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Gaia G, Sighinolfi MC, Rocco B, Cannoletta M, Sampogna V, Lamarca A, Alboni C. Learning curve of optical trocar access during laparoscopic pelvic surgery: A prospective study. Actas Urol Esp 2023; 47:675-680. [PMID: 37442225 DOI: 10.1016/j.acuroe.2023.07.002] [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: 02/06/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION The optical trocar access (OTA) is a modified closed technique that aims to minimize the risk of vascular or bowel injuries while reducing the likelihood of gas leakage. A learning curve (LC) effect for OTA has been invoked with n = 30 procedures being considered as a threshold to define expertise. We aim to evaluate the impact of the LC within the first thirty cases of OTA performed by a trainee. METHODS This is a prospective randomized study on 60 patients elected to laparoscopic gynecological surgery. Patients were randomized to have OTA insertion by a junior surgeon or by an expert. LC was evaluated by: 1) insertion time; number of: 2) corrections by the senior; 3) times the tip of the trocar stopped in the preperitoneal layer; 4) mistakes of skin incision; 5) times the tip of the trocar ends under the omentum; 6) complications. To analyze the LC within the first 30 cases, procedures were stratified in 3 groups (cases 1-10; 11-20; 21-30) for both trainee and expert and LC variables were compared. RESULTS Overall, mean OTA insertion time was 56 s. No major intra- and post-operative complications were recorded. Mean insertion time was statistically significantly longer for the trainee compared to the expert within the first 10 cases (91 vs 33 s respectively, P = .01). For cases 11-20 and 21-30, time advantage of the senior surgeon is less evident (P = .05). The number of times the tip of the trocar stopped in the preperitoneal layer was similar between groups, as well as times the tip of the trocar ends under the omentum. CONCLUSIONS OTA is a fast and simple way to achieve the pneumoperitoneum and first trocar insertion as a single step. The current series confirms the effectiveness of the technique since the beginning of the LC.
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Affiliation(s)
- G Gaia
- Servicio de Obstetricia y Ginecología, ASST Santi Paolo e Carlo, Italy
| | | | - B Rocco
- Servicio de Urología, ASST Santi Paolo e Carlo, Italy
| | - M Cannoletta
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - V Sampogna
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - A Lamarca
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - C Alboni
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
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Liu Y, Yuan Y, Gao G, Liang Y, Li T, Li T. Safety and feasibility of robotic surgery for colon cancer patients with previous abdominal surgery: a propensity score-matching analysis. J Robot Surg 2023; 17:3025-3033. [PMID: 37950110 DOI: 10.1007/s11701-023-01741-5] [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: 08/10/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
Robotic surgery is widely used in gastrointestinal surgery. While the application of robotic surgery for colon cancer patients with previous abdominal surgery (PAS) remains controversial for the fear of intra-abdominal adhesions. This study was aimed to evaluate the safety and feasibility of robotic colectomy for patients with PAS. The medical records of colon cancer patients who underwent robotic surgery at our hospital from June 2015 to August 2020 were extracted and analyzed. Propensity score-matching (PSM) analysis was implemented to minimize selection bias. We compared perioperative outcomes and postoperative complications between the patients with PAS or with no PAS (NPAS). A total of 79 patients (PAS group) and 348 patients (NPAS group) were included in our study. After PSM, 79 patients of PAS group and 79 patients of NPAS group were selected for further analysis. We did not find statistical difference in operative time, estimated blood loss, lymph nodes retrieved, length of hospital stay and hospital costs between the two groups. No difference was noted in the incidence of postoperative complications, conversion to open surgery and mortality between the two groups. According to the results of multivariate analysis, PAS was not identified as risk factor for postoperative complications. Left hemicolectomy and perioperative transfusion were associated with postoperative complications. PAS did not negatively affect the outcomes of robotic colectomy. After individually preoperative assessment, robotic surgery could be performed feasibly and safely for colon cancer patients with PAS.
