Magnet-Assisted Robotic Prostatectomy Using the da Vinci SP Robot: An Initial Case Series

Magnetic-Assisted Reduced-Port Sleeve Gastrectomy Versus Laparoscopic Sleeve Gastrectomy: a Comparative Study

BACKGROUND

Sleeve gastrectomy is one of the most popular bariatric surgeries. With the advent of new technologies, a reduced-port approach assisted by magnets for sleeve gastrectomy (RPSG-MA) has been developed. The aim of our study is to compare the short-term results of RPSG-MA vs conventional laparoscopic SG (CLSG).

METHODS

A comparative study was performed. We compared two groups who underwent RPSG-MA (n=150) and CLSG (n=135) between January 2020 and January 2022.

RESULTS

Both groups were similar in body mass index, age, sex, and type of comorbidities. The operative time was similar in both groups (RPSG-MA, 52.5 min vs CLSG, 52.9 min; p = 0.829). Length of hospital (1.07 days) stay was significantly shorter in the RPSG-MA group (p = 0.00) than in the CLSG group (1.51 days). There were no conversions to open surgery in any patient or any fatal event. Complications encountered were similar in both groups postoperative. There were minor adverse events directly related to the magnetic device in 3 cases, these being mild hepatic lacerations, resolved with hemostatic measures.

CONCLUSION

The magnet-assisted reduced-port gastric sleeve compared to the conventional technique has proven to be safe, technically feasible and with multiple benefits.

Improving disease prevention, diagnosis, and treatment using novel bionic technologies

Increased human life expectancy, due in part to improvements in infant and childhood survival, more active lifestyles, in combination with higher patient expectations for better health outcomes, is leading to an extensive change in the number, type and manner in which health conditions are treated. Over the next decades as the global population rapidly progresses toward a super-aging society, meeting the long-term quality of care needs is forecast to present a major healthcare challenge. The goal is to ensure longer periods of good health, a sustained sense of well-being, with extended periods of activity, social engagement, and productivity. To accomplish these goals, multifunctionalized interfaces are an indispensable component of next generation medical technologies. The development of more sophisticated materials and devices as well as an improved understanding of human disease is forecast to revolutionize the diagnosis and treatment of conditions ranging from osteoarthritis to Alzheimer's disease and will impact disease prevention. This review examines emerging cutting-edge bionic materials, devices and technologies developed to advance disease prevention, and medical care and treatment in our elderly population including developments in smart bandages, cochlear implants, and the increasing role of artificial intelligence and nanorobotics in medicine.

Robotic Magnetic Surgery: Results From the First Prospective Clinical Trial

To evaluate a novel Magnetic Robotic Platform during reduced-port laparoscopic surgery in a prospective, multicenter clinical trial.

Background

Magnetic surgery has been developed to increase the benefits of minimally invasive surgery, with prior studies demonstrating its clinical benefits. Robotic-assisted surgery increases the surgeon's control over the instruments, offering less dependency on an assistant. The synergism of both techniques may escalate these individual benefits.

Methods

A prospective, multicenter, single-arm, open-label study was performed to assess the safety and performance of a robotic magnetic surgical system (Levita Robotic Platform). The investigational device was used during reduced-port laparoscopic cholecystectomy and laparoscopic bariatric surgery. The primary endpoints evaluated were safety and feasibility. Patients were followed for 30 days post-procedure.

Results

Between May 2021 and December 2021, 30 patients undergoing laparoscopic surgery were recruited. There were 22 females and 8 males with a mean age of 39 years (22-69 years) and median body mass index of 33 kg/m2 (21.6-50.4 kg/m2). Procedures included 15 gastric sleeves, 14 cholecystectomies, and 1 Roux en-Y gastric bypass. The procedures were successfully performed by utilizing the robotic magnetic surgical system and a reduced-port technique in all 30 patients. No device-related serious adverse events were reported. The device provided adequate visualization and retraction in all cases.

Conclusions

This clinical trial shows for the first time that this novel Magnetic Robotic Platform is safe and feasible in reduced-port laparoscopic cholecystectomy and laparoscopic bariatric surgery. This robotic platform brings the benefits of magnetic surgery in terms of reduction of incisions plus increasing the control for the surgeon.

