1
|
Tanhaeivash R, Grimm MO. Factors Affecting Transperitoneal Robot-Assisted Laparoscopic Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2021; 32:781-786. [PMID: 34962160 DOI: 10.1089/lap.2021.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To evaluate the impact of body mass index (BMI), preoperative risk classification, previous inguinal herniotomy, and abdominal operations on several steps of robot-assisted radical prostatectomy (RARP) and lymph node (LN) involvement. Methods: A total number of 225 consecutive patients were included in the study who underwent transperitoneal RARP by 1 surgeon. We defined the following parameters as dependent variables: duration of prostatectomy, duration of pelvic lymphadenectomy, incision to suture time, console time, number of dissected LNs and number of positive LNs for metastasis. We assessed the impact of the following covariates using univariate nonparametric and multivariate analysis: BMI, preoperative D'Amico risk classification, history of inguinal herniotomy, and previous abdominal operations. Results: We observed a statistically significant difference among our three BMI groups (<25, ≥25 and <30, and ≥30 kg/m2) regarding pelvic lymphadenectomy and LN metastasis. Moreover, among the three risk groups (low, intermediate, and high) duration of prostatectomy, pelvic lymphadenectomy, and LN metastasis were statistically different. Previous abdominal operations have been also demonstrated to significantly influence the pelvic lymphadenectomy. In addition, our multivariate model proved the impact of our covariates on pelvic lymphadenectomy. Conclusions: Our findings highlight the impact of BMI and preoperative risk on various steps of RARP. We revealed longer duration of pelvic lymphadenectomy and more nodal yield in patients with higher BMI and high-risk disease. Therefore, we suggest that BMI and risk classification according to D'Amico should be taken into account while a RARP is being planned.
Collapse
Affiliation(s)
- Roozbeh Tanhaeivash
- Department of Urology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| |
Collapse
|
2
|
Uchida T, Higure T, Kawakami M, Nakano M, Nakajima N, Kim H, Nitta M, Hasegawa M, Kawamura Y, Shoji S, Miyajima A. What factors affect the operative time of robot-assisted laparoscopic radical prostatectomy? Surg Endosc 2020; 35:4436-4443. [PMID: 32909210 DOI: 10.1007/s00464-020-07946-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) has gained prominence since the da Vinci surgical system was introduced in 2000. RARP has now become a standard procedure for treating cases with localized prostate cancer. However, no study has examined its surgical time by accurately measuring the pelvic visceral fat (PVF) volume. This study aimed to investigate the factors associated with prolonged console time and surgical difficulty by RARP surgeons. METHODS This study included 405 patients who underwent RARP between 2014 and 2019 at our institution. Given that the anatomical characteristics were considered to affect RARP, PVF and working space (WS) were estimated preoperatively by computed tomography using a 3D image analysis system. Univariate and multivariate logistic regression analyses were performed to identify the factors prolonging console time, such as body mass index (BMI), prostate volume, previous abdominal surgery, nerve-sparing procedure, PVF, and WS. We also investigated whether post-operative complications were associated with any of these factors. RESULTS Larger PVF (p = 0.028, odds ratio (OR) 1.43), smaller WS (p < 0.001, OR 2.48), and the nerve-sparing procedure (p = 0.037, OR 1.61) were statistically significant factors associated with prolonged console time. Furthermore, higher BMI (p = 0.013, OR 1.49) and smaller pelvic width (p < 0.001, OR 2.63) were the alternative and more practical factors associated with prolonged console time. The post-operative anastomotic leakage occurrence rate increased with the number of risk factors, while post-operative complications did not change even in high-risk cases. CONCLUSION PVF and WS are significant factors associated with prolonged console time in RARP cases. However, BMI can be as useful as PVF, since BMI significantly correlated with PVF. Additionally, pelvic width (PW) can be an alternative to WS, since PW correlated with WS. This study demonstrated that preoperative BMI and PW might predict the surgical risk and identify suitable RARP cases for novice surgeons.
