1
|
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).
Collapse
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
| | | | | |
Collapse
|
2
|
Ren S, Zheng Y, Hu X, Bao Y, Wang D, Chang Y. Recent advances in single-site/incision robotic-assisted radical prostatectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1341-1350. [PMID: 36935223 DOI: 10.1016/j.ejso.2023.03.213] [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: 01/18/2023] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Single-site robotic-assisted radical prostatectomy (ssRARP) has been successfully applied to treat prostate cancer. This review aims to describe the recent advances of surgical approaches, working accesses and novel robotic platforms in ssRARP. MATERIAL AND METHODS A systematic literature search was performed by searching the PubMed, EMBASE, Web of Science and Scopus databases in December 2022 to identify all literature related to ssRARP. RESULTS A total of 48 relevant studies were found worldwide from 2008 to 2023. Since the introduction of ssRARP, various modifications of this technique in surgical approaches, working accesses and novel robotic platforms have been developed. The application of ssRARP using the da Vinci SP platform has shown great superiority with encouraging clinical outcomes. DISCUSSION There has been a potential shift toward ssRARP using the da Vinci SP platform due to its potential advantages in terms of lower blood loss, minimal postoperative pain, better cosmetic outcome and rapid recovery. More convincing evidence, further technical improvement and higher cost-effectiveness are needed for its widespread acceptance.
Collapse
Affiliation(s)
- Shangqing Ren
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Yang Zheng
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610051, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Dong Wang
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.
| | - Yifan Chang
- Department of Urology, Changhai Hospital, Shanghai, 200433, China.
| |
Collapse
|
3
|
Tunc L, Bozzini G, Scoffone CM, Guven S, Hermann T, Porreca A, Misrai V, Ahyai S, Zor M, Aksoy E, Gozen AS. Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study. EUR UROL SUPPL 2021; 32:28-34. [PMID: 34667956 PMCID: PMC8505198 DOI: 10.1016/j.euros.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 01/15/2023] Open
Abstract
Background Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. Objective To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participants Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysis The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitations A total of 26 answers were returned (81%). The experts agreed on the model’s suitability for AEEP training (mean Likert score: 8). According to the responses, “identifying anatomic structures and landmarks” was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model’s ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) Conclusions Based on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summary An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training.
Collapse
Affiliation(s)
- Lutfi Tunc
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Italy
| | | | - Selcuk Guven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Thomas Hermann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Münsterlingen, Switzerland
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Sascha Ahyai
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Murat Zor
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Emin Aksoy
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ali S Gozen
- SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| |
Collapse
|
4
|
Minafra P, Carbonara U, Vitarelli A, Lucarelli G, Battaglia M, Ditonno P. Robotic radical perineal prostatectomy: tradition and evolution in the robotic era. Curr Opin Urol 2021; 31:11-17. [PMID: 33229862 DOI: 10.1097/mou.0000000000000830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To provide an updated review of robotic radical perineal prostatectomy (r-RPP) with emphasis on the recent advances in terms of surgical technique, outcomes, and new robotic platforms. RECENT FINDING The technological innovations in the urological field have been applied to radical prostatectomy with the aim of preserving important anatomical structures and reduce patients' morbidity and mortality. In recent years, robotic surgery contributed to resurge radical perineal prostatectomy. In 2014, the Cleveland Clinic group was the first to demonstrate the utility of a robotic approach in RPP. To date, the majority of the reported studies showed that r-RPP has noninferior perioperative, short-term oncological, and functional outcomes compared with the traditional robot-assisted radical prostatectomy (RARP). Given these benefits, r-RPP is a promising approach in selected patients, such as obese ones. Moreover, robotic perineal pelvic lymph node dissection performed through the same incision of r-RPP and the new Single-Port (SP) Robotic System represent further steps towards the overcoming of some intrinsic limitation of this surgical approach making this technique suitable for a larger number of patients with prostatic cancer. SUMMARY Overall, r-RPP represents a reliable and effective novel surgical technique. However, more studies with long-term follow-up are needed to clarify the advantages over RARP.