Extraperitoneal tissue retraction technique: An effective assistant of extraperitoneal pure single-port robotic-assisted radical prostatectomy with the da Vinci Si surgical system

Objective

The limitations of tissue retraction and the amount of surgical working space have a great impact on extraperitoneal single-port robotic-assisted radical prostatectomy (sp-RARP) with the multiport robotic surgical system. We used an extraperitoneal tissue retraction technique to achieve tissue exposure and working space expansion. This study evaluated the safety, feasibility, and efficacy of the extraperitoneal tissue retraction technique in extraperitoneal pure sp-RARP with the da Vinci Si surgical system.

Methods

Data from 42 patients were analyzed retrospectively from December 2018 to February 2020. The extraperitoneal tissue retraction technique was not used in 20 patients (group I) and was used in 22 patients (group II). Preoperative, intraoperative, and postoperative data were collected. The oncological and functional data during late follow-up were recorded.

Results

All patients successfully underwent extraperitoneal pure sp-RARP. No patients required conversion to a multiport surgery or placement of additional assistant ports. The two groups were similar regarding baseline features. The median operation time in group I was significantly longer than that in group II (P < 0.001). The estimated blood loss volume in group I was significantly higher than that in group II (P < 0.001). There were no serious complications in either group. There were four cases of peritoneal tears in group I and none in group II (P = 0.043). The surgical margin and lymph nodes were negative in both groups. The oncological and functional outcomes were similar between the two groups 6 months after the procedure.

Conclusions

The extraperitoneal tissue retraction technique is safe and feasible. The technique promotes tissue exposure and expands the surgical working space, which is important for achieving extraperitoneal pure sp-RARP with the da Vinci Si surgical system, especially for beginners. The short-term oncological and functional outcomes were within acceptable ranges. The long-term effects of this technique need further evaluation.

Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care

We reviewed the evolving strategies, practice patterns, and recent advancements aimed at improving the perioperative and surgical outcomes in patients undergoing robot-assisted radical prostatectomy for the management of localized prostate cancer.

Novel Gerota-edge-sling technique facilitates retroperitoneal robot-assisted partial nephrectomy: a comparative study

Background

Retroperitoneal robotic partial nephrectomy is markedly restricted by limited space and visual field. We introduced a novel Gerota-edge-sling (GES) technique with self-designed traction devices to overcome these defects by attaching Gerota fascia to abdominal wall, and comparatively evaluated its utilization with routine technique.

Methods

A retrospective analysis was performed for consecutive patients who underwent routine (control group) or GES assisted (GES group) retroperitoneal robotic partial nephrectomy for localized renal tumors in our hospital between March 2018 and June 2020. Clinical data of perioperative outcomes and complications were collected and compared. Comparison of outcomes between anterior versus posterior tumor subgroups was also conducted. Linear regression analysis was used to define the relationship between dissection time and perinephric fat status in each group.

Results

Totally 103 patients were included, 48 in control and 55 in GES group respectively. All the procedures were completed successfully without conversion or positive surgical margin. GES group had significantly decreased console time (91 ± 36 min vs. 117 ± 41 min, p < 0.01) and dissection time (67 ± 35 min vs. 93 ± 38 min, p < 0.01) than control, while ischemia time, blood loss, and nephrometry score comparable between them. No major postoperative complications occurred. Dissection time of GES group was notably shorter than that of control in both anterior/posterior subgroups. Only in control group, dissection time was positively associated with perinephric fat status.

Conclusions

The GES technique acting as an adjunct to robotic arms with space-sparing feature, notably improves surgical exposure and facilitates dissection in retroperitoneal partial nephrectomy, while having great feasibility, efficacy and safety.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12894-022-01079-4.

The role of magnetic anchoring and traction technique in thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve

BACKGROUND

Dissecting lymph nodes along the left recurrent laryngeal nerve (LRLN) is the most challenging step in thoracoscopic-assisted esophagectomy. To retract the proximal esophagus in the existing lymphadenectomy methods, either a special trocar is required to insert and take out endoscopic instruments or thoracic punctures are needed to externally retract the esophageal loop. Therefore, advanced skills for esophageal traction are important to facilitate the LRLN lymphadenectomy and to reduce the incidence of trauma to the chest wall. Herein, we present the magnetic anchoring and traction technique, a novel method for LRLN lymphadenectomy during thoracoscopic esophagectomy.

