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Greig P, Sotiriou A, Kailainathan P, Carvalho CYM, Onwochei DN, Thurley N, Desai N. Evaluation of neuraxial analgesia on outcomes for patients undergoing robot assisted abdominal surgery. J Clin Anesth 2024; 95:111468. [PMID: 38599160 DOI: 10.1016/j.jclinane.2024.111468] [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: 01/15/2024] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
STUDY OBJECTIVE Following robot assisted abdominal surgery, the pain can be moderate in severity. Neuraxial analgesia may decrease the activity of the detrusor muscle, reduce the incidence of bladder spasm and provide effective somatic and visceral analgesia. In this systematic review, we assessed the role of neuraxial analgesia in robot assisted abdominal surgery. DESIGN Systematic review. SETTINGS Robot assisted abdominal surgery. PATIENTS Adults. INTERVENTIONS Subsequent to a search of the electronic databases, observational studies and randomized controlled trials that assessed the effect of neuraxial analgesia instituted at induction of anesthesia or intraoperatively in adult and robot assisted abdominal surgery were considered for inclusion. The outcomes of observational studies as well as randomized controlled trials which were not subjected to meta-analysis were presented in descriptive terms. Meta-analysis was conducted if an outcome of interest was reported by two or more randomized controlled trials. MAIN RESULTS We included 19 and 11 studies that investigated spinal and epidural analgesia in adults, respectively. The coprimary outcomes were the pain score at rest at 24 h and the cumulative intravenous morphine consumption at 24 h. Spinal analgesia with long acting neuraxial opioid did not decrease the pain score at rest at 24 h although it reduced the cumulative intravenous morphine consumption at 24 h by a mean difference (95%CI) of 14.88 mg (-22.13--7.63; p < 0.0001, I2 = 50%) with a low and moderate quality of evidence, respectively, on meta-analysis of randomized controlled trials. Spinal analgesia with long acting neuraxial opioid had a beneficial effect on analgesic indices till the second postoperative day and a positive influence on opioid consumption up to and including the 72 h time point. The majority of studies demonstrated the use of spinal analgesia with long acting neuraxial opioid to lead to no difference in the incidence of postoperative nausea and vomiting, and the occurrence of pruritus was found to be increased with spinal analgesia with long acting neuraxial opioid in recovery but not at later time points. No difference was revealed in the incidence of urinary retention. The evidence in regard to the quality of recovery-15 score at 24 h and hospital length of stay was not fully consistent, although most studies indicated no difference between spinal analgesia and control for these outcomes. Epidural analgesia in robot assisted abdominal surgery was shown to decrease the pain on movement at 12 h but it had not been studied with respect to its influence on the pain score at rest at 24 h or the cumulative intravenous morphine consumption at 24 h. It did not reduce the pain on movement at later time points and the evidence related to the hospital length of stay was inconsistent. CONCLUSIONS Spinal analgesia with long acting neuraxial opioid had a favourable effect on analgesic indices and opioid consumption, and is recommended by the authors, but the evidence for spinal analgesia with short acting neuraxial opioid and epidural analgesia was limited.
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Affiliation(s)
- P Greig
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - A Sotiriou
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - P Kailainathan
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - C Y M Carvalho
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - D N Onwochei
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom
| | - N Thurley
- Bodleian Health Care Libraries, University of Oxford, United Kingdom
| | - N Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom.
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Haeuser L, Münker M, Frey UH, Klaaßen M, Noldus J, Palisaar R. Hypoxemia of the lower limbs during robot-assisted radical prostatectomy in Trendelenburg position. BJUI COMPASS 2024; 5:313-318. [PMID: 38371210 PMCID: PMC10869652 DOI: 10.1002/bco2.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 02/20/2024] Open
Abstract
Objectives The objective of this study is to assess frequency and risk factors for intraoperative hypoxemia of the lower limbs during robot-assisted radical prostatectomy (RARP). Trendelenburg position during RARP may contribute to hypoxemia and compartment syndrome (CS) of the lower limbs as a major but rare complication. Patients and methods This prospective study included patients undergoing RARP for prostate cancer. Preoperative calculation of the ankle-brachial-index (ABI) was performed. Peripheral oxygen saturation (SpO2) at the toes was routinely measured. Occurrence of SpO2 levels of <90% was defined as hypoxemic events and treated immediately. Blood pressure, intraabdominal pressure, SpO2 of the upper limb and surgery time were monitored in case of hypoxemia. A multivariable logistic regression model was performed with age, BMI, nicotine abuse, MAP, comorbidities as covariates and hypoxemia of the lower limbs as the outcome. Results A total of 207 patients were included. Among these, 126 patients had ABI measurements with 10.6% having an abnormal ABI value. One, two or at least three events of lower limb hypoxemia occurred intraoperatively in 19.7%, 14.8% and 16.9%, respectively. In 20 events, surgical instruments were affecting vascular perfusion by compression. None of the covariates were statistically significant associated with lower limb hypoxemia. No patient developed a compartment syndrome. Conclusion Decrease in oxygen saturation of the lower extremities was observed frequently during RARP, without revealing any risk factors for its occurrence. Routine oximetry leads to an early detection of hypoxemia of the lower extremities, giving the anaesthesiologist and surgeon the opportunity to make adequate adjustments (increasing blood pressure and ending iliac vessel compression).
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Affiliation(s)
- Lorine Haeuser
- Department of Urology and Neuro‐Urology, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Mara Münker
- Department of Urology and Neuro‐Urology, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Ulrich H. Frey
- Department of Anesthesiology, Surgical Intensive Care, Pain and Palliative Care, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Marina Klaaßen
- Department of Anesthesiology, Surgical Intensive Care, Pain and Palliative Care, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Joachim Noldus
- Department of Urology and Neuro‐Urology, Marien Hospital HerneRuhr University BochumHerneGermany
| | - Rein‐Jüri Palisaar
- Department of Urology and Neuro‐Urology, Marien Hospital HerneRuhr University BochumHerneGermany
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Arakawa K, Sako A. Well-leg compartment syndrome after robot assisted laparoscopic surgery for rectal cancer: A case report. Int J Surg Case Rep 2023; 104:107924. [PMID: 36801764 PMCID: PMC9958421 DOI: 10.1016/j.ijscr.2023.107924] [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: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Lower limb compartment syndrome caused by improper positioning during surgery is called well-leg compartment syndrome. Although well-leg compartment syndrome has been reported in urological and gynecological patients, there have been no reports of well-leg compartment syndrome in patients who have undergone robot-assisted surgery for rectal cancer. PRESENTATION OF CASE A 51-year-old man was diagnosed with lower limb compartment syndrome by an orthopedic surgeon due to pain in both of his lower legs immediately following robot-assisted surgery for rectal cancer. Due to this, we started placing the patient in the supine position during these surgeries, and repositioned the patient to the lithotomy position following intestinal tract cleansing after rectal movement in the latter half of the surgery. This avoided the long-term effects of being in the lithotomy position. We compared the operation time and complications before and after the above measures were changed, in 40 cases of robot-assisted anterior rectal resection for rectal cancer performed at our hospital from 2019 to 2022. We found no extension of operation time and no occurrence of lower limb compartment syndrome. DISCUSSION There have been several reports describing the risk reduction of WLCS using intraoperative postural changes. An intraoperative postural change from a natural supine position without pressure which we reported is considered to be a simple preventive method for WLCS. CONCLUSION Changing the patient from the supine position to the lithotomy position during surgery may be a clinically acceptable countermeasure to prevent lower limb compartment syndrome.