Collapse
Affiliation(s)
- Paolo Minafra
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, SS. Annunziata Hospital, Taranto, Italy
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, VCU Health, Richmond, Virginia, USA
| | - Antonio Vitarelli
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, National Cancer Institute IRCCS 'Giovanni Paolo II", Bari, Italy
| |
Collapse
|
5
|
Lenfant L, Garisto J, Sawczyn G, Wilson CA, Aminsharifi A, Kim S, Schwen Z, Bertolo R, Kaouk J. Robot-assisted Radical Prostatectomy Using Single-port Perineal Approach: Technique and Single-surgeon Matched-paired Comparative Outcomes. Eur Urol 2020; 79:384-392. [PMID: 33357990 DOI: 10.1016/j.eururo.2020.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/03/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Radical perineal prostatectomy (RPP) has been revived with the advent of single-port (SP) robotic surgery. However, its interest and precise role need to be evaluated and better defined. OBJECTIVE To describe in detail the technique of SP-RPP and compare initial perioperative outcomes with those of multiport robot-assisted transperitoneal radical prostatectomy (MP-RARP). DESIGN, SETTING, AND PARTICIPANTS From October 2018 to June 2020, perioperative data of 26 consecutive patients who underwent SP-RPP for localized prostate cancer (PCa) in a single institution were prospectively entered into an institutional review board-approved database. Data of 86 consecutive patients treated from September 2017 to September 2018 with MP-RARP by the same surgeon, before the beginning of the SP experience, were used as comparators. SURGICAL PROCEDURE SP-RPP was performed using the SP robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) according to the technique described in the supplementary video. MEASUREMENTS Demographics, and intra- and postoperative data were analyzed in a matched-paired design with a 1:1 ratio on the following factors: age at surgery, prostate-specific antigen level, preoperative Gleason score, and history of abdominal surgery. RESULTS AND LIMITATIONS After matching, baseline characteristics were comparable except for the rate of prior laparotomy, which was higher in the SP-RPP group (52% vs 8%, p < 0.001). In the SP-RPP group, 84% of the patients had a high risk and an unfavorable intermediate risk of positive surgical margins (PSMs) versus 57% in the MP-RARP group (p = 0.03). While the rate of nonlimited PSMs (ie, >3 mm) was higher in the SP-RPP group (38.5% vs 7.7%, p < 0.01), the number of patients with biochemical recurrence at 1 yr was comparable between SP-RPP and MP-RARP (1 vs 3, p = 0.3). CONCLUSIONS SP-RPP is a complex procedure for patients with a complex surgical history and high-risk localized PCa with limited alternative therapeutic options. PATIENT SUMMARY Our study suggests that patients with high-risk localized prostate cancer and limited treatment options due to a complex abdominal surgical history (ie, frozen pelvis) may be suitable candidates for single-port radical perineal prostatectomy.