Collapse
Affiliation(s)
- Takato Uchida
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Taro Higure
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Masayoshi Kawakami
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Mayura Nakano
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Nobuyuki Nakajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Hakushi Kim
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Masahiro Nitta
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Masanori Hasegawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Yoshiaki Kawamura
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan.
| |
Collapse
|
3
|
Suh J, Yoo S, Park J, Cho MC, Jeong CW, Ku JH, Kwak C, Kim HH, Jeong H. Differences in risk factors for biochemical recurrence after radical prostatectomy stratified by the degree of obesity: Focused on surgical methods. Sci Rep 2020; 10:10157. [PMID: 32576921 PMCID: PMC7311457 DOI: 10.1038/s41598-020-67237-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022] Open
Abstract
This study aims to evaluate differences in the risk factors for biochemical recurrence (BCR) for radical prostatectomy stratified by degree of obesity, focusing on the surgical method used. All 3099 patients who underwent radical prostatectomy in two medical centres from January 2008 to March 2018 were retrospectively reviewed. Patients were divided into three groups based on body mass index: ‘normal’, ‘overweight’, and ‘obese’. Risk factors associated with biochemical recurrence were compared between different degrees of obesity. We analysed the contributing risk factors of BCR-free survival using univariate and multivariable Cox hazard models. There were 378 (12.2%) and 1815 (58.6%) patients in the ‘obese’ and ‘overweight’ groups, respectively. Accordingly, 1324 patients underwent retropubic radical prostatectomy (RRP), and 1775 underwent robotic-assisted laparoscopic prostatectomy (RALP). Multivariable analysis showed that patients who underwent RALP had significantly lower BCR free survival in the ‘overweight’ and ‘obese’ groups than those who underwent RRP, with adjusted hazard ratios of 0.75 (95% CI 0.59–0.95, p-value = 0.01) and 0.55 (95% CI 0.33–0.90, p-value = 0.02), respectively. The degree of obesity was not directly associated with BCR-free survival. Robotic prostatectomy showed greater benefits in BCR-free survival than open prostatectomy in the ‘overweight’ and ‘obese’ groups.
Collapse
Affiliation(s)
- Jungyo Suh
- Hospital Medicine Center, Department of Urology, Seoul National University Hospital, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sangjun Yoo
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Juhyun Park
- Department of Urology, Asan Medical Center, Seoul, South Korea
| | - Min Chul Cho
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
| |
Collapse
|
4
|
Peard L, Goodwin J, Hensley P, Dugan A, Bylund J, Harris AM. Examining and Understanding Value: The Impact of Preoperative Characteristics, Intraoperative Variables, and Postoperative Complications on Cost of Robot-Assisted Laparoscopic Radical Prostatectomy. J Endourol 2019; 33:541-548. [DOI: 10.1089/end.2019.0066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Leslie Peard
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky
- University of Kentucky Medical Center, Lexington, Kentucky
| | - Jeffrey Goodwin
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky
- University of Kentucky Medical Center, Lexington, Kentucky
| | - Patrick Hensley
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky
- University of Kentucky Medical Center, Lexington, Kentucky
| | - Adam Dugan
- University of Kentucky Medical Center, Lexington, Kentucky
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Jason Bylund
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky
- University of Kentucky Medical Center, Lexington, Kentucky
| | - Andrew M. Harris
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky
- University of Kentucky Medical Center, Lexington, Kentucky
| |
Collapse
|
5
|
Lim K, Autorino R, Veccia A, Zukovksi EB, Levy M, Hampton LJ. Robot assisted laparoscopic prostatectomy in liver transplant recipient. MINERVA UROL NEFROL 2019; 71:185-188. [PMID: 30895766 DOI: 10.23736/s0393-2249.19.03334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robotic assisted laparoscopic prostatectomy (RALP) in liver transplant recipients (LTRs) is not well documented. We present two cases of RALP in LTRs with localized prostate cancer (PCa). In both cases, a transperitoneal approach was used, and they were successfully completed without perioperative complications. Thus, RALP seems to be a feasible, safe and effective treatment for PCa in LTRs. Significant modifications to the surgical technique do not seem to be required, and patient optimization in preparation for surgery remains the key factor. History of liver transplant should not discourage embarking in a RALP in Centers with adequate robotic expertise.
Collapse
Affiliation(s)
- Kenneth Lim
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA -
| | - Alessandro Veccia
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Eduardo B Zukovksi
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Marlon Levy
- Division of Transplant Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Lance J Hampton
- Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA
| |
Collapse
|
6
|
Skarecky D. Editorial Comment on: Development of a Patient-Based Model for Estimating Operative Times for Robot-Assisted Radical Prostatectomy by Huben et al. J Endourol 2018; 32:737. [PMID: 29848068 DOI: 10.1089/end.2018.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|