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Affiliation(s)
| | - Akihiro Sako
- Department of Surgery, Hitachi General Hospital, Japan.
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4
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Bjøro B, Ballestad I, Rustøen T, Fosmark MH, Bentsen SB. Positioning patients for robotic-assisted surgery: A qualitative study of operating room nurses' experiences. Nurs Open 2023; 10:469-478. [PMID: 36631733 PMCID: PMC9834175 DOI: 10.1002/nop2.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/21/2021] [Accepted: 07/29/2022] [Indexed: 01/16/2023] Open
Abstract
AIM One of the challenges of robotic-assisted surgery is related to positioning of the patient on the operating table. Technological developments place increased demands on operating room nurses' competence to prevent positioning injuries and ensuring care quality. Therefore, the aim of the present study was to describe operating room nurses' experiences when positioning the patients for robotic-assisted surgery. DESIGN A descriptive qualitative design. METHODS Seven operating room nurses with experience in robotic-assisted surgery were included at a university hospital. Data were obtained through individual interviews and analysed using qualitative content analysis. The Consolidated Criteria for Reporting Qualitative research COREQ checklist was used. RESULTS We identified three categories, (a) patient positioning is challenging during robotic-assisted surgery, (b) operating room nurses take responsibility for patient positioning during robotic-assisted surgery, but teamwork is important and (c) operating room nurses aim to achieve safe patient positioning during robotic-assisted surgery.
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Affiliation(s)
- Benedikte Bjøro
- Department of Operating Services, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Nursing Science, Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOsloNorway
| | - Ingvild Ballestad
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOsloNorway
- Department of Research and Development, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
| | - Monica Hetlesæther Fosmark
- Faculty of Health SciencesUniversity of StavangerStavangerNorway
- Operating DepartmentHelse Stavanger HFStavangerNorway
| | - Signe Berit Bentsen
- Department of Operating Services, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
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Lower leg blood pressure decreases while calf external pressure increases with the angulation of the Trendelenburg position in the lithotomy position with calf- and foot-supported leg holders. J Robot Surg 2022; 17:949-958. [DOI: 10.1007/s11701-022-01481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022]
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Reporting and grading of complications for intracorporeal robot-assisted radical cystectomy: an in-depth short-term morbidity assessment using the novel Comprehensive Complication Index ®. World J Urol 2022; 40:1679-1688. [PMID: 35670880 DOI: 10.1007/s00345-022-04051-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To assess suitability of Comprehensive Complication Index (CCI®) vs. Clavien-Dindo classification (CDC) to capture 30-day morbidity after robot-assisted radical cystectomy (RARC). MATERIALS AND METHODS A total of 128 patients with bladder cancer (BCa) undergoing intracorporeal RARC with pelvic lymph node dissection between 2015 and 2021 were included in a retrospective bi-institutional study, which adhered to standardized reporting criteria. Thirty-day complications were captured according to a procedure-specific catalog. Each complication was graded by the CDC and the CCI®. Multivariable linear regression (MVA) was used to identify predictors of higher morbidity. RESULTS 381 complications were identified in 118 patients (92%). 55 (43%), 43 (34%), and 20 (16%) suffered from CDC grade I-II, IIIa, and ≥ IIIb complications, respectively. 16 (13%), 27 (21%), and 2 patients (1.6%) were reoperated, readmitted, and died within 30 days, respectively. 31 patients (24%) were upgraded to most severe complication (CCI® ≥ 33.7) when calculating morbidity burden compared to corresponding CDC grade accounting only for the highest complication. In MVA, only age was a positive estimate (0.44; 95% CI = 0.03-0.86; p = 0.04) for increased cumulative morbidity. CONCLUSION The CCI® estimates of 30-day morbidity after RARC were substantially higher compared to CDC alone. These measurements are a prerequisite to tailor patient counseling regarding surgical approach, urinary diversion, and comparability of results between institutions.
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Tsubouchi K, Gunge N, Tominaga K, Matsuzaki H, Fujikawa A, Emoto T, Miyazaki T, Okabe Y, Nakamura N, Kataoka M, Ogawa S, Akaihata H, Sato Y, Hata J, Matsuoka H, Kojima Y, Haga N. Efficacy of the opened legs position for protecting against postoperative rhabdomyolysis after robot-assisted radical prostatectomy: A propensity score-matched analysis of perioperative outcomes. Int J Urol 2022; 29:1132-1138. [PMID: 35606052 DOI: 10.1111/iju.14935] [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] [Received: 09/06/2021] [Accepted: 04/27/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of the present study was to clarify the relationships of intraoperative surgical position with the incidence of postoperative rhabdomyolysis and with postoperative renal function to safely perform robot-assisted radical prostatectomy. METHODS The participants in the present study were 276 consecutive patients who underwent robot-assisted radical prostatectomy at our institutions between 2013 and 2020; 130 cases were performed in the opened legs position and 146 cases in the lithotomy position with a steep 23°-25° head-down position. Rhabdomyolysis was defined as creatine kinase values greater than 1000 IU/L. Propensity score matching including age, body mass index, the presence of comorbidities, preoperative creatine kinase, preoperative estimated glomerular filtration rate, and prostate-specific antigen was performed, resulting in a matched cohort of 146 patients (opened legs position group n = 73; lithotomy position group n = 73). RESULTS After propensity score matching, creatine kinase values on the first day after surgery were significantly lower in the opened legs position group than in the lithotomy position group (opened legs position group: lithotomy position group = 246.9 ± 114.9 IU/L: 558.2 ± 114.9 IU/L, P = 0.034). There were significantly fewer patients diagnosed with postoperative rhabdomyolysis in the opened legs position group (opened legs position group: lithotomy position group = 0% (0/73): 9.6% (7/73), P < 0.001). In addition, fluid replacement volume was significantly less in the opened legs position group (opened legs position group: lithotomy position group = 5747 ± 180 mL: 6349 ± 0176 mL, P = 0.018). CONCLUSIONS To prevent rhabdomyolysis after surgery, robot-assisted radical prostatectomy should be performed in the opened legs position.