Collapse
Affiliation(s)
- Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Urology Department, GRC n°5, Predictive Onco-urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clark A Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
6
|
Mantica G, Leonardi R, Pini G, Esperto F, Proietti S, van Deventer H, Giusti G, Gaboardi F, van der Merwe A, Terrone C. The current use of human cadaveric models in urology: a systematic review. MINERVA UROL NEFROL 2020; 72:313-320. [DOI: 10.23736/s0393-2249.19.03558-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Chang Y, Xu W, Lu X, Zhou Y, Ji M, Xiao YT, Sun Y, Ren S. Robotic Perineal Radical Prostatectomy: Initial Experience with the da Vinci Si Robotic System. Urol Int 2020; 104:710-715. [PMID: 32289797 DOI: 10.1159/000505557] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the feasibility and surgical technique of robotic perineal radical prostatectomy (RPRP). MATERIALS AND METHODS We retrospectively analyzed 6 consecutive patients diagnosed with prostate cancer from December 2018 to May 2019 who underwent RPRP at our center. Perioperative outcomes were recorded for safety and feasibility analysis. RESULTS Six patients successfully underwent RPRP with no conversion to open procedures. Operative time was 140 (interquartile range [IQR] 123.75-148.75) min, console time was 70 (IQR 62.5-70) min, with an estimated blood loss of 125 (IQR 100-187.5) mL. Patients were discharged 2 days postoperatively (IQR range 1-3) with pelvic drainages removed. The Foley catheter was removed 2 weeks after surgery. Postoperative pathology revealed 5 patients with locally advanced disease (apical margin-positive prostate cancer [pT3a]bNx). Two patients had a positive surgical margin (33.3%). No complications of Clavien grade 3 and above were recorded; 1 patient had a delay in wound-healing of 1 week. Postoperative continence was achieved for 2 patients immediately after Foley catheter removal, 2 recovered 1-month postoperatively, and 1 recovered within 3 months, and 1 still had mild incontinence at the latest follow-up 1-month postoperatively. CONCLUSION RPRP is a safe and feasible alternative for the transperitoneal route in selected patients. Further investigation is required to assess its oncological and quality-of-life results.
Collapse
Affiliation(s)
- Yifan Chang
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Weidong Xu
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiaojun Lu
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yi Zhou
- Department of Anesthesiology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ming Ji
- Department of Urology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yu-Tian Xiao
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shancheng Ren
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China,
| |
Collapse
|
8
|
Rodrigues GJ, Coelho RF. Editorial Comment: Effect of pelvimetric diameters on success of surgery in patients submitted to robot-assisted perineal radical prostatectomy. Int Braz J Urol 2020; 46:434-435. [PMID: 32167709 PMCID: PMC7088502 DOI: 10.1590/s1677-5538.ibju.2019.0413.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Gilberto J Rodrigues
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Rafael F Coelho
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| |
Collapse
|
9
|
Garisto J, Bertolo R, Wilson CA, Kaouk J. The evolution and resurgence of perineal prostatectomy in the robotic surgical era. World J Urol 2019; 38:821-828. [PMID: 31811370 DOI: 10.1007/s00345-019-03004-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To review the recent advances in terms of surgical technique and new robotic platforms applied to radical perineal prostatectomy (RPP). METHODS A literature review was performed focusing on original articles on perineal prostatectomy searching via Medline/Pubmed and Embase. The entire spectrum was covered such as development of surgical technique including pelvic lymphadenectomy, adoption of novel surgical platforms, learning curve and future directions. RESULTS Surgical removal of the prostate plays a significant role on the treatment of localized prostate cancer (PCa). RPP was the first surgical approach described for radical prostatectomy. This technique declined in popularity secondary to the development of the retropubic approach. Recently, the appearance of novel robotic technology has generated renewed interest in the perineal approach. CONCLUSION There has been a recent resurgence on the interest of radical perineal prostatectomy for the treatment of localized PCa driven by the advent of new robotic surgical technologies into the field. Future studies are needed to better determine the learning curve of the perineal approach and its current role in the treatment of prostate cancer.
Collapse
Affiliation(s)
- Juan Garisto
- Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA
| | - Riccardo Bertolo
- Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA
| | - Clark A Wilson
- Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA
| | - Jihad Kaouk
- Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA.
