1
|
Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Torres-Martinez M, Alanis-Garza C, Estrada-Mendizabal RJ, Gonzalez-Bonilla EA, Flores-Villalba E, Olvera-Posada D. Single-port versus multiport robotic-assisted radical prostatectomy: A systematic review and meta-analysis on the da Vinci SP platform. Prostate 2022; 82:405-414. [PMID: 34985775 DOI: 10.1002/pros.24296] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/14/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
CONTEXT Prostate cancer is the most common cancer in men; robotic prostatectomy has cemented itself as part of the standard of care. Since its approval by the Food and Drug Administration in 2018, the SP console's application has been increasingly studied and compared with the multiport (MP) robotic approach. METHODS Following PRISMA guidelines and PROSPERO registration CRD42021228744, a systematic review was performed in April 2021 on single-port robotic-assisted radical prostatectomies (SP-RARPs) compared to MP. Outcomes of interest were operative time, bleeding, complications, analgesic use, and postoperative continence, and erectile function. Data were analyzed with Review Manager 5.3. RESULTS Seven studies were included, of which six studies met the inclusion criteria for quantitative synthesis, totalling 1068 patients, out of which 324 underwent SP-RARP and 744 underwent MP-RARP. No differences were found in baseline characteristics such as age, body mass index, prostatic-specific antigen, or stage. No differences in blood loss-15.77 mL [-42.44, 10.89], p = 0.25, operative time 3.93 min [-4.12, 11.98], p = 0.34, or positive surgical margins, with an odds ratio (OR) of 0.78 [0.55, 1.10], p = 0.15-were found. Length of stay was significantly shorter in SP -0.94 days [-1.56, -0.33], p = 0.003, with no differences in complication rates, with an OR of 1.29 [0.78, 2.14], p = 0.32, continence rates, with an OR of 1.29 [0.90, 1.83], p = 0.16, erectile function, with an OR of 0.86 [0.52, 1.40], p = 0.54, or biochemical recurrence. Qualitative evidence suggests decreased opioid consumption. CONCLUSION SP-RARPs are feasible alternatives to the traditional MP with possible benefits in pain management and length of stay. Future high-quality studies are needed to confirm these findings.
Collapse
Affiliation(s)
| | | | | | - Cordelia Alanis-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| | | | | | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| | - Daniel Olvera-Posada
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, N.L., México
| |
Collapse
|
2
|
Kim WW, Lee YM, Chung KW, Hong SJ, Sung TY. Safety and feasibility of reduced-port site surgery for robotic posterior retroperitoneal adrenalectomy. Surg Endosc 2020; 34:4291-4297. [PMID: 31741155 DOI: 10.1007/s00464-019-07273-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/12/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Minimally invasive surgery, such as laparoscopic adrenalectomy and robotic adrenalectomy, has become a treatment of choice for benign adrenal tumors. Efforts are ongoing to minimize the invasiveness of the procedure and to reduce the number of port sites. The primary endpoint of this study was the safety and feasibility of a reduced-port site technique for robotic posterior retroperitoneal adrenalectomy (RPRA). METHODS This study retrospectively analyzed 74 RPRAs performed by a single surgeon, including 30 conventional three-port site early-phase RPRAs, 30 three-port site late-phase RPRAs, and 14 reduced-port site RPRAs. Reduced-port site RRPA was defined as using two port sites: one for a multi-glove port and one for an additional side port. The clinicopathological features and surgical outcomes were compared in these three groups. RESULTS No major complications were observed following RPRA in the three groups of patients. Operation time, pain score, and hospital stay did not differ significantly among these three groups. CONCLUSIONS RPRA using a reduced-port site system was safe and feasible and may be a good alternative to conventional three-port site RPRA for benign adrenal tumors in certain situations.