METHODS

The magnetic anchoring traction system was successfully used to retract the upper thoracic esophagus and to help expose the upper mediastinum in 10 cases of thoracoscopic-assisted esophagectomy. When the external magnet was moved outside of body, the internal magnet was coupled with a magnetic force to pull the proximal esophagus to the appropriate direction, which helped to expose the LRLN and adjacent lymph nodes. The lymph nodes adjacent to the LRLN could then be dissected completely without any damage to the nerve.

RESULTS

In all surgeries, the LRLN and adjacent lymph nodes were well visualized, and the number of trocars used to pass endoscopic instruments for retraction of the proximal esophagus or the number of thoracic punctures for external traction of the esophagus during the surgery were reduced.

CONCLUSIONS

In thoracoscopic-assisted esophagectomy, the magnetic anchoring and traction technique can improve the exposure of the LRLN, facilitate LRLN lymphadenectomy, and reduce chest wall trauma.

Efficacy and safety of single port robotic radical prostatectomy and multiport robotic radical prostatectomy: a systematic review and meta-analysis

Background

The purpose of this study is to compare the clinical efficacy and safety of single port (SP) robot radical prostatectomy and multiport (MP) robot radical prostatectomy.

Methods

Using the China National Knowledge database, EMBASE, Cochrane library, PubMed, and other databases to obtain relevant research, SP robot radical prostatectomy and MP robot radical prostatectomy were comprehensively evaluated. The software used to evaluate the impact of the results in the selected articles was Review Manager 5.2. Deviation analysis, forest plot analysis, and sensitivity analysis were carried out for the collected data.

Results

A total of 7 related studies that met the criteria were finally included. The data showed that the operation time of MP in the control group was significantly longer than that in the SP group [mean difference (MD) =−13.29; 95% confidence interval (CI): (−17.35, −9.23); P<0.00001; I²=50%]. The duration of intensive care unit (ICU) stay for SP surgery was shorter than that for MP surgery [MD =−18.30; 95% CI: (−29.17, −7.42); P=0.0010; I²=94%]. The blood loss of SP surgery was less than that of MP surgery [MD =−15.54; 95% CI: (−28.37, −2.71); the total effective rate was 0.02; I²=0%]. There was no significant difference in the incidence of postoperative complications between SP and MP surgery [risk ratio (RR) =0.95; 95% CI: (0.55, 1.63); P=0.85; I²=0%]. At the same time, the sensitivity analysis and funnel plot showed that this study was robust and publication bias was limited.

Discussion

Our results show that SP robotic radical prostatectomy is superior to MP robotic radical prostatectomy in terms of efficacy and safety. SP robot radical prostatectomy is worthy of wide promotion.

Single-port, Retzius-sparing robotic-assisted radical prostatectomy: feasibility and early outcomes

BACKGROUND Determine safety and feasibility of single-port, Retzius-sparing robot-assisted radical prostatectomy (SP-rsRARP) using the da Vinci® SP (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform in men with adenocarcinoma of the prostate. PATEINTS AND METHODS Twenty-eight consecutive men with prostate cancer underwent SP-rsRARP by one of two surgeons (J.B., S.C.). Data for peri-operative, pathologic, and functional outcomes were collected prospectively and retrospectively analyzed. RESULTS Mean (SD) follow-up was 6 (3) months. Mean age was 65.3 years old with an average body mass index of 25.2 kg/m2. Mean preoperative PSA was 10.2 ng/mL. Average prostate weight was 42 grams. Three patients (11%) had prior radiation to the prostate. There were no intraoperative complications or conversions of technique. Lymphadenectomy was performed in twenty-four (86%) patients and nerve-sparing in fourteen (46%). Mean operative time (skin to skin) was 234 minutes with an average estimated blood loss of 148 mL. Length of hospital stay averaged 23 hours. Seventeen (61%) of the patients did not require opioids for post-operative pain. Two Clavien Grade IIIa complications occurred (lymphocele aspiration, dilation of bladder neck contracture). Pathological grade group was group 1 (0%), grade 2 (57%), group 3 (29%) and group 4-5 (14%). Pathologic stage was T2 (15/28, 54%) and T3a,b (13/28, 46%). Five patients (18%) had a positive surgical margin, four (80%) of whom had T3 disease. One patient (4%) had a detectable PSA in follow-up and opted for adjuvant radiation. Twenty-three patients (82%) were continent at foley removal. Post-operative mean SHIM scores in those who underwent nerve-sparing was 18 at 3-months follow-up. CONCLUSIONS SP-rsRARP appears safe and feasible. Early continence rates are promising. Full characterization of outcomes require longer follow-up and larger cohort validation.