| |
Collapse
|
10
|
Robotic One Access Surgery (R-1): Initial Preclinical Experience for Urological Surgeries. Urology 2019; 133:5-10.e1. [DOI: 10.1016/j.urology.2019.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/21/2022]
|
11
|
Taşçı Aİ, Şimşek A, Şam E, Şeker KG, Atar FA, Şahin S. Perineoscopic radical prostatectomy: A novel surgical technique for the treatment of prostate cancer. Turk J Urol 2019; 46:31-36. [PMID: 31658015 DOI: 10.5152/tud.2019.19052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this article is to discuss the technical details of perineoscopic radical prostatectomy (perineoscopic-RP), which we performed for the first time as a surgical treatment for prostate cancer (PCa), and to present the outcomes of three patients who underwent this procedure. MATERIAL AND METHODS Using a robotic scope as an optical system, we performed perineoscopic-RP in 3 patients in March 2018. Technical details of the procedure have been explained step-by-step in this article. Preoperative, perioperative, and postoperative data of all the patients was analyzed. RESULTS Perineoscopic-RP was completed successfully without the need to convert to other approaches and/or techniques in all three patients. The patients were in a low-risk group for PCa. The mean time that elapsed to reach the prostate apex was 50±3.6 minutes, including the time required to install the optic and retractor system. The mean total operative time was 144.3±8.4 minutes. No intraoperative or postoperative complications were observed. Surgical margins were negative in all patients. Incontinence was observed in 2 patients after the removal of the Foley catheter. All patients achieved complete continence in the 3rd month during the follow-up. CONCLUSION This technique, of which we presented the initial results in this article, can be successfully performed as a surgical intervention method for PCa. Prospective and comparative studies with larger patient series are required to place this method in routine practice.
Collapse
Affiliation(s)
- Ali İhsan Taşçı
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Abdulmuttalip Şimşek
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Emre Şam
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Kamil Gökhan Şeker
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Feyzi Arda Atar
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Şahin
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
12
|
Garisto J, Bertolo R, Kaouk J. Transperineal Approach for Intracorporeal Ileal Conduit Urinary Diversion Using a Purpose-built Single-port Robotic System: Step-by-step. Urology 2018; 122:179-184. [DOI: 10.1016/j.urology.2018.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
|
13
|
Taşçı Aİ, Şimşek A, Şam E, Şeker KG, Atar FA, Şahin S, Tuğcu V. Gasless robotic perineal radical prostatectomy: An initial experience. Turk J Urol 2018; 45:S117-S120. [PMID: 30475698 DOI: 10.5152/tud.2018.48085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/12/2018] [Indexed: 11/22/2022]
Abstract
Radical prostatectomy (RP) is the gold standard treatment method of localized prostate cancer. Today, this surgery is performed with open or minimally invasive methods. The history of open perineal RP (RPP) is very old, but it is not often preferred by urologists. The use of robot-assisted laparoscopic RP (RALP) is very frequently applied today. Robotic perineal RP (r-RPP) by using a Gel-Point and insufflating CO2 into the perineal region was first described in 2014. In this case report, we report a 68-year-old patient with localized prostate cancer in whom we successfully performed gasless r-RPP, and according to our knowledge, this is the first case of gasless r-RPP to be reported.
Collapse
Affiliation(s)
- Ali İhsan Taşçı
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Health Application and Research Center, İstanbul, Turkey
| | - Abdulmuttalip Şimşek
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Health Application and Research Center, İstanbul, Turkey
| | - Emre Şam
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Health Application and Research Center, İstanbul, Turkey
| | - Kamil Gökhan Şeker
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Health Application and Research Center, İstanbul, Turkey
| | - Feyzi Arda Atar
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Health Application and Research Center, İstanbul, Turkey
| | - Selçuk Şahin
- Department of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Health Application and Research Center, İstanbul, Turkey
| | - Volkan Tuğcu
- Department of Urology, Memorial Bahçelievler Hospital, İstanbul, Turkey
| |
Collapse
|
14
|
Bertolo R, Garisto J, Gettman M, Kaouk J. Novel System for Robotic Single-port Surgery: Feasibility and State of the Art in Urology. Eur Urol Focus 2018; 4:669-673. [DOI: 10.1016/j.euf.2018.06.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/27/2018] [Accepted: 06/07/2018] [Indexed: 11/17/2022]
|
15
|
Kaouk J, Garisto J, Bertolo R. Different approaches to the prostate: The upcoming role of a purpose-built single-port robotic system. Arab J Urol 2018; 16:302-306. [PMID: 30147958 PMCID: PMC6105340 DOI: 10.1016/j.aju.2018.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 03/27/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023] Open
Abstract
With the aim of minimising the patient’s postoperative pain, expediting recovery and improving cosmesis, the idea of performing a laparoscopic procedure through a single abdominal incision was introduced. In the present report, we describe five different access routes to the prostate that may be at the surgeon’s disposal with the potential of decreasing patient’s perioperative morbidity. Robotic radical prostatectomy has been refined and became a standard of care in surgery for localised prostate cancer. The advent of single-port robotic surgery has prompted the re-discovery of different access routes to the prostate and ideally all of them are feasible. The potential for avoiding the abdominal cavity will decrease the surgical morbidity and minimise the surgical dissection. In the near future, each of the described approaches could be chosen on the basis of the patient’s preoperative comorbidities, body habitus, anatomy, and disease characteristics and location.
