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Miyake H, Fujisawa M. Early experience and future prospects regarding use of newly developed surgical robot system, hinotori, in the field of urologic cancer surgery. Int J Clin Oncol 2024; 29:640-646. [PMID: 38625439 PMCID: PMC11130061 DOI: 10.1007/s10147-024-02503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
In the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical approach in the majority of major surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. Of these, hinotori, the first made-in-Japan robotic system, is characterized by various unique and attractive features different from the existing system, and the use of this system has gradually increased mainly in urologic cancer surgeries, including radical prostatectomy, partial nephrectomy, radical nephrectomy, and radical nephroureterectomy. This review initially describes detailed characteristics of hinotori, then summarizes the early experience with urologic cancer surgeries using hinotori at our institution, and finally discusses the future prospects of robotic surgery using hinotori, considering problems associated with the use of this robotic system.
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Affiliation(s)
- Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
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Chen R, Mei Z, Chen J. Scrutinizing VTE risk factors in complex renal tumor patients: a comprehensive look at the VTE-RT-IVCTT study. Int J Surg 2024; 110:1813-1814. [PMID: 38051929 PMCID: PMC10942190 DOI: 10.1097/js9.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Ru Chen
- Department of Urology, Fujian Medical University Union Hospital, Gulou District, Fuzhou City, Fujian Province
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, People’s Republic of China
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Gulou District, Fuzhou City, Fujian Province
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Motoyama D, Matsushita Y, Watanabe H, Tamura K, Otsuka A, Fujisawa M, Miyake H. Robot-assisted radical nephrectomy and inferior vena cava tumor thrombectomy using the novel surgical robot platform, hinotori: Initial experience with two cases. IJU Case Rep 2024; 7:96-99. [PMID: 38440702 PMCID: PMC10909141 DOI: 10.1002/iju5.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/09/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction A newly developed surgical robot system, hinotori, with various unique advantages has been in clinical use in Japan; however, there have not been any studies of robot-assisted radical nephrectomy and inferior vena cava tumor thrombectomy using hinotori. Case presentation We describe two male patients aged 67 and 76 years old with right renal cell carcinoma and a level II and I inferior vena cava tumor thrombus, respectively, undergoing robot-assisted radical nephrectomy and inferior vena cava tumor thrombectomy using hinotori. Both operations were successfully completed with a purely robotic procedure without any major perioperative complications, resulting in the following findings: time using robotic system, 158 and 156 min; total operative time, 228 and 214 min; estimated blood loss, 535 and 200 mL, respectively. Conclusion Based on our first experience, robot-assisted radical nephrectomy and inferior vena cava tumor thrombectomy using hinotori may be an effective treatment for renal cell carcinoma with inferior vena cava tumor thrombus ≤level II.
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Affiliation(s)
- Daisuke Motoyama
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
- Department of Developed Studies for Advanced Robotic SurgeryHamamatsu University School of MedicineHamamatsuJapan
| | - Yuto Matsushita
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
| | - Hiromitsu Watanabe
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
| | - Keita Tamura
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
| | - Atsushi Otsuka
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
| | - Masato Fujisawa
- Division of UrologyKobe University Graduate School of MedicineKobeJapan
| | - Hideaki Miyake
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
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Review of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy in Renal Cell Carcinoma. Curr Urol Rep 2022; 23:363-370. [PMID: 36454370 DOI: 10.1007/s11934-022-01120-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW Recent advances in minimally invasive technology have compelled surgeons to perform nephrectomy with inferior vena cava thrombectomy using robotic assistance. Here, we aim to review the data comparing open versus robot-assisted nephrectomy with IVC thrombectomy, as well as review operative robotic techniques for nephrectomy with IVC thrombectomy. RECENT FINDINGS Over the last decade, there have been increasing reports of successful robotic-assisted IVC thrombectomy among skilled robotic surgeons, with case series detailing operative technique, as well as operative and oncologic outcomes for levels I-IV caval thrombus. While there is immense promise in the future of robotic-assisted IVC thrombectomy, further studies with direct comparison to open surgical intervention will be needed to ensure the oncologic principles and outcomes are non-inferior.
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Liu Z, Li Y, Tang S, Zhao X, Chen K, Ge L, Zhu G, Hong P, Wu B, Wu Z, Zhang S, Tian X, Wang S, Liu C, Zhang H, Ma L. Preliminary experience of oblique occlusion technique in robot-assisted infrahepatic inferior vena cava thrombectomy: step-by-step procedures and short term outcomes. BMC Surg 2022; 22:377. [PMCID: PMC9636754 DOI: 10.1186/s12893-022-01821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
We aimed to compare the oncological outcomes between the oblique occlusion technique and the traditional technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) thrombectomy, and to explore the safety and effectiveness of the oblique occlusion technique.