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Affiliation(s)
- Kazuna Tsubouchi
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Naotaka Gunge
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kosuke Tominaga
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Aiko Fujikawa
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Taiki Emoto
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takeshi Miyazaki
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yu Okabe
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Nobuyuki Nakamura
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidenori Akaihata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junya Hata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirofumi Matsuoka
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nobuhiro Haga
- Department of Urology, Fukuoka University School of Medicine, Fukuoka, Japan
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Endo Y, Akatsuka J, Kuwahara K, Takasaki S, Takeda H, Yanagi M, Toyama Y, Mikami H, Hamasaki T, Kondo Y. A Case of Well Leg Compartment Syndrome After Robot-assisted Laparoscopic Prostatectomy:With Review. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:145-147. [PMID: 35466137 DOI: 10.2152/jmi.69.145] [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] [Indexed: 11/14/2022]
Abstract
Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System? can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position/Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position. J. Med. Invest. 69 : 145-147, February, 2022.
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Affiliation(s)
- Yuki Endo
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Kosuke Kuwahara
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Hayato Takeda
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Yuka Toyama
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | | | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, Tokyo, Japan
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The TransEnterix European Patient Registry for Robotic-Assisted Laparoscopic Procedures in Urology, Abdominal, Thoracic, and Gynecologic Surgery ("TRUST"). Surg Technol Int 2021. [PMID: 33513657 DOI: 10.52198/21.sti.38.gs1394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Robotic surgery was first introduced in the mid-1980s, and at the end of the '90s, the da Vinci® System (Intuitive Surgical Inc., Sunnyvale, California) was introduced in Europe and held a monopoly for years afterward. In 2016, Senhance™ digital laparoscopic platform (TransEnterix Inc., Morrisville, North Carolina) came to the market. This new platform is based on laparoscopic movements and is designed for laparoscopic surgeons. This study shows the surgical outcomes of patients after different visceral, colorectal, gynecological, and urological surgical procedures done with the Senhance™ digital laparoscopic platform with a focus on safety. MATERIALS AND METHODS The study population consists of 871 patients who underwent robotic surgery with the Senhance™ platform. The most common procedures were hernia repairs (unilateral and bilateral), cholecystectomies, and prostatectomies. The procedures were performed in five centers in Europe between February 2017 and July 2020 by experienced laparoscopic surgeons. RESULTS 220 (25.3 %) out of 871 patients had a unilateral hernia repair, 70 (8.0%) a bilateral hernia repair, 159 (18.3%) underwent a cholecystectomy, and 168 (19.3%) a prostatectomy. The other procedures included visceral, colorectal, and gynecological surgery procedures. The median docking time was 7.46 minutes for the four most common procedures. The duration of surgery varied from 32 to 313 minutes, the average time was 114.31 minutes. Adverse events were rare overall. There were 48 (5.5 %) adverse events out of 871 patients, 24 of them (2.8 % of all cases) were severe. Out of all 24 severe adverse events, five events (20.8%) were likely related to the robot, 17 events (70.8%) were unlikely related to the robot, and two events (8.3%) could not be categorized. Regarding complications following unilateral hernia repairs, data from 212 patients was available. Thirteen (6.1%) complications occurred, and six of those (2.8%) were serious. Out of 68 patients with a bilateral hernia repair, six patients (8.8%) developed complications, three of which were severe (4.4%). The complication rate was 2.8% in the patients following a cholecystectomy (4/144); two of them serious. After prostatectomy, six out of 141 patients (4.3 %) had complications; one serious (0.7%) No mortality was observed. Data about unplanned conversions to laparoscopic surgery could be collected from 761 patients which is a rate of 3.7%. There were 12 conversions out of 760 procedures to open surgery (1.6%). CONCLUSIONS Our series shows these procedures are safe and reproducible. The findings suggest that the surgical results after robotic surgery with the Senhance™ system are promising. Long-term data regarding complication rates should be the subject of future studies.
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Well leg compartment syndrome following robot-assisted radical cystectomy in the lithotomy position: a case report. JA Clin Rep 2021; 7:13. [PMID: 33507441 PMCID: PMC7843668 DOI: 10.1186/s40981-021-00414-2] [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] [Received: 11/26/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background The indications for robot-assisted urologic surgeries have expanded due to their low invasiveness. However, complicated surgical procedures lead to prolonged surgical duration, requiring patients to remain in the lithotomy position for an extended time. Well leg compartment syndrome (WLCS) is a known severe postoperative complication related to the lithotomy position. Case presentation We report a case of WLCS after robot-assisted radical cystectomy (RARC), in which the patient recovered without neurological sequelae. A 55-year-old, obese male who underwent RARC complained of right leg pain and paresthesia 3 h after the surgery that lasted for 481 min. Emergency evaluation revealed unilateral WLCS in the anterior and lateral compartments. Urgent fasciotomy was performed 4 h after symptom onset. He thereafter recovered completely and was discharged without any neuromuscular dysfunction. Conclusions Early detection of WLCS, surgical treatment, and additional measures are crucial to prevent its life-threatening and/or disabling outcomes.
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Haidl F, Al-Monajjed R. [Prostate cancer: surgical complications]. Aktuelle Urol 2020; 51:469-474. [PMID: 32557447 DOI: 10.1055/a-1185-8179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Radical prostatectomy (RP), performed as an open, laparoscopic or robotic procedure, remains the "gold standard" for patients with localised prostate cancer who can be cured with surgery and have a life expectancy of at least 10 years. Today, RP is also used as a first-line treatment for locally advanced prostate cancer, possibly in a multimodal setting with adjuvant radiation/hormonal therapy. The increasing experience of surgeons, better knowledge of anatomy and refinements of surgical techniques have greatly improved oncological and functional outcomes. In our article we would like to give an overview of the complications associated with this surgical procedure.