Robotic-assisted genitourinary reconstruction: current state and future directions

With the widespread dissemination of robotic surgical platforms, pathology previously deemed insurmountable or challenging has been treated with reliable and replicable outcomes. The advantages of precise articulation for dissection and suturing, tremor reduction, three-dimensional magnified visualization, and minimally invasive trocar sites have allowed for the management of such diverse disease as recurrent or refractory bladder neck stenoses, and radiation-induced ureteral strictures, with excellent perioperative and functional outcomes. Intraoperative adjuncts such as near-infrared imaging aid in identification and preservation of healthy tissue. More recent developments include robotics via the single port platform, gender-affirming surgery, and multidisciplinary approaches to complex pelvic reconstruction. Here, we review the recent literature comprising developments in robotic-assisted genitourinary reconstruction, with a view towards emerging technologies and future trends in techniques.

Perioperative and Oncologic Outcomes of Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Meta-Analysis

Purpose: Although single-port robot-assisted radical prostatectomy (SP-RARP) is considered a safe and feasible approach for radical prostatectomy, the comparative performance of the SP robot with earlier models, including da Vinci Xi or Si, is elusive. This systematic review summarizes the current evidence on SP-RARP and compares its perioperative, functional, and oncologic outcomes to multiport robot-assisted radical prostatectomy (MP-RARP). Methods: We performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library database for randomized control trials (RCTs) and non-RCTs that compare SP-RARP to MP-RARP. The primary outcomes included perioperative, functional, oncologic, and painful outcomes. The odds ratio (OR) and weighted mean difference (WMD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CIs). Results: Seven studies, including 1239 patients, were enrolled in the meta-analysis. We reported similar results for SP-RARP and MP-RARP in terms of the operative time, blood loss, continence and potency rates, complication rate, positive surgical margin, and biochemical recurrence. However, hospital stay (WMD -17.86 hours, 95% CI -27.80 to -7.92; p = 0.0004), catheterization time (WMD -1.51 days, 95% CI -2.60 to -0.41; p = 0.007), and the rate of opioid use (OR 0.26, 95% CI 0.13 to 0.53; p = 0.0002) were less with SP-RARP. In addition, more patients did not require any pain medication during the hospital stay with SP-RARP (OR 14.41, 95% CI 5.22 to 39.76; p < 0.00001). Conclusions: SP-RARP is associated with a shorter hospital stay and catheterization time, and the need for postoperative pain medication is lower compared to MP-RARP, with comparable perioperative, functional, and oncologic outcomes.

Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis

Robotic-assisted simple prostatectomy (RASP) has proven to be an effective minimally invasive option for benign prostatic enlargement (BPE) in recent years. Single-site surgery is theorized to reduce post-operative pain beyond traditional minimally invasive approaches. We sought to assess whether use of a single-port robotic platform decreases post-operative opioid use in patients undergoing robotic-assisted simple prostatectomy (RASP). A retrospective review was performed of all patients undergoing RASP our institution from November 2017 to July 2019. Demographic, intraoperative, and post-operative data, including morphine equivalent (ME) use, were collected. Patients were stratified by robotic platform utilized. Propensity score matching using nearest neighbor method was performed using prostate volume, Charlson comorbidity index (CCI), and post-op ketorolac use in 4:1 fashion. Chi-squared analysis and Kruskal-Wallis analyses were utilized. Two-hundred-and-seven men underwent RASP. After matching, 80 patients (64 multi-port, 16 single-port) were included in the analysis. Groups were comparable for age, body mass index, CCI, prostate volume, prior opioid use, and use of scheduled ketorolac post op. The single-port approach was associated with a reduction in MEs once admitted to the floor (5 vs. 11 mg, p = 0.025) and an increase in the proportion of patients who did not require any narcotics post-operatively (44 vs. 19%, p = 0.036). In a propensity matched cohort of patients undergoing RASP at a single institution, use of the single-port robotic system conferred a significant decrease in post-operative narcotic use by approximately 50%.

