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Lee JH, Tanaka E, Woo Y, Ali G, Son T, Kim HI, Hyung WJ. Advanced real-time multi-display educational system (ARMES): An innovative real-time audiovisual mentoring tool for complex robotic surgery. J Surg Oncol 2017. [DOI: 10.1002/jso.24722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Joong Ho Lee
- Department of Surgery; National Health Insurance Service Ilsan Hospital; Goyang Republic of Korea
| | - Eiji Tanaka
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Department of Surgery; Kobe City Medical Center West Hospital; Kobe Japan
| | - Yanghee Woo
- Department of Surgery; City of Hope National Medical Center; Duarte California
| | - Güner Ali
- Department of General Surgery, Karadeniz Technical University College of Medicine; Farabi Hospital; Trabzon Turkey
| | - Taeil Son
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Gastric Cancer Center; Yonsei Cancer Center; Yonsei University Health System; Seoul Republic of Korea
- Robot and MIS Center, Severance Hospital; Yonsei University Health System; Seoul Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Gastric Cancer Center; Yonsei Cancer Center; Yonsei University Health System; Seoul Republic of Korea
- Robot and MIS Center, Severance Hospital; Yonsei University Health System; Seoul Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery; Yonsei University College of Medicine; Seoul Republic of Korea
- Gastric Cancer Center; Yonsei Cancer Center; Yonsei University Health System; Seoul Republic of Korea
- Robot and MIS Center, Severance Hospital; Yonsei University Health System; Seoul Republic of Korea
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Sato F, Nakagawa K, Kawauchi A, Matsubara A, Okegawa T, Habuchi T, Yoshimura K, Hoshi A, Kinoshita H, Miyajima A, Naitoh Y, Inoue S, Itaya N, Narita S, Hanai K, Okubo K, Yanishi M, Matsuda T, Terachi T, Mimata H. Laparoendoscopic single-site surgeries: A multicenter experience of 469 cases in Japan. Int J Urol 2016; 24:69-74. [PMID: 27699877 DOI: 10.1111/iju.13235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/12/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To report on a multi-institutional series of non-robotic urological laparoendoscopic single-site surgery in Japan. METHODS Consecutive cases of laparoendoscopic single-site surgery carried out between February 2009 and December 2012 at nine academic institutions were included. We examined the surgical outcomes, including conversion and complications rates. RESULTS Four hundred and sixty-nine cases were included in the analysis. The most common procedure was adrenalectomy (n = 177) and the second most common procedure was radical nephrectomy (n = 143). The procedures also included nephroureterectomy (n = 40), living donor nephrectomy (n = 40), pyeloplasty (n = 30), urachal remnant excision (n = 9), simple nephrectomy (n = 7), radical prostatectomy (n = 6) and others (n = 17). The access sites included umbilicus (n = 248, 53%) and other sites (n = 221, 47%). A transperitoneal approach was used in 385 cases (82%), and retroperitoneal approach in 84 cases (18%). The median operation time of all procedures was 198 min. Conversion to reduced port surgery, conventional laparoscopy, or open surgery was noted in 27 cases (5.8%), 12 cases (2.6%), and two cases (0.4%), respectively, with an overall conversion rate of 8.7%. Intraoperative complications occurred in 10 cases (2.1%). Post-operative complications were noted in 29 cases (6.2%), including five major complications (1.1%). No mortality was recorded in this series. CONCLUSIONS Non-robotic laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases in Japan. Furthermore, urological laparoendoscopic single-site surgery is a promising minimally invasive surgical option that is feasible for experienced urological surgeons in intermediate-volume centers as well as high-volume centers.