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Affiliation(s)
- Friederike Haidl
- Universitätsklinikum Köln, Urologie, Uro-Onkologie, spezielle urologische und Roboter-assistierte Chirurgie, Köln
| | - Rouvier Al-Monajjed
- Heinrich-Heine Universität Düsseldorf, Klinik für Urologie und Kinderurologie, Universitätsklinikum, Düsseldorf
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Anaesthetic management for robotic-assisted laparoscopic prostatectomy: the first UK national survey of current practice. J Robot Surg 2020; 15:335-341. [PMID: 32583048 DOI: 10.1007/s11701-020-01105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Robotic-assisted laparoscopic prostatectomy (RALP) is the most common robotic surgical procedure, but there are little published data to inform anaesthetic practice. We aimed to characterise the range of anaesthetic practice for RALP in the United Kingdom through a national survey. We conducted an online national survey to determine current anaesthetic practice for RALP. The survey was distributed to all NHS hospitals within the UK that perform RALP. Thirty-four (79%) of 43 hospitals responded to the survey. Fourteen (41%) centres routinely provide spinal anaesthesia and 79% of these use diamorphine as their intrathecal opioid of choice. Thirty-one (91%) centres administer intravenous strong opioids intraoperatively, and a wide range of non-opioid analgesic agents are also administered. Five (15%) centres reported that they discharge a minority of patients on the day of surgery. High-volume centres are more likely to have a formalised enhanced recovery after surgery (ERAS) pathway and to provide ambulatory surgery for selected patients. This represents the first UK national survey of anaesthetic practice for RALP. The results of the survey revealed significant variation in anaesthetic practice implying a lack of consensus on best perioperative management.
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Hosseini A, Mortezavi A, Sjöberg S, Laurin O, Adding C, Collins J, Wiklund PN. Robot-assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes - a single-institution experience. BJU Int 2020; 126:464-471. [PMID: 32403199 DOI: 10.1111/bju.15112] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To report a single-institution experience with totally intracorporeal neobladder urinary diversion (UD) after robot-assisted laparoscopic radical cystectomy (RARC). PATIENTS AND METHODS A total of 158 patients underwent totally intracorporeal neobladder UD after RARC between 2003 and 2016. Patient demographics, intraoperative and pathological data, 30- and 90-day perioperative mortality and complications were recorded. Complications were classified according to the modified Clavien-Dindo classification. The 5-year overall (OS) and cancer-specific survival (CSS) rates were estimated by Kaplan-Meier plots. RESULTS Most of the patients were male (84%) and had clinical T Stage ≤2 (87%). The mean operation time was 359 (SD ±98) min, with a median (range) estimated blood loss of 300 (50-2200) mL. Most of the men (86%) received a nerve-sparing procedure and 38% of the females an organ-sparing approach. A lymph node dissection was performed in 156 (99%) patients, with a median (range) yield of 23 (7-48) nodes. Conversion to open surgery occurred in five patients (3%). We recorded negative margins in 156 patients (99%). The median (range) follow-up was 34 (1-170) months, with 30- and 90-day mortality rates of 0%. Clavien-Dindo Grade III-IV complications occurred in 29 of 158 (18%) patients at 30-days and in eight of 158 (5%) between 30-90 days, resulting into a 90-day overall high-grade complication rate of 23%. The unadjusted estimated 5-years recurrence-free survival, CSS and OS rates were 70%, 72%, and 71%, respectively. CONCLUSION In our present series the complication and oncological results were similar to open RC series, suggesting that RARC followed by totally intracorporeal neobladder UD is a safe and feasible alternative.
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Affiliation(s)
- Abolfazl Hosseini
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Ashkan Mortezavi
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Siri Sjöberg
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Oscar Laurin
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Christofer Adding
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Justin Collins
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, UCLH, London, UK
| | - Peter N Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Onagi A, Haga N, Tanji R, Honda R, Matsuoka K, Hoshi S, Koguchi T, Hata J, Sato Y, Akaihata H, Kataoka M, Ogawa S, Kojima Y. Transient renal dysfunction due to rhabdomyolysis after robot-assisted radical prostatectomy. Int Urol Nephrol 2020; 52:1877-1884. [DOI: 10.1007/s11255-020-02500-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
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15
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Laughlin RS, Johnson RL, Burkle CM, Staff NP. Postsurgical Neuropathy: A Descriptive Review. Mayo Clin Proc 2020; 95:355-369. [PMID: 32029088 DOI: 10.1016/j.mayocp.2019.05.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/27/2019] [Accepted: 05/21/2019] [Indexed: 11/21/2022]
Abstract
Postsurgical neuropathies represent an infrequent but potentially devastating complication of surgery that may result in significant morbidity with medicolegal implications. Elucidation of this phenomenon has evolved over the past few decades, with emerging evidence for not only iatrogenic factors contributing to this process but also inflammatory causes. This distinction can be important; for instance, cases in which inflammatory etiologies are suspected may benefit from further investigations including nerve biopsy and may benefit from treatment in the form of immunotherapy. In contrast, postsurgical neuropathies due to perioperative causes including anesthesia, traction, compression, and transection will not benefit in the same manner. This article summarizes early and current literature surrounding the frequency of new neurologic deficits after various surgical types, potential causes including anatomical and inflammatory considerations, and roles for treatment. To capture the scope of the issue, a literature review was conducted for human studies in English via MEDLINE and EMBASE from January 1, 1988 to March 31, 2018. Search terms included anesthesia and/or surgical procedures, operative, peripheral nervous system diseases, trauma, mononeuropathy, polyneuropathy, peripheral nervous system, nerve compression, neuropathy, plexopathy, postoperative, postsurgical, perioperative, complication. We excluded case series with less than 10 patients and review papers. We then narrowed the studies to those presented highlighting key concepts in postsurgical neuropathy.
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16
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Gill M, Fligelstone L, Keating J, Jayne DG, Renton S, Shearman CP, Carlson GL. Avoiding, diagnosing and treating well leg compartment syndrome after pelvic surgery. Br J Surg 2020; 106:1156-1166. [PMID: 31304580 PMCID: PMC6772077 DOI: 10.1002/bjs.11177] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 01/17/2023]
Abstract
Background Patients undergoing prolonged pelvic surgery may develop compartment syndrome of one or both lower limbs in the absence of direct trauma or pre‐existing vascular disease (well leg compartment syndrome). This condition may have devastating consequences for postoperative recovery, including loss of life or limb, and irreversible disability. Methods These guidelines represent the collaboration of a multidisciplinary group of colorectal, vascular and orthopaedic surgeons, acting on behalf of their specialty associations in the UK and Ireland. A systematic analysis of the available peer‐reviewed literature was undertaken to provide an evidence base from which these guidelines were developed. Results These guidelines encompass the risk factors (both patient‐ and procedure‐related), diagnosis and management of the condition. Key recommendations for the adoption of perioperative strategies to facilitate prevention and effective treatment of well leg compartment syndrome are presented. Conclusion All surgeons who carry out abdominopelvic surgical procedures should be aware of well leg compartment syndrome, and instigate policies within their own institution to reduce the risk of this potentially life‐changing complication.