Optimizing outcomes of colorectal cancer surgery with robotic platforms

Advanced robotic technology makes it easier to perform total mesorectal excision procedures in the narrow pelvis for rectal cancer while maintaining the advantages of minimally invasive surgery. Robotic surgery for rectal cancer leads to lower conversion rates and faster recovery of urogenital function than conventional laparoscopic surgery. However, longer operative time and high cost are major weaknesses of robotic surgery. To date, most other short-term surgical outcomes, pathologic outcomes, and long-term oncologic outcomes of robotic surgery have not shown significant advantages over laparoscopic surgery. However, robotic surgery is still a valid and highly anticipated surgical approach for rectal cancer because it greatly reduces the surgeon's workload and learning curve. There are also advantages when robotic techniques are applied to technically demanding procedures such as lateral pelvic lymph node dissection or intersphincteric resection. The introduction of new surgical robot systems, including the da Vinci® SP system, is expected to expand the applications of robotic surgery and provide new advantages.

Single Port Robotic Surgery in Urology

PURPOSE

To provide a comprehensive review on the new da Vinci SP (single port) robotic surgical system. The published literature to date within urology and a description of the new system will be discussed.

FINDINGS

There are currently no high-quality published studies with the SP robotic system. All studies are case series, many with 10 or fewer patients. However, all studies have found the SP system to be safe and feasible in performing most urological procedures. Renal and pelvic surgery using the SP robotic system is safe and feasible in the hands of expert robotic surgeons. Long-term, high-quality data is lacking. While the current high price and the learning curve will limit the SP systems' use in many health care systems, new updates and the release of robotic surgical systems from other developers may help drive down costs and encourage uptake.

First prospective clinical trial of reduced incision bariatric procedures using magnetic liver retraction

BACKGROUND

Exposure of the surgical field is an essential component of minimally invasive surgery. Liver retraction is an important element of bariatric procedures because visualization of the stomach and gastroesophageal junction is key. The magnetic surgical system provides a well-tolerated and effective option for adjustable liver retraction without the use of a dedicated port.

OBJECTIVE

The purpose of this study was to evaluate the safety profile and effectiveness of the magnetic surgical system in patients undergoing bariatric procedures.

SETTING

Two investigational sites in Chile.

METHODS

A prospective, single-arm study (ClinicalTrials.govNCT03508674) with adherence to Good Clinical Practices and ISO 14155:2011(E) was undertaken to evaluate the safety profile and effectiveness of the magnetic surgical system in patients undergoing bariatric surgery. Patient follow-up occurred at 7 and 30 days postprocedure.

RESULTS

A total of 50 patients who met the inclusion criteria had a body mass index ranging from 28.4 to 58.2 kg/m². All procedures were completed without complications or conversions. The average overall procedure time was 61 minutes, and the amount of coupling time between the magnetic controller and the detachable grasper was 37 minutes. In all cases the device was able to adequately retract the liver to achieve an effective exposure of the target tissue and perform the bariatric procedure. A total of 24 adverse effects were reported throughout the course of the study. All device-related adverse effects were mild in severity and resolved with no clinical sequelae.

CONCLUSION

The magnetic surgical system is a well-tolerated and effective option for liver retraction in minimally invasive and bariatric surgery in patients with a varying range of body mass indexes.

First in-human experience with a novel robotic platform and Magnetic Surgery System

BACKGROUND

Magnetic technologies have been introduced to reduce invasiveness of surgical procedures. This study was aimed to analyse the performance of a novel combined magnetic-robotic controller as an enhanced accessory to the Magnetic Surgical System in laparoscopic cholecystectomy (LC).

METHODS

This was a prospective study of 10 consecutive patients undergoing LC with this novel surgical system.

RESULTS

Ten patients were included, nine were female. The mean age was 30.3 ± 9 years. All patients had chronic cholecystitis. Procedures were completed successfully. The median operative time was 50 ± 11 min. The system performed effectively in all cases with no need of additional interventions. There were no device-related complications or side effects. All patients were discharged the same day. Recovery was uneventful during follow-up.

CONCLUSIONS

This study demonstrates the first in-human successful performance of surgeries utilizing a novel combination of magnetic and robotic technologies in one integrated system.

