed IH at the supra-umbilical port (not extraction) site in the post-2017 group. The rate of IH was almost double in the pre-July 2017 group (12.5% vs. 6.7%). No patient developed an incisional hernia at the Pfannenstiel site in the post-2017 group. In our series, no patient developed a hernia at the Pfannenstiel site. This is in keeping with the reported < 1% IH rate following Pfannenstiel specimen extraction. Given that incisional hernias are a known complication of robotic surgery, thought should be given to changing the site of specimen extraction site to lower the rate of incisional hernias and the morbidity associated with such.
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Affiliation(s)
- Marianna Zukiwskyj
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - Alice Nicol
- Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Peter Heathcote
- Greenslopes Hospital, Newdegate Street, Greenslopes, QLD, 4121, Australia
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Rabinowitz J, Kinnear N, O'Callaghan M, Hennessey D, Shafi F, Fuller A, Ibrahim M, Lane T, Adshead J, Vasdev N. Systematic review of the ophthalmic complications of robotic-assisted laparoscopic prostatectomy. J Robot Surg 2024; 18:46. [PMID: 38240959 DOI: 10.1007/s11701-023-01771-z] [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: 09/24/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
This study aims to review ophthalmic injuries sustained during of robotic-assisted laparoscopic prostatectomy (RALP). A search of Medline, Embase, Cochrane and grey literature was performed using methods registered a priori. Eligible studies were published 01/01/2010-01/05/2023 in English and reported ophthalmic complications in cohorts of > 100 men undergoing RALP. The primary outcome was injury incidence. Secondary outcomes were type and permanency of ophthalmic complications, treatments, risk factors and preventative measures. Nine eligible studies were identified, representing 100,872 men. Six studies reported rates of corneal abrasion and were adequately homogenous for meta-analysis, with a weighted pooled rate of 5 injuries per 1000 procedures (95% confidence interval 3-7). Three studies each reported different outcomes of xerophthalmia, retinal vascular occlusion, and ophthalmic complications unspecified in 8, 5 and 2 men per 1000 procedures respectively. Amongst identified studies, there were no reports of permanent ophthalmic complications. Injury management was poorly reported. No significant risk factors were reported, while one study found African-American ethnicity protective against corneal abrasion (0.4 vs. 3.9 per 1000). Variables proposed (but not proven) to increase risk for corneal abrasion included steep Trendelenburg position, high pneumoperitoneum pressure, prolonged operative time and surgical inexperience. Compared with standard of care, occlusive eyelid dressings (23 vs. 0 per 1000) and foam goggles (20 vs. 1.3 per 1000) were found to reduce rates of corneal abrasion. RALP carries low rates of ophthalmic injury. Urologists should counsel the patient regarding this potential complication and pro-actively implement preventative strategies.
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Affiliation(s)
| | - Ned Kinnear
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK.
- Flinders Medical Centre, Adelaide, Australia.
| | - Michael O'Callaghan
- Flinders Medical Centre, Adelaide, Australia
- Flinders University, Adelaide, Australia
- University of Adelaide, Adelaide, Australia
| | | | - Fariha Shafi
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | | | | | - Timothy Lane
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - James Adshead
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - Nikhil Vasdev
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
- University of Hertfordshire, Hatfield, UK
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Togioka BM, Harriman KA, Ye S, Berli J. Frequency and Characteristics of Postoperative Neuropathy in Individuals on Gender-Affirming Hormone Therapy Undergoing Gender Affirmation Surgery: A Retrospective Cohort Study. Cureus 2023; 15:e47988. [PMID: 38034215 PMCID: PMC10686520 DOI: 10.7759/cureus.47988] [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] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Gender affirmation surgery includes procedures of the face, larynx, chest, reproductive system, external genitalia, and adipose tissue performed to ameliorate incongruence between gender identity and phenotype. The annual number of gender affirmation surgeries performed in the United States has increased significantly. There have been no investigations into the frequency of peripheral neuropathy after gender affirmation surgery, which is an important topic, given transgender individuals are at increased risk for delaying necessary medical care. After appreciating a number of cases of postoperative neuropathy in our clinical practice, we hypothesized that gender affirmation surgery is a high-risk procedure for postoperative neuropathy. Methods We conducted a one-year, monocentric, retrospective cohort study utilizing clinical data of individuals on gender-affirming hormone therapy undergoing gender-affirmation surgery under general anesthesia. The study included transgender women, assigned male at birth, receiving antiandrogen, progesterone, or estrogen therapy (target range plasma estradiol concentration 90-200 pg/ml) and transgender men, assigned female at birth, receiving antiestrogen or testosterone therapy (target range plasma testosterone concentration 320-1000 ng/dl). The primary objective was to estimate the incidence of postoperative peripheral neuropathy, defined as new numbness, paresthesia, neuropathic pain, or muscle weakness occurring in a peripheral innervation territory. Secondary objectives were to summarize the clinical presentation of neuropathy and investigate for associations between procedure characteristics and neuropathy. Results We identified nine cases of postoperative peripheral nerve injury in 232 consecutive gender affirmation procedures establishing an incidence of 3.9%. All injuries were associated with surgery longer than six hours and were characterized by sensory deficits including numbness 89% (8/9) and tingling 56% (5/9), which were diagnosed by postoperative day one. Conclusions Our results suggest that gender affirmation surgery is a high-risk procedure for postoperative neuropathy, with an incidence similar to other high-risk procedures, and an incidence that is higher than the general surgical population. However, given this has not been previously reported and our study includes a heterogenous population from a single institution, our results should be considered hypothesis generating. Additional studies that include multiple institutions are needed to confirm our findings and identify modifiable risk factors for postoperative neuropathy.