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Affiliation(s)
- M Gill
- Department of Surgery, East Lancashire NHS Trust, Blackburn, UK
| | - L Fligelstone
- Department of Vascular Surgery, Swansea Bay University Health Board, Swansea, UK
| | - J Keating
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - D G Jayne
- Department of Surgery, University of Leeds, Leeds, UK
| | - S Renton
- Department of Surgery, Northwick Park Hospital, Harrow, UK
| | - C P Shearman
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G L Carlson
- Department of Surgery, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
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17
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Short- and long-term outcomes of robotic surgery for rectal cancer: a single-center retrospective cohort study. Surg Today 2019; 50:240-247. [PMID: 31485749 DOI: 10.1007/s00595-019-01874-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/04/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to clarify the short- and long-term outcomes of robotic surgery with or without lateral lymph node dissection (LLND) for rectal cancer at Fujita Health University Hospital, Aichi, Japan, during a self-pay period. METHODS We retrospectively evaluated 115 consecutive patients who underwent robotic surgery for rectal cancer between September 2009 and March 2018, with a median follow-up period of 48 months. Total mesorectal excision was completed by two certified surgeons using a da Vinci S, Si, or Xi Surgical System with an entirely robotic single-docking technique. The surgical and pathological outcomes, morbidity, and oncological results were examined. RESULTS Lateral lymph node dissection was performed in 26 patients (22.6%). Neither conversion to open surgery nor perioperative blood transfusion occurred. Ten patients (8.7%) experienced Clavien-Dindo grade III postoperative complications. Pathologically, both the distal and radial margins were negative in all cases. The 5-year relapse-free survival rates for stages I, II, III, and IV were 93.5%, 100%, 83.8%, and not reached, respectively. CONCLUSIONS Even in the period before coverage by the health insurance system, robotic surgery for rectal cancer performed by experienced surgeons was safe and technically feasible, with favorable perioperative results and long-term oncological outcomes, including rates of the relapse-free survival.
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18
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Peri-operative efficacy and long-term survival benefit of robotic-assisted radical cystectomy in septuagenarian patients compared with younger patients: a nationwide multi-institutional study in Japan. Int J Clin Oncol 2019; 24:1588-1595. [PMID: 31123937 DOI: 10.1007/s10147-019-01470-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To determine the peri-operative safety and oncological value of robotic-assisted radical cystectomy (RARC) for older and younger patients in an initial Japanese RARC series. METHODS We retrospectively analyzed the demographics, complications, peri-operative and oncological outcomes of 253 consecutive patients with bladder cancer who underwent RARC at 34 institutions in Japan between April 2009 and March 2017. The patients were assigned to groups according to ages at surgery of < 70 (younger; n = 125) and ≥ 70 (older; n = 128) years. RESULTS Mean Charlson comorbidity index (p = 0.045) and the incidence of a history of previous abdominal surgery (p = 0.002) were significantly higher, whereas a history of neoadjuvant chemotherapy (p = 0.028) and neobladder (p < 0.001) were significantly lower in the older group. Mean total operative time was significantly shorter (p = 0.019) and mean estimated blood loss (p = 0.013) was significantly lower in the older group. Post-operative Grade ≥ II complications were comparable at 0-30, 31-90 and 91 days after surgery despite urinary tract associations. Rates of positive surgical margins and mean numbers of removed lymph nodes were comparable between the two groups. Although 5-year overall survival rates were significantly lower (p = 0.03) for older patients, 5-year cancer-specific (p = 0.10) and recurrence-free survival rates were comparable (p = 0.20) between the groups. CONCLUSION Using RARC potentially allows the application of less invasive procedures and cancer control for septuagenarian patients that are equivalent to those for younger patients.
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19
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Johansson VR, von Vogelsang A. Patient‐reported extremity symptoms after robot‐assisted laparoscopic cystectomy. J Clin Nurs 2019; 28:1708-1718. [DOI: 10.1111/jocn.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/28/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ann‐Christin von Vogelsang
- Theme Neuro Karolinska University Hospital Stockholm Sweden
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
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20
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Takechi K, Kitamura S, Shimizu I, Yorozuya T. Lower limb perfusion during robotic-assisted laparoscopic radical prostatectomy evaluated by near-infrared spectroscopy: an observational prospective study. BMC Anesthesiol 2018; 18:114. [PMID: 30121089 PMCID: PMC6098825 DOI: 10.1186/s12871-018-0567-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/30/2018] [Indexed: 11/24/2022] Open
Abstract
Background Decreased perfusion in the lower extremities is one of the several adverse effects of placing patients in a lithotomy or Trendelenburg position during surgery. This study aimed to evaluate the effects of patient positioning in lower limb perfusion patients undergoing robotic-assisted laparoscopic radical prostatectomy (RARP) using near-infrared spectroscopy (NIRS). Methods This observation study comprised 30 consenting males with American Society of Anaesthesiologists physical status classes I and II (age range, ≥20 to < 80 years). Regional saturation of oxygen measurements was obtained using an INVOS™ oximeter (Somanetics, Troy, MI, USA). A NIRS sensor was positioned on the surface of the skin at the mid-diaphyseal region of the calf muscles (the gastrocnemius and soleus), over the posterior compartment, in the right lower leg. Regional saturation of oxygen (rSO2) was sampled during the following time points: before and 5 min after induction of anaesthesia (T0,T1); 5 min after establishment of pneumoperitoneum in a 0° lithotomy position (T2); 5 min after a 25° Trendelenburg position (T3); 30, 60, 90 and 120 min after pneumoperitoneum in a Trendelenburg position (T4, T5, T6 and T7, respectively); after desufflation in a supine position (T8); and after tracheal extubation (T9). Results Lower limb perfusion evaluated by NIRS was increased after induction of anaesthesia and maintained during steep Trendelenburg positions in RARP patients with no risk for lower limb compartment syndrome (LLCS) (T0:65 ± 7.2%, T1:69 ± 6.1%, T2:70±:6.1%, T3:68 ± 6.7%, T4:66 ± 7.5%, T5:67 ± 6.9%, T6:68 ± 7.2%, T8:73 ± 7.2%, T9:71 ± 7.9%, respectively). Conclusions Lower limb perfusion evaluated by NIRS was maintained during the RARP procedure. Correct patient positioning and careful assessment of risk factors such as vascular morbidity could be important for the prevention of LLCS during RARP.