Comparison of Perioperative and Pathologic Outcomes Between Single-port and Standard Robot-assisted Radical Prostatectomy: An Analysis of a High-volume Center and the Pooled World Experience

OBJECTIVE

To perform an early comparative study of outcomes between single-port and robot-assisted laparoscopic radical prostatectomy (SP-RALRP) and standard RALRP at our institution and pooled analysis of series to date.

PATIENTS AND METHODS

Patients with organ-confined prostate cancer undergoing SP-RALRP at a high-volume institution were identified retrospectively along with reported SP-RALRP series to date. Data were compared to a contemporary prospective cohort of men undergoing standard RALRP. Patient demographics, perioperative and postoperative data, and complications categorized by the Clavien-Dindo system were compared for the institutional and pooled SP-RALRP cohorts to standard RALRP.

RESULTS

A total of 208 SP-RALRP cases were identified (26 from our institution) and compared to 376 standard RALRP cases. In the institutional analysis, there was no difference in operative time, length of stay, overall complications (15.4% vs 17.3%, P= 1.0), major (Clavien ≥III) complications (3.8% vs 3.7%, P = .6), inpatient opioid use, or patient-reported pain scores; median estimated blood loss (100 mL vs 150 mL, P = .02) and number of lymph nodes removed (5.5 vs 9, P = .002) were lower for SP-RALRP. In the pooled analysis, 208 patients receiving SP-RALRP had similar estimated blood loss and complication rates but fewer lymph nodes removed (P = .02) and marginally longer operating time (+16 minutes, P = .01) compared to standard RALRP. The difference in rate of positive surgical margins was not statistically significant (31.3% vs 24.5%, P = .08).

CONCLUSION

Based on an early experience with SP-RALRP at a high-volume center and a pooled analysis of SP series to date, perioperative and pathologic outcomes appear nearly equivalent compared to standard RALRP.

Mobilization of a peritoneal dialysis catheter using an extra-corporeal magnet: preliminary experimental phase study

PURPOSE

To evaluate in an experimental model, the mobility of a novel peritoneal dialysis catheter with a metallic tip (Mag-Cath) using an extra-corporeal magnet.

MATERIALS AND METHODS

The Mag-Cath was installed in a porcine model under general anesthesia using laparoscopic access. A senior urologist, a urology resident, and a 3rd-year medical student were assigned to complete 2 tasks guided by fluoroscopy: (1) Move the catheter tip from the right flank to the pelvis and (2) move the catheter tip from the pelvis to the left flank. Accomplishment and time to complete the tasks were recorded. Participants were asked independently to grade the difficulty of the tasks using an analog scale from 1 (extremely easy) to 10 (extremely difficult).

RESULTS

All participants completed the tasks. The difficulty of the tasks was graded equal to 1 by the senior urologist and urology resident and equal to 3 by the medical student. The time to move the Mag-Cath from the right flank to the target was 14, 10, and 55 s for the senior urologist, urology resident, and medical student, respectively. The time to move the Mag-Cath from the target to the left flank was 17, 18, and 43 s for the senior urologist, urology resident, and medical student, respectively.

CONCLUSION

In this preliminary analysis, the use of an extra-corporeal magnet to move the Mag-Cath was feasible, with a low grade of difficulty, and individuals with different levels of expertise could perform it. Further studies in human subjects are needed to evaluate the clinical applicability of the Mag-Cath properly.

Single-Port Robot-Assisted Dismembered Pyeloplasty With Mini-Pfannenstiel or Peri-Umbilical Access: Initial Experience in a Single Center

OBJECTIVE

To assess the feasibility and describe the surgical technique for single-port robotic-assisted laparoscopic pyeloplasty using the new da Vinci SP surgical platform (Intuitive Surgical Inc., Sunnyvale, CA), and to describe the approach through a mini-pfannenstiel incision.

METHODS

Data from a prospectively maintained single-institution database on all patients undergoing single-port robotic-assisted pyeloplasty between November 2018 and November 2019 were reviewed. Pyeloplasty was performed with the da Vinci SP system through a pure single site approach (except for the first patient). The initial procedures were performed through a midline incision and the technique evolved to a mini-pfannenstiel incision. Patient demographics, intraoperative data, post-operative data and surgical outcomes were collected.