Collapse
Affiliation(s)
- Jihad Kaouk
- Corresponding author at: Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH 44195, USA.
| | | | | |
Collapse
|
16
|
Maurice MJ, Kaouk JH. Single-Port Robot-Assisted Perineal Prostatectomy and Pelvic Lymphadenectomy: Step-by-Step Technique in a Cadaveric Model. J Endourol 2018; 32:S93-S96. [DOI: 10.1089/end.2017.0707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew J. Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
17
|
Tuğcu V, Akça O, Şimşek A, Yiğitbaşı İ, Yenice MG, Şahin S, Taşcı Aİ. Robotic perineal radical prostatectomy and robotic pelvic lymph node dissection via a perineal approach: The Tugcu Bakirkoy Technique. Turk J Urol 2018; 44:114-118. [PMID: 29511579 DOI: 10.5152/tud.2018.24603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 11/22/2022]
Abstract
Objective To describe The Tugcu Bakirkoy robotic perineal radical prostatectomy and pelvic lymph node dissection technique, and present the results of seven patients. Material and methods We performed seven robotic perineal radical prostatectomy and pelvic lymph node dissection operation using Da Vinci Xi HD Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) on single Gel-port platform. The operation is completed in 4 stages: stage 1 open perineal dissection and gel port placement, stage 2 robotic perineal radical prostatectomy, stage 3 robotic pelvic lymph node dissection, stage 4 vesico-urethral anastomosis. In addition to describing the operation technique step by step, we aimed to present the perioperative and postoperative findings of the seven patients who underwent The Tugcu Bakirkoy Technique. Results All operations were successfully completed without any complications in fully the robotic procedure by a single surgeon. Demographic data of the patients were as follows: Mean age (62.1±8 years), mean body mass index (28.2±0.7 kg/m2), mean prostate specific antigen value (10.7±3 ng/mL), and mean prostate volume (64.2±15.3 cc). Mean operative time (184.1±20.2 mins), blood loss (64.2±15.3 cc), hospitalization time (2.1±0.6 days), and time to withdrawal of the urethral catheter (7.8±0.8 days) were also estimated. According to the pathology results, lymph node metastasis was detected in 3 patients while the surgical margin was positive in one. Conclusion We demonstrated for the first time that a new The Tugcu Bakirkoy robotic perineal radical prostatectomy technique which was previously tested in a cadaveric model, can be safely applied for the first time in vivo, and presented our results. On the basis of this, for problems that can not be overcome by traditional methods, this method is a good alternative as a way out. In this regard, it is necessary to carry out advanced studies so that this method can be applied to daily practice.