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Affiliation(s)
- Yaxiong Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Yuli Yuan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Gengmei Gao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Yahang Liang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Tao Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China
| | - Taiyuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China.
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Prata F, Raso G, Ragusa A, Iannuzzi A, Tedesco F, Cacciatore L, Civitella A, Tuzzolo P, D’Addurno G, Callè P, Basile S, Fantozzi M, Pira M, Prata SM, Anceschi U, Simone G, Scarpa RM, Papalia R. Robot-Assisted Renal Surgery with the New Hugo Ras System: Trocar Placement and Docking Settings. J Pers Med 2023; 13:1372. [PMID: 37763140 PMCID: PMC10532520 DOI: 10.3390/jpm13091372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The current literature relating to the novel HugoTM RAS System lacks consistent data concerning the bedside features of robot-assisted partial nephrectomy (RAPN). To describe the trocar placement and docking settings for RAPN with a three-arm configuration to streamline the procedure with HugoTM RAS, between October 2022 and April 2023, twenty-five consecutive off-clamp RAPNs for renal tumors with the HugoTM RAS System were performed. We conceived a trouble-free three-arm setting to ease and standardize RAPN trocar placement and docking settings with HugoTM RAS. Perioperative data were collected. Post-operative complications were reported according to the Clavien-Dindo classification. The eGFR was calculated according to the CKD-EPI formula. Continuous variables were presented as the median and IQR, while frequencies were reported as categorical variables. Off-clamp RAPNs were successfully performed in all cases without the need for conversion or additional port placement. The median age and BMI were 69 years (IQR, 60-73) and 27.3 kg/m2 (IQR, 25.7-28.1), respectively. The median tumor size and R.E.N.A.L. score were 32.5 mm (IQR, 26-43.7) and 6 (IQR, 5-7), respectively. Two patients were affected by cT2 renal tumors. The median docking and console time were 5 (IQR, 5-6) and 90 min (IQR, 68-135.75 min), respectively, with slightly progressive improvements in the docking time achieved. No intraoperative complications occurred alongside clashes between instruments or with the bed assistant. In experienced hands, this simplified three-instrument configuration of the HugoTM RAS System for off-clamp RAPN resulted in feasible and safe practice, providing patient-tailored trocar placement and docking with non-inferior peri-perioperative outcomes to other robotic platforms.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Gianluigi Raso
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Angelo Civitella
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Piergiorgio Tuzzolo
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Giuseppe D’Addurno
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Pasquale Callè
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Salvatore Basile
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Marco Fantozzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Matteo Pira
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Salvatore Mario Prata
- Simple Operating Unit of Lower Urinary Tract Surgery, SS. Trinità Hospital, Sora, 03039 Frosinone, Italy;
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
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Gadus L, Chmelik F, Matejkova M, Heracek J. Transperitoneal Laparoscopic and Robotic Partial Nephrectomy for Renal Cancer in Patients with Previous Abdominal Surgery: a Single Centre Experience. Indian J Surg 2023:1-9. [PMID: 37361397 PMCID: PMC10136388 DOI: 10.1007/s12262-023-03743-x] [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: 09/19/2022] [Accepted: 03/21/2023] [Indexed: 06/28/2023] Open
Abstract
Patients with previous abdominal surgery are at an increased risk of peritoneal adhesions, which may complicate transperitoneal surgery. The objective of this article is to report single centre experience with transperitoneal laparoscopic and robotic partial nephrectomy for renal cancer in patients with previous abdominal surgery. We evaluated data from 128 patients who underwent laparoscopic or robotic partial nephrectomy from January 2010 to May 2020. Patients were divided into three groups according to the localization of main previous surgery: in the upper contralateral abdominal quadrant, in the upper ipsilateral abdominal quadrant or in the middle line, in lower abdominal quadrants. Each group was divided into two subgroups (laparoscopic/robotic partial nephrectomy). We separately analysed data of indocyanine green-enhanced robotic partial nephrectomy. Our study did not find significant difference in the rate of intraoperative or postoperative complications between any of the groups. The type of partial nephrectomy (robotic or laparoscopic) affected the surgery time, blood loss, and length of stay in hospital, but did not significantly influence the frequency of complications. Partial nephrectomy in group of patients with prior renal surgery led to a higher rate of intraoperative low-grade complications. We did not observe more favourable results for indocyanine green-enhanced robotic partial nephrectomy. The location of previous abdominal surgery does not influence the rate of intraoperative or postoperative complications. The type of partial nephrectomy (robotic or laparoscopic) does not affect the frequency of complications.