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Affiliation(s)
- Kenichi Takechi
- Matsuyama Red Cross Hospital, 1 Bunkyochou, Matsuyama City, Ehime, Japan.
| | - Sakiko Kitamura
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime, Japan
| | - Ichiro Shimizu
- Matsuyama Red Cross Hospital, 1 Bunkyochou, Matsuyama City, Ehime, Japan
| | - Toshihiro Yorozuya
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime, Japan
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21
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Waqas A, Arulampalam T, Naqvi S, Khan J. Positional complications of minimal access surgery, laparoscopic/robotic/transanal surgery. Colorectal Dis 2018; 20:449-450. [PMID: 29502333 DOI: 10.1111/codi.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/20/2018] [Indexed: 02/08/2023]
Affiliation(s)
- A Waqas
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - T Arulampalam
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - S Naqvi
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - J Khan
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
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22
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Abstract
Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific to robotic-assisted procedures.
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23
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Clinical Issues-January 2018. AORN J 2018; 107:132-141. [DOI: 10.1002/aorn.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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24
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Anesthesia for Robot Assisted Gynecological Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Christoffersen JK, Hove LD, Mikkelsen KL, Krogsgaard MR. Well Leg Compartment Syndrome After Abdominal Surgery. World J Surg 2017; 41:433-438. [PMID: 27590466 DOI: 10.1007/s00268-016-3706-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature. METHODS Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal operations 1996-2013 and cases in literature 1970-2013 were evaluated. Cases of fasciotomy within 2 weeks after abdominal surgery 1999-2008 were extracted from the Danish National Patient Register (DNPR). RESULTS There were 40 cases in DPCA and 124 in literature. In 68 % legs were supported under the knees during surgery. Symptoms of WLCS presented within 2 h after surgery in 56 % and in only 3 cases after 24 h. Obesity was not confirmed as risk factor for WLCS. The mean diagnostic delay was 10 h. One-third of fasciotomies were insufficient. The diagnostic delay increased with duration of the abdominal surgery (p = 0.04). Duration of the abdominal surgery was 4 times as important as the diagnostic delay for severity of the final outcome. DNPR recorded 4 new cases/year, and half were reported to DPCA. CONCLUSION The first 24 h following abdominal surgery of >4 h' duration with elevated legs observation for WLCS should be standard. Pain in the calf is indicative of WLCS, and elevated serum CK can support the diagnosis. Mannitol infusion and acute four-compartment fasciotomy of the lower leg is the treatment. The risk of severe outcome of WLCS increases with duration of the primary operation. A broad support and change of legs' position during surgery are suggested preventative initiatives.
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Affiliation(s)
| | - Lars Dahlgaard Hove
- Danish Patient Compensation Association, Kalvebod Brygge 45, 1560, Copenhagen V, Denmark.,Department of Anaesthesilogy, Hvidovre Hospital, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Kim Lyngby Mikkelsen
- Danish Patient Compensation Association, Kalvebod Brygge 45, 1560, Copenhagen V, Denmark
| | - Michael Rindom Krogsgaard
- Danish Patient Compensation Association, Kalvebod Brygge 45, 1560, Copenhagen V, Denmark. .,Section for Sportstraumatology M51, Bispebjerg-Frederiksberg Hospital (Part of IOC Research Center Copenhagen), Bispebjerg Bakke 23, 2450, Copenhagen NV, Denmark.
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26
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Balbay MD, Koc E, Canda AE. Robot-assisted radical cystectomy: patient selection and special considerations. ROBOTIC SURGERY (AUCKLAND) 2017; 4:101-106. [PMID: 30697568 PMCID: PMC6193425 DOI: 10.2147/rsrr.s119858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Robot-assisted (RA) procedures are increasingly being performed as minimally invasive surgical approaches. Less insensible losses due to a closed abdomen, smaller incisions with less retractor strain, decreased analgesic requirements, and earlier postoperative ambulation are suggested advantages of robot-assisted radical cystectomy (RARC). Patients who undergo open radical cystectomy are also candidates for RARC procedure. However, the steep Trendelenburg position and pneumoperitoneum develop a non-physiological condition. Intra-abdominal adhesions preventing the placement of the ports and patients who cannot tolerate the pneumoperitoneum and/or steep Trendelenburg position are special contraindications of RARC. Besides, body mass index >30 kg/m2, presence of extravesical disease, bulky lymphadenopathy, previous vascular surgery, previous distal colorectal surgery, previous pelvic radiation, previous pelvic trauma, and/or preexisting cardiovascular/pulmonary disease that is compromised with positioning are not certainly contraindicated but unwanted conditions in which the RARC may be performed successfully as the surgeons gain experience.
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Affiliation(s)
| | - Erdem Koc
- Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, School of Medicine, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
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27
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Zillioux JM, Krupski TL. Patient positioning during minimally invasive surgery: what is current best practice? ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:69-76. [PMID: 30697565 PMCID: PMC6193419 DOI: 10.2147/rsrr.s115239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Positioning injuries are a known surgical complication and can result in significant patient morbidity. Studies have shown a small but significant number of neurovascular injuries associated with minimally invasive surgery, due to both patient and case-specific factors. We sought to review the available literature in regards to pathophysiological and practical recommendations. Methods A literature search was conducted and categorized by level of evidence, with emphasis on prospective studies. The result comprised 14 studies, which were summarized and analyzed with respect to our study objectives. Results While incidence of positioning injury has been identified in up to one-third of prospective populations, its true prevalence after surgery is likely 2%-5%. The mechanism is thought to be intraneural disruption from stretching or pressure, which results in decreased perfusion. On a larger scale, this vascular compromise can lead to ischemia and rhabdomyolysis. Prevention hinges on addressing patient modifiable factors such as body mass index, judicious positioning with appropriate devices, and intraoperative team awareness consisting of recurrent extremity checks and time management. Conclusion The risk for positioning injuries is underappreciated. Surgeons who perform minimally invasive surgery should discuss the potential for these complications with their patients, and operative teams should take steps to minimize risk factors.