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Affiliation(s)
| | - Ken Nakagawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Kawauchi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akio Matsubara
- Department of Urology, Hiroshima University, Hiroshima, Japan
| | | | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Koji Yoshimura
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Hoshi
- Department of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Naitoh
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Inoue
- Department of Urology, Hiroshima University, Hiroshima, Japan
| | - Naoshi Itaya
- Department of Urology, Kyorin University, Tokyo, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuya Hanai
- Department of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Kazutoshi Okubo
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaaki Yanishi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Toshiro Terachi
- Department of Urology, Tokai University School of Medicine, Kanagawa, Japan
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Laparoendoscopic single-site surgery adrenalectomy - own experience and matched case-control study with standard laparoscopic adrenalectomy. Wideochir Inne Tech Maloinwazyjne 2014; 9:596-602. [PMID: 25561998 PMCID: PMC4280428 DOI: 10.5114/wiitm.2014.46803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/04/2014] [Accepted: 10/21/2014] [Indexed: 12/29/2022] Open
Abstract
Introduction At our institution, laparoendoscopic single-site surgery (LESS) has been established as a technique for laparoscopic nephrectomy since 2011, and since 2012 in selected cases for adrenalectomy (AE) as well. Aim To compare LESS AE with standard laparoscopic AE (SLAE). Material and methods Between 3/2012 and 7/2014, 35 adrenalectomies were performed. In 18 (51.4%), a LESS approach was chosen. Indications were strictly non-complicated cases (body mass index (BMI) < 34 kg/m2, tumour ≤ 7 cm, non-malignant aetiology, no previous surgery). All LESS procedures were done by one surgeon. Standard equipment was a 10 mm rigid 0° camera, Triport+, one pre-bent grasper, and a sealing instrument. The approach was pararectal in all cases except one (transumbilical in a slim man). Three patients with LESS were excluded (2 partial AEs only, one adrenal cancer converted to SLAE and then to open surgery). These 15 LESS AE procedures were compared to 15 SLAEs with similar characteristics chosen among 54 SLAEs performed in the period 1/2008–2/2012. Results In 8 cases (53.3%) of LESS AE, a 3 mm port was added to elevate the liver/spleen. Mean parameters of LESS AE vs. SLAE (Wilcoxon test): maximal tumour diameter 43.7 mm vs. 36.1 mm (p = 0.28), time of surgery 63.3 min vs. 55.3 min (p = 0.22), blood loss 38.0 ml vs. 38.0 ml (p = 0.38), BMI 26.9 kg/m2 vs. 28.5 kg/m2 (p = 0.13), discharge from hospital 5.4 days vs. 3.9 days (p = 0.038). There were no complications in either group. Conclusions The LESS AE is feasible in selected cases, especially small left-sided tumours in thin patients with no history of previous abdominal operations, but requires an additional port in half of the cases.
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Bhandarkar DS, Mittal GK, Katara AN, Behera RR. Laparo-endoscopic single-site left adrenalectomy using conventional ports and instruments. Urol Ann 2014; 6:169-72. [PMID: 24833835 PMCID: PMC4021663 DOI: 10.4103/0974-7796.130660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/28/2012] [Indexed: 12/29/2022] Open
Abstract
Laparo-endoscopic single-site adrenalectomy (LESS-A) is commonly performed using specialized access devices and/or instruments. We report a LESS-A in a 47-year-old woman with a left aldosteranoma via a subcostal approach utilizing conventional laparoscopic ports and instruments. The feasibility and cost-effectiveness of this approach are highlighted and the literature on the subject is reviewed.
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Affiliation(s)
| | - Gaurav K Mittal
- Department of Surgery, Pushpanjali Crosslay Hospital, Vaishali, Ghaziabad, India
| | - Avinash N Katara
- Department of Minimal Access Surgery, Hinduja Hospital, Mahim, Mumbai, India
| | - Ramya R Behera
- Department of Minimal Access Surgery, Hinduja Hospital, Mahim, Mumbai, India
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Yuan X, Wang D, Zhang X, Cao X, Bai T. Retroperitoneal Laparoendoscopic Single-Site Adrenalectomy for Pheochromocytoma: Our Single Center Experiences. J Endourol 2014; 28:178-83. [PMID: 24004249 DOI: 10.1089/end.2013.0488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Xiaobin Yuan
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Dongwen Wang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xuhui Zhang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoming Cao
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Tao Bai
- Department of Pathology, First Hospital of Shanxi Medical University, Taiyuan, China
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Byon W, Hyun K, Yun JS, Park YL, Park CH. The Optimal Approach for Laparoscopic Adrenalectomy through Mono Port regarding Left or Right Sides: A Comparative Study. Int J Endocrinol 2014; 2014:747361. [PMID: 25371676 PMCID: PMC4209790 DOI: 10.1155/2014/747361] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/07/2014] [Indexed: 12/18/2022] Open
Abstract
Introduction. Several studies have shown the feasibility and safety of both transperitoneal and posterior retroperitoneal approaches for single incision laparoscopic adrenalectomy, but none have compared the outcomes according to the left- or right-sided location of the adrenal glands. Materials and Methods. From 2009 to 2013, 89 patients who received LAMP (laparoscopic adrenalectomy through mono port) were analyzed. The surgical outcomes attained using the transperitoneal approach (TPA) and posterior retroperitoneal approach (PRA) were analyzed and compared. Results and Discussion. On the right side, no significant differences were found between the LAMP-TPA and LAMP-PRA groups in terms of patient characteristics and clinicopathological data. However, outcomes differed in which LAMP-PRA group had a statistically significant shorter mean operative time (84.13 ± 41.47 min versus 116.84 ± 33.17 min; P = 0.038), time of first oral intake (1.00 ± 0.00 days versus 1.21 ± 0.42 days; P = 0.042), and length of hospitalization (2.17 ± 0.389 days versus 3.68 ± 1.38 days; P ≤ 0.001), whereas in left-sided adrenalectomies LAMP-TPA had a statistically significant shorter mean operative time (83.85 ± 27.72 min versus 110.95 ± 29.31 min; P = 0.002). Conclusions. We report that LAMP-PRA is more appropriate for right-sided laparoscopic adrenalectomies due to anatomical characteristics and better surgical outcomes. For left-sided laparoscopic adrenalectomies, however, we propose LAMP-TPA as a more suitable method.