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Affiliation(s)
- Lukas Gadus
- Department of Urology, Military University Hospital, 16902 Prague, Czech Republic
- First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Frantisek Chmelik
- Department of Urology, Military University Hospital, 16902 Prague, Czech Republic
| | - Marketa Matejkova
- Department of Urology, Military University Hospital, 16902 Prague, Czech Republic
| | - Jiri Heracek
- Department of Urology, Military University Hospital, 16902 Prague, Czech Republic
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El-Asmar JM, Ayoub CH, Kfoury P, Abou-Mrad A, El-Hajj A. Surgical Complications Requiring Reoperation in Open Versus Minimally Invasive Radical Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program. World J Surg 2023; 47:856-862. [PMID: 36587175 DOI: 10.1007/s00268-022-06869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND To explore reoperation rates for different radical nephrectomy (RN) approaches that are experiencing a shift from open radical nephrectomy (ORN) toward minimally invasive surgery (MIS), we aimed to compare reoperation rates along with their culprit etiologies between the different types of surgical approaches for RN. METHODS The national surgical quality improvement program dataset was used to select patients who underwent RN between the years 2012-2019. A 1:1 propensity score matched analysis was used. Reoperation rates and causes were then compared between open and MIS approach. RESULTS The propensity matched cohort included 15,294 patients. Reoperation rates due to large bowel injury (0.01 vs. 0.14%), vascular injury (0.07 vs. 0.22%), and other abdominal (0.5 vs. 0.77%) were more common in ORN as compared to MIS (MIS vs. ORN, respectively, p < 0.034). Reoperation due to hernia (0.14 vs. 0.03%) was more common in MIS as compared to ORN (p = 0.027). No difference was seen for small bowel injury and incision/wound debridement. General reoperation (1.61 vs. 2.22%) and mortality (0.57 vs. 1.47%) were also more common in ORN as compared to MIS (p < 0.008). CONCLUSION Reoperation due to large bowel injury, vascular injury, and other abdominal was more likely to occur in ORN. Whereas reoperation due to hernia was more likely to occur in MIS. Surgical approach was an independent risk factor for immediate and early reoperation rates in RN patients. These results could be used to counsel patients pre-operatively on possible surgical approaches and complications.
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Affiliation(s)
- Jose M El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Peter Kfoury
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Anthony Abou-Mrad
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon.
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Milone M, Manigrasso M, Anoldo P, D’Amore A, Elmore U, Giglio MC, Rompianesi G, Vertaldi S, Troisi RI, Francis NK, De Palma GD. The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12020307. [PMID: 35207795 PMCID: PMC8878352 DOI: 10.3390/jpm12020307] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 12/17/2022] Open
Abstract
Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic and robotic surgery; reporting data on conversion to open surgery for each group due to adhesions and studies including at least five patients in each group. The main outcomes were the conversion rates due to adhesions and surgeons’ expertise (novice vs. expert). The meta-analysis included 70 studies from different surgical specialities with 14,329 procedures (6472 robotic and 7857 laparoscopic). The robotic approach was associated with a reduced risk of conversion (OR 1.53, 95% CI 1.12–2.10, p = 0.007). The analysis of the procedures performed by “expert surgeons” showed a statistically significant difference in favour of robotic surgery (OR 1.48, 95% CI 1.03–2.12, p = 0.03). A reduced conversion rate due to adhesions with the robotic approach was observed in patients undergoing colorectal cancer surgery (OR 2.62, 95% CI 1.20–5.72, p = 0.02). The robotic approach could be a valid option in patients with abdominal adhesions, especially in the subgroup of those undergoing colorectal cancer resection performed by expert surgeons.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
- Correspondence: ; Tel.: +39-333-299-3637
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (P.A.)