Collapse
Affiliation(s)
- Won Woong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| |
Collapse
|
3
|
Wei Y, Tang J, Yuan L, Su J, Zhang Y, Deng Z, Zhu C, Shen L, Wang N, Xu G, Yang Y, Zhu Q. Laparoendoscopic radical prostatectomy (LRP): stepwise transition from multi-site to single-site with the aid of the transurethral port. Int Urol Nephrol 2020; 53:249-255. [PMID: 32902797 DOI: 10.1007/s11255-020-02638-0] [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: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe our initial experience with laparoendoscopic radical prostatectomy (LRP) and a stepwise transition towards transurethral assisted laparoendoscopic single-site RP (TU-LESS RP). PATIENTS AND METHODS From Jan. 2007 to Dec. 2016, 195 patients underwent RP, of which 89 patients were performed by LRP (Group A), 106 by TU-LESS RP (Group B). The peri-operative data were collected and analyzed. All data referring to patient demographics, surgery, pathology, and peri-operative outcomes were recorded. The cosmetic result was investigated by the Patient Scar Assessment Questionnaire (PSAQ). Analysis of variance or Chi squared test were adopted to analyze the data. RESULTS 195 procedures were completed successfully. The operation time (109.6 ± 31.9 vs. 151.5 ± 87.3, P = 0.025) and anastomosis time (10.1 ± 4.8 vs. 21.8 ± 9.9, P < 0.001) of Group B was significantly reduced compared with Group A. Estimated blood loss in Group B was significantly lower than that in Group A (95.9 ± 11.1 vs. 180.2 ± 99.7, P = 0.006). About perioperative complications, Group B was also less compared with Group A (1.9% vs. 7.9%, P = 0.047). As to the usage of postoperative analgesics, Group B apparently used less than that in Group A (6.6% vs. 62.9%, P < 0.001), which is consistent with the visual analogue scale (VAS) of the two groups (1.7 ± 1.3 vs. 7.8 ± 1.1, P < 0.001). Patients in Group B were significantly more satisfied with incision healing than in group A (74.9 ± 9.3 vs. 49.7 ± 5.8, P < 0.001). There was no significant difference both in BCR rate and time between Group B and Group A. In urination control, more patients in Group B did not have urinary incontinence 3 month after RP compared with Group A (81.1% vs. 67.4%, P = 0.028). CONCLUSIONS LESS RP is proved to be feasible for the proper patients, but it is difficult to popularized due to inconvenient operation. While by means of TU-LESS, operating difficulty can be significantly decreased. TU-LESS RP will be wildly accepted by surgeons and patients because of cosmetic satisfaction and quicker recovery.
Collapse
Affiliation(s)
- Yunfei Wei
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Jingyuan Tang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Lin Yuan
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Jian Su
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Yang Zhang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Zhonglei Deng
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Chen Zhu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Luming Shen
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Ninghong Wang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Guojiang Xu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Yong Yang
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Qingyi Zhu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China.
| |
Collapse
|
4
|
Laparoendoscopic Single-site Plus 1-port Donor Nephrectomy: Division of Roles to Shorten Warm Ischemic Time. Transplant Proc 2018; 50:1238-1242. [PMID: 29880341 DOI: 10.1016/j.transproceed.2018.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/29/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND In this study we present our new surgical procedure, laparoendoscopic single-site surgery plus 1 for donor nephrectomy (LESS+1-DN), which shortens warm ischemic time (WIT) and improves surgical outcomes. METHODS From January 2013 to February 2017, 15 patients who underwent LESS-DN and 41 patients who underwent LESS+1-DN at our institution were evaluated retrospectively. Patients were divided into 3 groups: group A, 15 cases of LESS-DN; group B, the first 15 patients who underwent LESS+1-DN; and group C, 26 patients who underwent subsequent LESS+1-DN. To reduce WIT, we clearly defined the roles of the surgeon and first assistant in the 26 subsequent LESS+1-DN cases. The surgeon dissected the renal pedicle and harvested the kidney graft using a recovery bag and the first assistant held the recovery bag. RESULTS The mean operative time in group C (213.7 minutes) was significantly shorter than that in groups A (253.3 minutes) and B (253.8 minutes). The WIT in group C (195.2 seconds) was significantly shorter than that in groups A (389.8 seconds) and B (313.2 seconds). Open conversion was required in 1 case in group A. None of the donors required conversion to open surgery and no perioperative complications occurred in groups B and C. Linear regression analysis of the LESS+1-DN operative times and consecutive case numbers demonstrated a shallow learning curve (R2 = 0.392, P < .05). CONCLUSION Our new procedure that divides the roles of the operator and the first assistant contributed significantly to a shortening of WIT. Dividing roles can facilitate a safer laparoscopic donor nephrectomy.