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Affiliation(s)
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, VA, USA,
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28
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Maerz D, Beck L, Sim A, Gainsburg D. Complications of robotic-assisted laparoscopic surgery distant from the surgical site. Br J Anaesth 2017; 118:492-503. [DOI: 10.1093/bja/aex003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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29
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Kaplan JR, Lee Z, Eun DD, Reese AC. Complications of Minimally Invasive Surgery and Their Management. Curr Urol Rep 2016; 17:47. [PMID: 27075019 DOI: 10.1007/s11934-016-0602-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Minimally invasive surgery, including both traditional laparoscopic and robot-assisted laparoscopic approaches, has increasingly become the standard of care for urologic abdominal and pelvic surgery. This is a comprehensive review of the contemporary literature regarding complications of laparoscopic and robotic urologic surgery. The review highlights pertinent studies with the goal of providing the minimally invasive urologic surgeon with an up-to-date overview of general and procedure-specific complications and their management.
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Affiliation(s)
- Joshua R Kaplan
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Ziho Lee
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Daniel D Eun
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA
| | - Adam C Reese
- Temple University School of Medicine, 3509 North Broad Street, 6th Floor, Boyer Pavilion, Philadelphia, PA, 19140, USA.
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30
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Collins JW, Patel H, Adding C, Annerstedt M, Dasgupta P, Khan SM, Artibani W, Gaston R, Piechaud T, Catto JW, Koupparis A, Rowe E, Perry M, Issa R, McGrath J, Kelly J, Schumacher M, Wijburg C, Canda AE, Balbay MD, Decaestecker K, Schwentner C, Stenzl A, Edeling S, Pokupić S, Stockle M, Siemer S, Sanchez-Salas R, Cathelineau X, Weston R, Johnson M, D'Hondt F, Mottrie A, Hosseini A, Wiklund PN. Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View. Eur Urol 2016; 70:649-660. [PMID: 27234997 DOI: 10.1016/j.eururo.2016.05.020] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/12/2016] [Indexed: 12/17/2022]
Abstract
CONTEXT Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC). Due to the multimodal nature of ERPs, they are not easily validated through randomised controlled trials. OBJECTIVE To provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients. EVIDENCE ACQUISITION The guidance was formulated in four phases: (1) systematic literature review of evidence for ERPs in robotic, laparoscopic, and open RC; (2) an online questionnaire survey formulated and sent to ERUS Scientific Working Group members; (3) achievement of consensus from an expert panel using the Delphi process; and (4) a standardised reporting template to audit compliance and outcome designed and approved by the committee. EVIDENCE SYNTHESIS Consensus was reached in multiple areas of an ERP for RARC. The key principles include patient education, optimisation of nutrition, RARC approach, standardised anaesthetic, analgesic, and antiemetic regimens, and early mobilisation. CONCLUSIONS This consensus represents the views of an expert panel established to advise ERUS on ERPs for RARC. The ERUS Scientific Working Group recognises the role of ERPs and endorses them as standardised perioperative care for patients undergoing RARC. ERPs in robotic surgery will continue to evolve with technological and pharmaceutical advances and increasing understanding of the role of surgery-specific ERPs. PATIENT SUMMARY There is currently a lack of high-level evidence exploring the benefits of enhanced recovery programmes (ERPs) in patients undergoing robot-assisted radical cystectomy (RARC). We reported a consensus view on a standardised ERP specific to patients undergoing RARC. It was formulated by experts from high-volume RARC hospitals in Europe, combining current evidence for ERPs with experts' knowledge of perioperative care for robotic surgery.
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Affiliation(s)
- Justin W Collins
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Hiten Patel
- Department of Urology, University Hospital of Northern Norway, Tromsø, Norway
| | - Christofer Adding
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Walter Artibani
- Department of Urology, Verona University Hospital, Verona, Italy
| | | | | | - James W Catto
- Department of Urology, Sheffield University Hospital, Sheffield, UK
| | | | - Edward Rowe
- Department of Urology, Bristol Urological Institute, Bristol, UK
| | | | - Rami Issa
- Department of Urology, St Georges, London, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter Hospital, Exeter, UK
| | | | | | - Carl Wijburg
- Department of Urology, Rijnstate, Arnhem, Netherlands
| | | | - Meviana D Balbay
- Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey
| | | | | | - Arnulf Stenzl
- Department of Urology, University of Tuebingen, Tubingen, Germany
| | | | - Sasa Pokupić
- Department of Urology, Da Vinci Zentrum, Hanover, Germany
| | - Michael Stockle
- Department of Urology, Universittatsklinikum des Saarlandes, Homburg, Germany
| | - Stefan Siemer
- Department of Urology, Universittatsklinikum des Saarlandes, Homburg, Germany
| | | | | | - Robin Weston
- Department of Urology, Royal Liverpool Hospital, Liverpool, UK
| | - Mark Johnson
- Department of Urology, Newcastle upon Tyne Hospitals, Newcastle, UK
| | | | | | - Abolfazl Hosseini
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter N Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
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31
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Pucheril D, Campbell L, Bauer RM, Montorsi F, Sammon JD, Schlomm T. A Clinician's Guide to Avoiding and Managing Common Complications During and After Robot-assisted Laparoscopic Radical Prostatectomy. Eur Urol Focus 2016; 2:30-48. [PMID: 28723448 DOI: 10.1016/j.euf.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 01/21/2023]
Abstract
CONTEXT Robot-assisted radical prostatectomy (RARP) is on the advance globally, and it is essential for surgeons and patients to know the rates of perioperative complications. OBJECTIVE To provide evidence-based clinical guidance on avoiding and managing common complications during and after RARP in the context of a comprehensive literature review. EVIDENCE ACQUISITION In concordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis 2015 statement guidelines, a literature search of the PubMed database from August 1, 2011, to August 31, 2015, using the predefined search terms robot* AND radical prostatectomy, was conducted. The search resulted in 653 unique results that were subsequently uploaded to DistillerSR (Evidence Partners, Ottawa, Canada) for team-based screening and processing of references. EVIDENCE SYNTHESIS Overall, 37 studies met the inclusion criteria and were included. Median rate of overall complication was 12.6% (range: 3.1-42%). Most of the complications were minor (Clavien-Dindo grades 1 and 2). Grade 3 complications comprised the bulk of the major complications with a median rate of 2.7%; grade IV and V complications were exceedingly rare in all reports. CONCLUSIONS Despite continued adoption of the RARP technique globally, rates of overall complication remain low. Many of the complications experienced during and after RARP can be mitigated and prevented by experience and the implementation of safe techniques. PATIENT SUMMARY Despite continued adoption of the robot-assisted radical prostatectomy (RARP) technique globally, rates of overall and major complications remain low at 12.6% and 2.7%, respectively. Complications can be minimized and successfully managed using established techniques. RARP is a safe and reproducible technique.