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (P.A.)
| | - Anna D’Amore
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | - Ugo Elmore
- Department of Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, 20132 Milan, Italy;
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | - Gianluca Rompianesi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | - Roberto Ivan Troisi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | | | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
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Saoud R, Abou Heidar N, Andolfi C, Gundeti M. Antegrade Colonic Enema Channels in Pediatric Patients Using Appendix or Cecal Flap: A Comparative Robotic versus Open series. J Endourol 2021; 36:462-467. [PMID: 34931548 DOI: 10.1089/end.2021.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction We present perioperative outcomes of a single center experience with robotic assisted ACE channel creation for the treatment of chronic constipation refractory to medical therapy and compare it to the traditional open surgical approach. We also demonstrate a step-by-step video presentation of the robotic approach for cecal flap ACE performed as part of a dual continence procedure in patients with short length of appendix. Methods A retrospective chart review of pediatric patients who underwent ACE channel creation between 2008-2020 was performed. We compared demographics, intraoperative, and postoperative variables of the open versus robotic approach. Results Among 28 patients, 15 were open and 13 robotic. In order to construct the ACE channel, a cecal flap was utilized in 36%, split appendix in 50%, full length appendix in 11%, and sigmoid colon in 3% of patients. Both approaches showed equivalent estimated blood loss (50 ml [IQR=20-100]), median length of hospital stay (7 vs. 8 days, p=0.7) and median time to return to regular diet (4 vs. 5 days, p=0.5) (table 1). Patients in the open group were more likely to have a history of prior abdominal surgeries than those in the robotic group (80% vs. 38.5%, p=0.02). The risk of Clavien-Dindo grade 3 or more complications (40% vs. 23.1%, p=0.04) and the rate of ACE channel stenosis (46.7% vs. 7.7%, p=0.02) were significantly higher in the open approach. Channel stenosis was significantly higher in patients with an appendix ACE channel (87.5% vs. 12.5%, p<0.05) compared to those with cecal flap ACE. Conclusions Robotic assisted ACE channel creation is a safe and acceptable alternative with a significantly lower rate of channel stenosis and other Clavien grade 3 complications compared to the traditional open approach. Cecal flaps are also at a lower risk of stomal stenosis than appendix.
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Affiliation(s)
- Ragheed Saoud
- University of Chicago, 2462, Surgery, 5840 S MARYLAND AVE, Chicago, Chicago, Illinois, United States, 60637-5418;
| | - Nassib Abou Heidar
- American University of Beirut Medical Center, 66984, Beirut, Lebanon, Lebanon;
| | - Ciro Andolfi
- The University of Chicago Medical Center, 21727, Surgery (Urology), Chicago, Illinois, United States;
| | - Mohan Gundeti
- University of Chicago , Surgery( Urology), 5841, South Maryland Av, chicago, chicago , Illinois, United States, 60637;
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Shimbo M, Endo F, Tominaga K, Sano M, Nishino T, Kyono Y, Komatsu K, Ohyama T, Sakurai M, Narimoto K, Matsushita K, Hattori K. Optimizing first trocar access for robot-assisted radical prostatectomy: Optical trocar access through the upper abdominal quadrant using the Kii Fios First Entry trocar. Asian J Endosc Surg 2021; 14:443-450. [PMID: 33145955 DOI: 10.1111/ases.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES A pre-equipped metal trocar is required to use as a camera trocar due to a specification change in the da Vinci X/Xi system (Intuitive Surgical). We observed slight slippage of a trocar placed by the open method. With optical trocar access (OTA), the initial trocar is viewed directly with a laparoscope during placement. Reports regarding OTA for robotic surgery are limited, particularly for robot-assisted radical prostatectomy (RARP). We modified the OTA procedure such that it was appropriate for RARP. PATIENTS AND METHODS A total of 158 patients were enrolled in this study. The first trocar placement time (FTPT) was compared between the open and OTA groups. In the OTA group, the trocar was mainly placed through the upper abdominal quadrant. We also analyzed the differences between the conventional and modified OTA procedures using the Kii Fios First Entry trocar (Applied Medical). We examined the factors affecting the FTPT using linear regression models. A P value <.05 was considered significant. RESULTS The FTPT was significantly shorter in the OTA group than the open group (P < .0001). The modified method was associated with a shorter FTPT (P = .0001). None of the patient characteristics affected the FTPT in either group. No major complications were observed. CONCLUSIONS OTA was applied successfully during RARP. Use of the Kii Fios First Entry trocar with upper abdominal quadrant placement was suitable for RARP.