Collapse
|
5
|
Narita M, Kageyama S, Okegawa T, Kinoshita H, Sato F, Nakagawa K, Habuchi T, Hoshi A, Matsubara A, Yoshimura K, Terachi T, Mimata H, Kawauchi A. Urological laparoendoscopic single-site and reduced port surgery: A nationwide survey in Japan. Int J Urol 2017; 25:263-268. [DOI: 10.1111/iju.13504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Mitsuhiro Narita
- Department of Urology; Shiga University of Medical Science; Shiga Japan
| | - Susumu Kageyama
- Department of Urology; Shiga University of Medical Science; Shiga Japan
| | | | - Hidefumi Kinoshita
- Department of Urology and Andrology; Kansai Medical University; Osaka Japan
| | | | - Ken Nakagawa
- Department of Urology; Tokyo Dental College Ichikawa General Hospital; Chiba Japan
| | - Tomonori Habuchi
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Akio Hoshi
- Department of Urology; Tokai University School of Medicine; Kanagawa Japan
| | - Akio Matsubara
- Department of Urology; Hiroshima University; Hiroshima Japan
| | - Koji Yoshimura
- Department of Urology; Shizuoka General Hospital; Shizuoka Japan
| | - Toshiro Terachi
- Department of Urology; Tokai University School of Medicine; Kanagawa Japan
| | | | - Akihiro Kawauchi
- Department of Urology; Shiga University of Medical Science; Shiga Japan
| |
Collapse
|
6
|
Lo IS, Lee HY, Chou YH, Huang CN, Wu WJ, Yeh HC, Yang KF, Lee CH, Li CC. Robot-Assisted Extraperitoneal Radical Prostatectomy, Single Site Plus Two Model. J Laparoendosc Adv Surg Tech A 2017; 28:140-144. [PMID: 29090978 DOI: 10.1089/lap.2017.0421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To demonstrate a feasible procedure of robot-assisted extraperitoneal radical prostatectomy single site plus two model to overcome the limitation of traditional single-port laparoscopic surgery. MATERIALS AND METHODS All consecutive cases of robot-assisted extraperitoneal radical prostatectomy single site plus two model between November 2015 and April 2016 in our institution were included. We analyze the surgical and continence outcome. RESULTS Twenty cases were included in the analysis. All cases successfully completed without any necessity for conversion to a standard laparoscopic approach or open surgery. The average age is 64.3 ± 8.2 years and average body mass index is 24.3 ± 2.9 kg/m2. Eight focal positive margins (40%) (5 in T2 and 3 in T3a disease) were encountered and all occurred at the apex. For continence outcomes, 9 (45%) patients need average 0-1 pads/day and 2 (10%) patients need average 3 pads/day after surgery, but most recover after several months. No intraoperative complications or major postoperative complications were recorded, excluding blood transfusion in one case. CONCLUSIONS Robot-assisted extraperitoneal radical prostatectomy single site plus two model is technically feasible and safe in our experience. It can also be performed in patients that have previously received intraperitoneal abdominal surgery using the extraperitoneal approach. We can take this procedure into account for minimal invasive surgical option.
Collapse
Affiliation(s)
- Ing-Shiang Lo
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Hsiang-Ying Lee
- 2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital , Kaohsiung, Taiwan .,3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Yii-Her Chou
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Chun-Nung Huang
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital , Kaohsiung, Taiwan .,3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital , Kaohsiung, Taiwan .,3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Kai Fu Yang
- 5 Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Cheng Hsueh Lee
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Ching-Chia Li
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital , Kaohsiung, Taiwan .,3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| |
Collapse
|
7
|
Sorokin I, Canvasser NE, Irwin B, Autorino R, Liatsikos EN, Cadeddu JA, Rane A. The Decline of Laparoendoscopic Single-Site Surgery: A Survey of the Endourological Society to Identify Shortcomings and Guidance for Future Directions. J Endourol 2017; 31:1049-1055. [DOI: 10.1089/end.2017.0280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Igor Sorokin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noah E. Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brian Irwin
- Department of Surgery, Division of Urology, The University of Vermont Medical Center, Burlington, Vermont
| | - Riccardo Autorino
- Department of Urology, Case Western Reserve University, Cleveland, Ohio
| | | | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
| |
Collapse
|
8
|
Golebiewski A. Editorial Comment to Laparoendoscopic single-site surgeries: A multicenter experience of 469 cases in Japan. Int J Urol 2016; 24:74. [PMID: 27859640 DOI: 10.1111/iju.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrzej Golebiewski
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|