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Affiliation(s)
- Daniel Pucheril
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA.
| | - Logan Campbell
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Ricarda M Bauer
- Department of Urology, Ludwig Maximilian University, Munich, Germany
| | - Francesco Montorsi
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Jesse D Sammon
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Thorsten Schlomm
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Enhanced recovery protocols (ERP) in robotic cystectomy surgery. Review of current status and trends. Curr Urol Rep 2015; 16:32. [PMID: 25850413 DOI: 10.1007/s11934-015-0497-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Open radical cystectomy with pelvic lymphadenectomy and urinary diversion is associated with a high complication rate. Robotic-assisted laparoscopic radical cystectomy is increasingly performed in many urologic surgical departments in an effort to reduce surgical stress and decrease perioperative morbidity. Robotic cystectomy survival studies demonstrate similar oncologic outcomes compared to the open procedure. Enhanced recovery protocols (ERP) after major surgery are multimodal perioperative interventions to reduce surgical stress, complications, and patient convalescence. Evidence for different ERP interventions are currently mainly from colorectal surgery and recently adapted to major urologic operations including cystectomy. Guidelines for perioperative care after open radical cystectomy for bladder cancer were recently published, but these recommendations may differ when considering a robotic approach. Therefore, we look at the current evidence for ERP in both open and robotic radical cystectomy and the potential for improving ERPs in robotic cystectomy by utilizing a totally intracorporeal robotic cystectomy approach. We also present the Karolinska ERP currently utilized in totally intracorporeal robotic cystectomy.
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Salomon L, Rozet F, Soulié M. La chirurgie du cancer de la prostate : principes techniques et complications péri-opératoires. Prog Urol 2015; 25:966-98. [DOI: 10.1016/j.purol.2015.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022]
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Sotelo RJ, Haese A, Machuca V, Medina L, Nuñez L, Santinelli F, Hernandez A, Kural AR, Mottrie A, Giedelman C, Mirandolino M, Palmer K, Abaza R, Ghavamian R, Shalhav A, Moinzadeh A, Patel V, Stifelman M, Tuerk I, Canes D. Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery. Eur Urol 2015; 69:334-44. [PMID: 26385157 DOI: 10.1016/j.eururo.2015.08.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video. OBJECTIVE We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care. DESIGN, SETTING, AND PARTICIPANTS Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015. SURGICAL PROCEDURE Surgical footage was available for a variety of complications during RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined. RESULTS AND LIMITATIONS As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable. CONCLUSIONS Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve. PATIENT SUMMARY Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.
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Affiliation(s)
- René J Sotelo
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela; University of Southern California, Los Angeles, CA, USA.
| | - Alexander Haese
- Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Victor Machuca
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luis Medina
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luciano Nuñez
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | | | | | | | | | | | | | | | - Ronney Abaza
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Arieh Shalhav
- Duchossois Center for Advanced Medicine, Chicago, IL, USA
| | - Alireza Moinzadeh
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
| | - Vipul Patel
- Global Robotics Institute, Celebration, FL, USA
| | | | - Ingolf Tuerk
- St. Elizabeth's Medical Center, Brighton, MA, USA
| | - David Canes
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
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Brinkman WM, Schout BMA, Rietbergen JB, de Vries AH, van der Poel HG, Koldewijn EL, Witjes JA, van Merriënboer JJG. Training robotic surgery in urology: experience and opinions of robot urologists. Int J Med Robot 2014; 11:308-318. [DOI: 10.1002/rcs.1631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 09/17/2014] [Accepted: 09/23/2014] [Indexed: 01/24/2023]
Affiliation(s)
- W. M. Brinkman
- Department of Urology; Catharina Hospital Eindhoven; The Netherlands
| | - B. M. A. Schout
- Department of Urology; Medical Centre Alkmaar; The Netherlands
- EMGO Institute; VU Medical Centre Amsterdam; The Netherlands
| | - J. B. Rietbergen
- Department of Urology; Sint Franciscus Gasthuis; Rotterdam The Netherlands
| | - A. H. de Vries
- Department of Urology; Catharina Hospital Eindhoven; The Netherlands
| | - H. G. van der Poel
- Department of Urology; Sint Franciscus Gasthuis; Rotterdam The Netherlands
- Department of Urology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - E. L. Koldewijn
- Department of Urology; Catharina Hospital Eindhoven; The Netherlands
- Department of Educational Development and Research, FHML; Maastricht University; The Netherlands
| | - J. A. Witjes
- Department of Urology; Radboud University Nijmegen Medical Centre; The Netherlands
| | - J. J. G. van Merriënboer
- Department of Educational Development and Research, FHML; Maastricht University; The Netherlands
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Collins JW, Wiklund NP. Totally intracorporeal robot-assisted radical cystectomy: optimizing total outcomes. BJU Int 2014; 114:326-33. [PMID: 24224480 DOI: 10.1111/bju.12558] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We performed a systematic literature review to assess the current status of a totally intracorporeal robot-assisted radical cystectomy (RARC) approach. The current 'gold standard' for radical cystectomy remains open radical cystectomy. RARC has lagged behind robot-assisted prostatectomy in terms of adoption and perceived patient benefit, but there are indications that this is now changing. There have been several recently published large series of RARC, both with extracorporeal and with intracorporeal urinary diversions. The present review focuses on the totally intracorporeal approach. Radical cystectomy is complex surgery with several important outcome measures, including oncological and functional outcomes, complication rates, patient recovery and cost implications. We aim to answer the question of whether there are advantages to a totally intracorporeal robotic approach or whether we are simply making an already complex procedure more challenging with an associated increase in complication rates. We review the current status of both oncological and functional outcomes of totally intracorporeal RARC compared with standard RARC with extraperitoneal urinary diversion and with open radical cystectomy, and assess the associated short- and long-term complication rates. We also review aspects in training and research that have affected the uptake of RARC. Additionally we evaluate how current technology is contributing to the future development of this surgical technique.
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Challacombe BJ. A stitch in time saves nine: better training may avoid complications in robot-assisted radical prostatectomy. BJU Int 2013; 112:426-7. [PMID: 23879902 DOI: 10.1111/bju.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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