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Affiliation(s)
- Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Fumiyasu Endo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Koki Tominaga
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masayuki Sano
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takato Nishino
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoko Kyono
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kenji Komatsu
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takehiro Ohyama
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masato Sakurai
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazutaka Narimoto
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | | | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
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9
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Yumioka T, Honda M, Teraoka S, Kimura Y, Iwamoto H, Morizane S, Hikita K, Takenaka A. The Influence of Prior Abdominal Surgery on Robot-Assisted Partial Nephrectomy. Yonago Acta Med 2021; 64:184-191. [PMID: 34025193 DOI: 10.33160/yam.2021.05.010] [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: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 11/05/2022]
Abstract
Background We evaluated the influence of prior abdominal surgery on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy in initial Japanese series. Methods We reviewed patients with small renal tumors who underwent robot-assisted partial nephrectomy from October 2011 to September 2020 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery based on perioperative outcomes. The chi-square test and Mann-Whitney U test were used for statistical analyses of variables. Results Of 156 patients who underwent robot-assisted partial nephrectomy, 90 (58%) had no prior abdominal surgery, whereas 66 patients (42%) underwent prior abdominal surgery. No significant differences in perioperative outcomes were observed between with and without prior abdominal surgery groups. In transperitoneal approach robot-assisted partial nephrectomy, 31 patients (80.4%) had prior abdominal surgery. Trocar insertion time in the with prior abdominal surgery group took longer than the without prior abdominal surgery group (32 vs. 28.5 min, P = 0.031). No significant difference was observed in the conversion rate between the two groups (P = 0.556). Conclusion Robot-assisted partial nephrectomy appears to be a safe approach for patients with prior abdominal surgery. In transperitoneal approach robot-assisted partial nephrectomy with prior abdominal surgery, trocar insertion time was longer, but no significant differences were found in other outcomes. Transperitoneal approach robot-assisted partial nephrectomy is thus considered a safe procedure for patients with prior abdominal surgery.