Methods
Overall, 21 patients with renal cell carcinoma (RCC) and IVC tumor thrombus (TT) were admitted to our hospital from August 2019 to June 2020. All the patients underwent RARN with IVC thrombectomy, of which the IVC oblique occlusion technique was used in 11 patients and traditional occlusion technique was used in 10 patients. The oblique occlusion technique refers to oblique blocking from the upper corner of the right renal vein to the lower corner of the left renal vein using a vessel tourniquet or a vessel clamp (left RCC with IVCTT as an example).
Results
Compared with patients in the traditional group, those in the oblique group had lower serum creatinine at follow-up (3 month) (95 ± 21.1 vs. 131 ± 30.7 μmol/L, P = 0.03). There was no significant difference in operation time [149 (IQR 143–245) min vs. 148 (IQR 108–261) min, p = 0.86], IVC clamping time [18 (IQR 12–20) min vs. 20 (IQR 14–23) min, p = 0.41], and estimated intraoperative blood loss [300 (IQR 100–800) mL vs. 500 (IQR 175–738) mL, p = 0.51] between both groups. During a 16-month (range, 15–23 months) follow-up period, two cases progressed in the oblique group and three cases progressed in the traditional group.
Conclusions
The modified IVC oblique occlusion technique procedure is relatively safe and effective in RARN with IVC thrombectomy. The IVC oblique occlusion technique may play a role in the protection of renal function.
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Motoyama D, Ito T, Sugiyama T, Otsuka A, Miyake H. Robot-assisted radical nephrectomy and inferior vena cava tumor thrombectomy: Initial experience in Japan. IJU Case Rep 2022; 5:145-148. [PMID: 35509774 PMCID: PMC9057738 DOI: 10.1002/iju5.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/11/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Open surgical approach remains the standard treatment for renal cell carcinoma with an inferior vena cava tumor thrombus. In recent years, however, robot-assisted radical nephrectomy and inferior vena cava tumor thrombectomy have emerged as minimally invasive alternatives to conventional open surgery. Case presentation Here, we describe a 76-year-old female patient with right renal cell carcinoma with a level I inferior vena cava thrombus undergoing robot-assisted radical nephrectomy and inferior vena cava tumor thrombectomy, which was successfully completed with a purely robotic procedure, resulting in the following outcomes: console time,167 min; total operative time, 211 min; and estimated blood loss, 150 mL. To our knowledge, this is the first case managed by robot-assisted radical nephrectomy and inferior vena cava tumor thrombectomy in Japan. Conclusion Based on our experience, it might be worthwhile to consider purely robotic surgery for the treatment of renal cell carcinoma with an inferior vena cava thrombus.
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Affiliation(s)
- Daisuke Motoyama
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
| | - Toshiki Ito
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
| | - Takayuki Sugiyama
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
| | - Atsushi Otsuka
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
| | - Hideaki Miyake
- Department of UrologyHamamatsu University School of MedicineHamamatsuJapan
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Surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today 2022; 52:1125-1133. [PMID: 34977987 DOI: 10.1007/s00595-021-02429-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
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Ma S, Jia W, Hou G, Quan P, Zhang L, Fan X, Yang B, Su X, Jiao J, Wang F, Yuan J, Qin W, Yang X. Case reports of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy: A retrospective analysis. Medicine (Baltimore) 2021; 100:e26886. [PMID: 34414942 PMCID: PMC8376354 DOI: 10.1097/md.0000000000026886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023] Open
Abstract
Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery procedure. High rates of operative complications and mortality are usually associated with an open surgery procedure. The recently emerged robot-assisted laparoscopic radical nephrectomy (RAL-RN) and IVC tumor thrombectomy have shown to reduce operative related complications in patients with renal cell carcinoma.This case series study aimed to summarize technical utilization, perioperative outcomes, and efficacies of RAL-RN and IVC tumor thrombectomy in our hospital. A retrospective analysis was performed on clinical data from 20 patients who underwent RAL-RN and IVC tumor thrombectomy from January 2017 to December 2019 in our department.Patients had a median age of 59 years (interquartile range [IQR], 46-68). Four patients had renal neoplasm on left side and 16 on right side. Nineteen patients underwent RAL-RN (level 0: n = 2) or RAL-RN with IVC thrombectomy (n = 17) (level I: n = 3; level II: n = 12; and level III: n = 3) and 1 patient was converted into an open surgery. The median operative time was 328 minutes (IQR, 221-453). The estimated median blood loss was 500 mL (IQR, 200-1200). The median size of removed renal carcinoma was 67 cm2 (IQR, 40-91); the length of IVC tumor thrombus was 5 cm (IQR, 3-7). The postsurgery hospital length of stay was 6 days (IQR, 5-7). The complications included intestinal obstruction (n = 1), lymphatic fistula (n = 1), heart failure (n = 1), and low hemoglobin level (n = 1). The outcomes for patients after 16 months (IQR, 11-21) follow-up were tumor-free (n = 10), tumor progression (n = 4), loss of contact (n = 1), and death (n = 5).We concluded that RAL-RN and IVC thrombectomy renders good safety profiles including minimal invasiveness, low estimated median blood loss, short hospitalization, low morbidity, and quick renal function recovery. The long-term efficacy needs a further investigation.