RESULTS

Overall, 10 patients were included and underwent the procedure without intraoperative complications or conversion to an alternate approach. The patients' ages ranged between 11 and 75 years. Mean operative time was 166 minutes (interquartile range [IQR] 146-181) and EBL was minimal. Pfannenstiel incision was performed for 6 patients and 4 patients had a vertical midline incision. The only complication recorded was a postoperative urinary tract infection treated with antibiotics. The median postoperative hospital stay was 21 hours (7-24). Postoperative pain management after discharge was managed exclusively with non-opioid medication. Overall success rate defined as the absence of pain and renal obstruction on post-operative imaging at 3 months after surgery was 100%.

CONCLUSION

Single-port robotic-assisted laparoscopic pyeloplasty is a safe and feasible procedure through a mini-pfannenstiel incision.

Single-port robot-assisted radical prostatectomy: a systematic review and pooled analysis of the preliminary experiences

OBJECTIVE

To summarize the clinical experiences with single-port (SP) robot-assisted radical prostatectomy (RARP) reported in the literature and to describe the peri-operative and short-term outcomes of this procedure.

MATERIAL AND METHODS

A systematic review of the literature was performed in December 2019 using Medline (via PubMed), Embase (via Ovid), Cochrane databases, Scopus and Web of Science (PROSPERO registry number 164129). All studies that reported intra- and peri-operative data on SP-RARP were included. Cadaveric series and perineal or partial prostatectomy series were excluded.

RESULTS

The pooled mean operating time, estimated blood loss, length of hospital stay and catheterization time were 190.55 min, 198.4 mL, 1.86 days and 8.21 days, respectively. The pooled mean number of lymph nodes removed was 8.33, and the pooled rate of positive surgical margins was 33%. The pooled minor complication rate was 15%. Only one urinary leakage and one major complication (transient ischaemic attack) were recorded. Regarding functional outcomes, pooled continence and potency rates at 12 weeks were 55% and 42%, respectively.

CONCLUSIONS

The present analysis confirms that SP-RARP is safe and feasible. This novel robotic platform resulted in similar intra-operative and peri-operative outcomes to those obtained with the standard multiport da Vinci system. The advantages of single incision can be translated into a preservation of the patient's body image and self-esteem and cosmesis, which have a great impact on a patient's quality of life.

Magnetic-Assisted Robotic and Laparoscopic Renal Surgery: Initial Clinical Experience with the Levita Magnetic Surgical System

Introduction: The Levita™ Magnetic Surgical System (LMSS) is a new device that can provide retraction using magnets and can reduce the number of ports used during laparoscopic and robotic procedure. It is U.S. Food and Drug Administration (FDA) approved for laparoscopic cholecystectomy, bariatric operation, and robotic radical prostatectomy. Our objective was to evaluate the safety and feasibility of the magnetic surgical system during renal procedure. Methods: We performed a prospective, single-center, single-arm, open-label study to assess the safety and performance of the LMSS. The system includes a deployable, single-use magnetic grasper and a reusable external magnet. Selected patients undergoing either laparoscopic or robotic renal procedure from April 2019 to August 2019 were included. Robotic procedures were performed with the da Vinci Xi or single-port (SP) surgical platforms. Preoperative demographic, intraoperative data, and postoperative data were collected and analyzed. Results: Ten procedures were performed using the LMSS. Cases included Xi robotic partial nephrectomy (n = 3), Xi robotic radical nephrectomy (n = 2), SP robotic partial nephrectomy (n = 2), SP robotic pyeloplasty (n = 1), laparoscopic donor nephrectomy (n = 1), and laparoscopic radical nephrectomy (n = 1). No cases required conversion to an open procedure. Issues included one small liver capsular tear from the device jaws necessitating fulguration and occasional robotic "recoverable fault" errors when the external magnet was placed too close to the robotic arms. All patients were discharged home on postoperative day 1 or 2, and there were no readmissions within 30 days. Conclusions: This is the first report on the use of the LMSS for renal procedure. Its use for laparoscopic and robotic renal procedure appears safe and feasible. The grasper is especially useful for exposing the renal hilum during dissection and the ureteropelvic junction during SP robotic procedures, mimicking multiport techniques. Further study is required to optimize use of the LMSS and evaluate its cost effectiveness.