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Affiliation(s)
- Tetsuya Yumioka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yusuke Kimura
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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10
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Milone M, de'Angelis N, Beghdadi N, Brunetti F, Manigrasso M, De Simone G, Servillo G, Vertaldi S, De Palma GD. Conversions related to adhesions in abdominal surgery. Robotic versus laparoscopic approach: A multicentre experience. Int J Med Robot 2020; 17:e2186. [PMID: 33079464 DOI: 10.1002/rcs.2186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/16/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND An advantage of robotic surgery over laparoscopy is the lower rate of unplanned conversion. One of the implicated reasons for conversion is adhesions from previous abdominal surgeries (PASs). METHODS A comparative analysis of 98 patients with history of open PAS treated by laparoscopic or robotic surgery was performed. Primary endpoint was the rate of conversion to open surgery related to adhesiolysis. Secondary endpoints were short-term outcomes and complications. RESULTS Conversion rate specifically related to adhesiolysis was significantly lower in robotic group (13 for laparoscopic group vs. 2 for robotic group; p = 0.046). Conversions occurred during adhesiolysis were significantly related to severity of adhesions expressed by peritoneal adhesion index (PAI) score (p < 0.001), number of abdominal areas involved by adhesions (p < 0.001) and severity of PAI into the target area of surgical intervention (p = 0.021). CONCLUSIONS Benefits of robotic surgery are more noticeable in performing procedures with increasing technical difficulties.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Nicola de'Angelis
- Unit of Digestive and Hepato-Pancreato-Biliary Surgery, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.,EA7375 (EC2M3 Research Team), Université Paris Est, Créteil, France
| | - Nassiba Beghdadi
- Unit of Digestive and Hepato-Pancreato-Biliary Surgery, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.,EA7375 (EC2M3 Research Team), Université Paris Est, Créteil, France
| | - Francesco Brunetti
- Unit of Digestive and Hepato-Pancreato-Biliary Surgery, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.,EA7375 (EC2M3 Research Team), Université Paris Est, Créteil, France
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Giuseppe De Simone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Sara Vertaldi
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
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11
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Zeuschner P, Greguletz L, Meyer I, Linxweiler J, Janssen M, Wagenpfeil G, Wagenpfeil S, Siemer S, Stöckle M, Saar M. Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years. Int J Med Robot 2020; 17:1-8. [DOI: 10.1002/rcs.2167] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/26/2020] [Accepted: 09/10/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Leonie Greguletz
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Irmengard Meyer
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Johannes Linxweiler
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Martin Janssen
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Gudrun Wagenpfeil
- Department of Medical Biometry Epidemiology and Medical Informatics Saarland University Homburg/Saar Germany
| | - Stefan Wagenpfeil
- Department of Medical Biometry Epidemiology and Medical Informatics Saarland University Homburg/Saar Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Matthias Saar
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
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12
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Leevan E, Carmichael JC. Iatrogenic bowel injury (early vs delayed). SEMINARS IN COLON AND RECTAL SURGERY 2019. [DOI: 10.1016/j.scrs.2019.100688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Cacciamani GE, Gill T, Medina L, Ashrafi A, Winter M, Sotelo R, Artibani W, Gill IS. Impact of Host Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis. J Urol 2018; 200:716-730. [DOI: 10.1016/j.juro.2018.04.079] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Giovanni E. Cacciamani
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Urology, University of Verona, Verona, Italy
| | - Tania Gill
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Luis Medina
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Akbar Ashrafi
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew Winter
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Renè Sotelo
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Inderbir S. Gill
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
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14
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Silva JP, Berger NG, Yin Z, Liu Y, Tsai S, Christians KK, Clarke CN, Mogal H, Gamblin TC. The effect of prior upper abdominal surgery on outcomes after liver transplantation for hepatocellular carcinoma: An analysis of the database of the organ procurement transplant network. Surgery 2018; 163:1028-1034. [DOI: 10.1016/j.surg.2017.10.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/27/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022]
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15
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A rare case of acute presentation of trocar site hernia from robot-assisted laparoscopic partial nephrectomy. J Robot Surg 2018; 13:159-162. [PMID: 29450803 DOI: 10.1007/s11701-018-0787-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/11/2018] [Indexed: 01/14/2023]
Abstract
Trocar site hernia is not a common acute complication encountered after robot-assisted surgery, especially in the urological cohort of patients. A few case reports of small bowel obstruction secondary to incarceration by trocar site hernia have been described in gynaecological surgery and prostatectomies. As the clinical presentation is non-specific, late diagnosis has significant implication on morbidity and mortality. Here, we present a rare case of a patient with recent robot-assisted laparoscopic partial nephrectomy for a renal cell carcinoma presented with features of impending bowel obstruction secondary to incarcerated small bowel in the trocar site. We also reviewed the literature focusing on clinical features of trocar site hernia and preventive measures.