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Affiliation(s)
- Shuaijun Ma
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Weijing Jia
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Penghe Quan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Longlong Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaozheng Fan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Bo Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xing Su
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jianhua Jiao
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Fuli Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaojian Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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Wu S, Peng C, Li HZ, Huang Q, Fan Y, Gao Y, Zhang X, Wang B, Ma X. Robotic retroperitoneal versus transperitoneal inferior vena cava thrombectomy: right-sided cases with level I-II tumor thrombus. J Endourol 2021; 35:1498-1503. [PMID: 33787317 DOI: 10.1089/end.2021.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare the perioperative hemodynamic consequences and oncology outcomes of robotic retroperitoneal versus transperitoneal inferior vena cava(IVC) thrombectomy(IVCT) for right renal cell carcinoma(RCC) with IVC tumor thrombus(IVCTT) that located below the first porta hepatis. PATIENTS AND METHODS Between January 2018 and June 2019, 35 patients of right RCC with IVCTT that located below the first porta hepatis underwent robotic retroperitoneal IVCT(16 patients) or transperitoneal IVCT(19 patients). We have described the procedures of transperitoneal IVCT earlier. The main procedure of robotic retroperitoneal IVCT include circumferential dissection of the IVC, sequentially clamping subhepatic IVC, the left renal vein and the caudal IVC with vessel loops, IVCT, IVC repair, radical nephrectomy(RN). The following parameters were compared between the two groups: baselines characteristic, perioperative consequences and hemodynamic changes. RESULTS Retroperitoneal and transperitoneal cohorts were comparable in terms of IVC thrombus length(3.2 vs 4.0 cm), IVC block time (18 vs 16 min, p=0.64), postoperative hospital stay (6 vs 6 days, p= 0.67), postoperative complications (0 vs 0), and recurrence or metastasis rate(0 vs 0) for patients with similar baseline characteristic. The retroperitoneal cohort tended to less blood loss (160 vs 240ml,p=0.024), shorter operative time(130 vs 145min,p=0.003), lower central venous pressure(p<0.05) and smaller diameter of IVC (p<0.05). CONCLUSIONS Robotic retroperitoneal RN and IVCT is feasible for patients of right RCC with IVCTT located below the first porta hepatis and is superior to transperitoneal IVCT in terms of bleeding control and operation time for skilled surgeons.
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Affiliation(s)
- Shengpan Wu
- Chinese PLA General Hospital, Urology, Beijing , Haidian District, Urology, No. 28,Fuxing Road,Chinese PLA General Hospital, Beijing, China, 100853;
| | - Cheng Peng
- Chinese PLA General Hospital, Urology, Beijing, Beijing, China;
| | - Hong Zhao Li
- Chinese PLA general hospital, urology, Beijng, China;
| | - Qingbo Huang
- Chinese PLA General Hospital, Urology, Beijing, Beijing, China;
| | - Yang Fan
- Chinese PLA General Hospital, Urology, Beijing, Beijing, China;
| | - Yu Gao
- Chinese PLA General Hospital, Urology, 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853;
| | - Xu Zhang
- Chinese PLA General Hospital, Department of Urology, No 28 Fuxing Road, Beijing, Beijing, China, 100853;
| | - Baojun Wang
- Chinese PLA General Hospital, 104607, Urology, 28 Fu Xing Road, Haidian District, Beijing, China, 100853;
| | - Xin Ma
- Chinese PLA General Hospital, Urology, 28 Fu Xing Road, Beijing 100853, China., Beijing, Beijing, China, 100853;
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