Collapse
Affiliation(s)
- Volkan Tuğcu
- Department of Urology, University of Health Sciences, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Oktay Akça
- Department of Urology, University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Abdulmuttalip Şimşek
- Department of Urology, University of Health Sciences, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - İsmail Yiğitbaşı
- Department of Urology, University of Health Sciences, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Gürkan Yenice
- Department of Urology, University of Health Sciences, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Şahin
- Department of Urology, University of Health Sciences, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Ali İhsan Taşcı
- Department of Urology, University of Health Sciences, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
18
|
Huri E, Ezer M, Chan E. The novel laparoscopic training 3D model in urology with surgical anatomic remarks: Fresh-frozen cadaveric tissue. Turk J Urol 2016; 42:224-229. [PMID: 27909613 DOI: 10.5152/tud.2016.84770] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Laparoscopic surgery is routinely used to treat many urological conditions and it is the gold standard treatment option for many surgeries such as radical nephrectomy. Due to the difficulty of learning, laparoscopic training should start outside the operating room. Although it is a very different model of laparoscopic training; the aim of this review is to show the value of human cadaveric model for laparoscopic training and present our experience in this area. Fresh frozen cadaveric model in laparoscopic training, dry lab, cadaveric model, animal models and computer based simulators are the most commonly used models for laparoscopic training. Cadaveric models mimic the live setting better than animal models. Also, it is the best way in demonstrating important anatomic landmarks like prostate, bladder, and pelvic lymph nodes templates. However, cadaveric training is expensive, and should be used by multiple disciplines for higher efficiency. The laparosopic cadaveric training starts with didactic lectures with introduction of pelvic surgical anatomy. It is followed by hands-on dissection. A typical pelvic dissection part can be completed in 6 hours. Surgical robot and some laparoscopy platforms are equipped with 3-D vision. In recent years, we have use the stereoscopic laparoscopy system for training purposes to show exact anatomic landmarks. Cadavers are removed from their containers 3 to 5 days prior to training session to allow enough time for thawing. Intracorporeal suturing is an important part of laparoscopic training. We believe that suturing must be practiced in the dry lab, which is significantly cheaper than cadaveric models. Cadaveric training model should focus on the anatomic dissection instead. In conclusion, fresh-frozen cadaveric sample is one of the best 3D simulation models for laparoscopic training purposes. Major aim of cadaveric training is not only mimicking the surgical technique but also teaching true anatomy. Lack of availability and higher financial cost are the two setbacks for the use of cadavers. Surgeon should learn basic laparoscopic skills with box trainers prior to cadaveric skill training.
Collapse
Affiliation(s)
- Emre Huri
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Ezer
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Eddie Chan
- Urology Department, Chinese University of Hong Kong School of Medicine, Hong Kong
| |
Collapse
|
19
|
Retzius Space Preservation Technique for Robotic-Assisted Laparoscopic Radical Prostatectomy in a Kidney Transplant Patient: First Case in Thailand and Our First Experience. Transplant Proc 2016; 48:3130-3133. [DOI: 10.1016/j.transproceed.2016.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 11/18/2022]
|
20
|
Ramirez D, Maurice MJ, Kaouk JH. Robotic perineal radical prostatectomy and pelvic lymph node dissection using a purpose-built single-port robotic platform. BJU Int 2016; 118:829-833. [PMID: 27410172 DOI: 10.1111/bju.13581] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To describe the features of the novel, purpose-built da Vinci model SP1098 single-port robotic platform and to describe a step-by-step approach for perineal prostatectomy and pelvic lymph node dissection in a cadaver model. METHODS Three single-port robotic radical perineal prostatectomies and two pelvic lymph node dissections were performed on three male cadavers to assess the feasibility of the SP1098 da Vinci robotic platform. The steps in the procedure included division of the rectourethralis muscle, splitting of the levator ani muscles bilaterally, opening of Denonvilliers fascia with dissection of the seminal vesicles, apical dissection and urethral division, anterior and lateral dissection with ligation of prostatic pedicles, bilateral pelvic lymph node dissection, and creation of the new vesico-urethral anastomosis. The main outcomes assessed were operating time per step, total operating time, intra-operative complications and need for conversion to conventional or open techniques. RESULTS No conversions were required. No intra-operative complications were seen. The median (range) operating time for performing single-port robotic radical perineal prostatectomy and pelvic lymph node dissection was 210 (180-240) min. CONCLUSIONS We have shown the feasibility and efficacy of a novel, purpose-built robotic system in performing single-port radical perineal prostatectomy and describe, for the first time, the feasibility of robotic perineal lymph node dissection. This single-port system will facilitate single-port applications and allow surgeons to perform major urological operations via a small, single incision while preserving triangulation and optics, and eliminating clashing between instruments. Future clinical studies are needed to support these encouraging outcomes.