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Affiliation(s)
- Wooseok Byon
- Department of Surgery & Breast-Thyroid Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Gu, Seoul 110-746, Republic of Korea
| | - Keehoon Hyun
- Department of Surgery & Breast-Thyroid Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Gu, Seoul 110-746, Republic of Korea
| | - Ji-Sup Yun
- Department of Surgery & Breast-Thyroid Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Gu, Seoul 110-746, Republic of Korea
- *Ji-Sup Yun:
| | - Yong Lai Park
- Department of Surgery & Breast-Thyroid Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Gu, Seoul 110-746, Republic of Korea
| | - Chan Heun Park
- Department of Surgery & Breast-Thyroid Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Gu, Seoul 110-746, Republic of Korea
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Wang L, Wu Z, Li M, Cai C, Liu B, Yang Q, Sun Y. Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies. J Endourol 2013; 27:743-50. [PMID: 23611672 DOI: 10.1089/end.2012.0599] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the surgical efficacy and potential advantages of laparoendoscopic single-site adrenalectomy (LESS-AD) compared with conventional laparoscopic adrenalectomy (CL-AD) based on published literature. METHODS An online systematic search in electronic databasesM including Pubmed, Embase, and the Cochrane Library, as well as manual bibliography searches were performed. All studies that compared LESS-AD with CL-AD were included. The outcome measures were the patient demographics, tumor size, blood loss, operative time, time to resumption of oral intake, hospital stay, postoperative pain, cosmesis satisfaction score, rates of complication, conversion, and transfusion. A meta-analysis of the results was conducted. RESULTS A total of 443 patients were included: 171 patients in the LESS-AD group and 272 patients in the CL-AD group (nine studies). There was no significant difference between the two groups in any of the demographic parameters expect for lesion size (age: P=0.24; sex: P=0.35; body mass index: P=0.79; laterality: P=0.76; size: P=0.002). There was no significant difference in estimated blood loss, time to oral intake resumption, and length of stay between the two groups. The LESS-AD patients had a significantly lower postoperative visual analog pain score compared with the CL-AD group, but a longer operative time was noted. Both groups had a comparable cosmetic satisfaction score. The two groups had a comparable rate of complication, conversion, and transfusion. CONCLUSIONS In early experience, LESS-AD appears to be a safe and feasible alternative to its conventional laparoscopic counterpart with decreased postoperative pain noted, albeit with a longer operative time. As a promising and emerging minimally invasive technique, however, the current evidence has not verified other potential advantages (ie, cosmesis, recovery time, convalescence, port-related complications, etc.) of LESS-AD.
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Affiliation(s)
- Linhui Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, PR China
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A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors. Surg Endosc 2011; 26:1135-9. [PMID: 22083326 DOI: 10.1007/s00464-011-2012-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/11/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND The safety and feasibility of laparoendoscopic single-site (LESS) adrenalectomy for benign adrenal lesions was proved in early clinical series. However, the advantages of LESS over multiport laparoscopic adrenalectomy still are under investigation. METHODS Since October 2009, the authors have prospectively performed LESS retroperitoneal adrenalectomy for 21 consecutive patients with benign adrenal tumors (LESS group). Another 28 patients with benign adrenal tumors were prospectively collected between June 2006 and October 2009 and served as a multiport laparoscopic adrenalectomy group. The patients' demographic data, operating time, estimated blood loss, peri- and postoperative complications, and short-term outcome were collected for further analysis. RESULTS The demographic data were comparable between the two groups in terms of the patient age, gender, body mass index (BMI), laterality, diagnosis, and resected specimen weight. No major complication or mortality occurred in either group. Neither group had any conversions. No differences were observed between the two groups in terms of intraoperative hemodynamic status or peri- or postoperative complications. The LESS patients had quicker resumption of oral intake (0.18 vs 1 day; p < 0.001), a shorter hospital stay (2 vs 4 days; p < 0.001), and a reduced analgesic requirement postoperatively (0 vs 0.84 mg/kg; p = 0.023) than the multiport laparoscopic patients. CONCLUSIONS The results demonstrate that LESS adrenalectomy is as safe and effective as conventional multiport laparoscopic adrenalectomy for benign adrenal tumors. In addition, LESS adrenalectomy provides short-term convalescence advantages over multiport laparoscopic adrenalectomy.
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