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Affiliation(s)
- Brandon M Togioka
- Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, USA
| | | | - Shangyuan Ye
- Biostatistics, Oregon Health & Science University, Portland, USA
| | - Jens Berli
- Plastic Surgery, Oregon Health & Science University, Portland, USA
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Ivos M, Wilhelm C, Sharma P. Evaluating the incidence, management, and recurrence of inguinal hernia during robotic prostatectomy: A literature review. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221095662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Robotic radical prostatectomy (RARP) is a well-established treatment for localised prostate adenocarcinoma. The benefits of this minimally invasive technique include shortened operative time and improved patient recovery. However, the development of inguinal hernia (IH) before, during, and following RARP has been reported. The aim of this study is to evaluate the incidence, management, and recurrence of IHs in patients undergoing RARP for prostate cancer. Methods: A literature search was conducted using the PubMed database from August 2007 to October 2020 using the keywords ‘robotic prostatectomy’ and ‘inguinal hernia’. Studies evaluating the incidence and recurrence of IH in patients undergoing RARP were identified and included. The initial search identified 77 articles. After excluding one duplicate, six case reports, three editorial comments, four articles not in English, eight review articles, and 14 studies that did not mention hernia incidence, 41 studies were included in our final literature review. Results: Concomitant IH repair (IHR) during RARP resulted in decreased symptomatic hernia recurrence during the follow-up period. When compared to patients who had not undergone hernia repair, the patients who underwent IHR during RARP did not experience greater complications in the postoperative period. Conclusions: Patients that undergo an intraoperative IHR during RARP did not experience significant adverse postoperative complications. Although operative time can slightly increase compared to RARP alone, we recommend a thorough preoperative physical examination in all patients scheduled to undergo RARP to evaluate for IH in addition to a thorough discussion with the patient of the risks and benefits of intraoperative repair. Level of evidence: Not applicable
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Affiliation(s)
- Mia Ivos
- School of Medicine, Texas Tech University Health Sciences Center, USA
| | | | - Pranav Sharma
- Department of Urology, School of Medicine, Texas Tech University Health Sciences Center, USA
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Risk of hernia formation after radical prostatectomy: a comparison between open and robot-assisted laparoscopic radical prostatectomy within the prospectively controlled LAPPRO trial. Hernia 2020; 26:157-164. [PMID: 32279170 PMCID: PMC8881255 DOI: 10.1007/s10029-020-02178-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/20/2020] [Indexed: 12/23/2022]
Abstract
Purpose In addition to incisional hernia, inguinal hernia is a recognized complication to radical retropubic prostatectomy. To compare the risk of developing inguinal and incisional hernias after open radical prostatectomy compared to robot-assisted laparoscopic prostatectomy. Method Patients planned for prostatectomy were enrolled in the prospective, controlled LAPPRO trial between September 2008 and November 2011 at 14 hospitals in Sweden. Information regarding patient characteristics, operative techniques and occurrence of postoperative inguinal and incisional hernia were retrieved using six clinical record forms and four validated questionnaires. Results 3447 patients operated with radical prostatectomy were analyzed. Within 24 months, 262 patients developed an inguinal hernia, 189 (7.3%) after robot-assisted laparoscopic prostatectomy and 73 (8.4%) after open radical prostatectomy. The relative risk of having an inguinal hernia after robot-assisted laparoscopic prostatectomy was 18% lower compared to open radical retropubic prostatectomy, a non-significant difference. Risk factors for developing an inguinal hernia after prostatectomy were increased age, low BMI and previous hernia repair. The incidence of incisional hernia was low regardless of surgical technique. Limitations are the non-randomised setting. Conclusions We found no difference in incidence of inguinal hernia after open retropubic and robot-assisted laparoscopic radical prostatectomy. The low incidence of incisional hernia after both procedures did not allow for statistical analysis. Risk factors for developing an inguinal hernia after prostatectomy were increased age and BMI. Electronic supplementary material The online version of this article (10.1007/s10029-020-02178-7) contains supplementary material, which is available to authorized users.
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