Collapse
Affiliation(s)
- Daniel Ramirez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew J Maurice
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
21
|
Descriptive Technique and Initial Results for Robotic Radical Perineal Prostatectomy. Urology 2016; 94:129-38. [PMID: 27233935 DOI: 10.1016/j.urology.2016.02.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/10/2016] [Accepted: 02/20/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To minimize technical challenges of radical perineal prostatectomy (RPP), we conceived and applied the robotic approach to this technique in an aim to improve surgical applicability of RPP. Radical prostatectomy via the perineal route, avoiding the intra-abdominal cavity, has been shown to be oncologically safe, with excellent functional outcomes and a short hospital stay. We report our initial results with this novel approach. MATERIALS AND METHODS We performed the procedure in 4 patients. With the patient in the exaggerated lithotomy position, following a 3 cm perineal incision, the initial perineal dissection using Belt's approach is performed, followed by single port placement and docking of the robot. RESULTS The median age for patients was 64 years (60-69). Two patients had no rectum because of the abdominoperineal resection due to inflammatory bowel diseases. One of the other 2 patients had a surgical history of aborted robotic-assisted laparoscopic radical prostatectomy and 1 patient had no surgical history. There were no perioperative complications and the patients were discharged within 16-48 hours. Urethral catheter was removed within 10 days in 3 patients, and 3 weeks in 1 patient. Two patients were immediately continent when Foley was removed. The final pathology revealed focally positive margin in those 3 patients who had surgical histories and it was margin negative in the patient with native anatomy. All patients had undetectable prostate-specific antigen postoperatively. CONCLUSION RPP was successfully completed in 4 cases, applying a single port robotic perineal approach. Initial results are encouraging, with short hospital stay and minimal postoperative pain.
Collapse
|
22
|
Robotic Single-port Surgery: Paving the Way for the Future. Urology 2016; 95:5-10. [PMID: 27211930 DOI: 10.1016/j.urology.2016.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/28/2016] [Accepted: 05/03/2016] [Indexed: 11/23/2022]
Abstract
Adoption of robotic technology in urology has been widely popularized as it provides considerable advantages over standard techniques, including improved instrument dexterity, three-dimensional high-definition optics, and enhanced ergonomics. As a result, these features have facilitated the adaptation of robotics for laparoendoscopic single-site surgery (LESS) to overcome challenges with clashing, suturing, and intra-abdominal triangulation. Since the inception of robotic LESS by our institution in 2008,(1) many centers have gone on to study this approach in various urologic applications. Herein we discuss the evolution of robotic LESS access, instrumentation, and outcomes with special focus on up-and-coming technology.
Collapse
|
23
|
Ramirez D, Zargar H, Caputo P, Kaouk JH. Robotic-assisted laparoscopic prostatectomy: An update on functional and oncologic outcomes, techniques, and advancements in technology. J Surg Oncol 2015; 112:746-52. [PMID: 26369794 DOI: 10.1002/jso.24040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 08/26/2015] [Indexed: 11/11/2022]
Abstract
The robotic platform has revolutionized the management of prostate cancer over the last 15 years. Several techniques have been developed to improve functional and oncologic outcomes, including meticulous apical and posterior dissection, nerve sparing techniques, bladder neck and urethral length sparing, and anastomotic reconstruction. Future developments involving novel single-site, robotic technology will undoubtedly further the field of minimally invasive urology. These topics are reviewed within this article.
Collapse
Affiliation(s)
- Daniel Ramirez
- Glickman Institute of Urology and Nephrology, Cleveland Clinic, Cleveland, Ohio
| | - Homayoun Zargar
- Glickman Institute of Urology and Nephrology, Cleveland Clinic, Cleveland, Ohio
| | - Peter Caputo
- Glickman Institute of Urology and Nephrology, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Glickman Institute of Urology and Nephrology, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|