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16
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Raison N, Doeuk N, Malthouse T, Kasivisvanathan V, Lam W, Challacombe B. Challenging situations in partial nephrectomy. Int J Surg 2016; 36:568-573. [DOI: 10.1016/j.ijsu.2016.05.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/25/2016] [Accepted: 05/28/2016] [Indexed: 12/20/2022]
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17
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Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysis. Int J Surg 2016; 30:109-15. [DOI: 10.1016/j.ijsu.2016.04.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 02/01/2023]
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18
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Hiess M, Seitz C. Robot-assisted renal surgery: current status and future directions. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2016; 3:1-12. [PMID: 30697551 PMCID: PMC6193442 DOI: 10.2147/rsrr.s71328] [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: 01/07/2023]
Abstract
This paper examines the current role of robot-assisted renal surgery as complex and partial nephrectomies, including vena cava thrombus, combined nephroureterectomies, living donor nephrectomy, autotransplantation, and difficult anatomy as in patients with obesity or adhesions. Indications for robot-assisted renal surgery are comparable to those of conventional laparoscopic approaches. A reduction in the learning curve leads to a stabilization of the procedure and further increases the number of minimally invasive procedures performed. A Medline literature search for publications on the field of robotic kidney surgery has been performed using the MeSH terms: robotic surgical procedures and kidney. Future directions include progress in robotic technology and instrumentation with further miniaturization of robotic procedures as laparoendoscopic single-site interventions and progress in image-guided robotic surgery.
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Affiliation(s)
- Manuela Hiess
- Department of Urology, Medical University of Vienna, Vienna, Austria,
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria,
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19
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Abdullah N, Rahbar H, Barod R, Dalela D, Larson J, Johnson M, Mass A, Zargar H, Allaf M, Bhayani S, Stifelman M, Kaouk J, Rogers C. Multicentre outcomes of robot-assisted partial nephrectomy after major open abdominal surgery. BJU Int 2016; 118:298-301. [PMID: 27417163 DOI: 10.1111/bju.13408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the outcomes of robot-assisted partial nephrectomy RAPN after major prior abdominal surgery (PAS) using a large multicentre database. PATIENTS AND METHODS We identified 1 686 RAPN from five academic centres between 2006 and 2014. In all, 216 patients had previously undergone major PAS, defined as having an open upper midline/ipsilateral incision. Perioperative outcomes were compared with those 1 470 patients who had had no major PAS. The chi-squared test and Mann-Whitney U-test were used for categorical and continuous variables, respectively. RESULTS There was no statistically significant difference in Charlson comorbidity index, tumour size, R.E.N.A.L. nephrometry score or preoperative estimated glomerular filtration rate (eGFR) between the groups. Age and body mass index were higher in patients with PAS. The PAS group had a higher estimated blood loss (EBL) but this did not lead to a higher transfusion rate. A retroperitoneal approach was used more often in patients with major PAS (11.2 vs 5.4%), although this group did not have a higher percentage of posterior tumours (38.8 vs 43.3%, P = 0.286). Operative time, warm ischaemia time, length of stay, positive surgical margin, percentage change in eGFR, and perioperative complications were not significantly different between the groups. CONCLUSIONS RAPN in patients with major PAS is safe and feasible, with increased EBL but no increased rate of transfusion. Patients with major PAS had almost twice the likelihood of having a retroperitoneal approach.
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Affiliation(s)
- Newaj Abdullah
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Haider Rahbar
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Ravi Barod
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Deepansh Dalela
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Jeff Larson
- Division of Urology, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael Johnson
- James Buchanan Brady Urological Institute, John Hopkins University, Baltimore, MD, USA
| | - Alon Mass
- Department of Urology, New York University, New York, NY, USA
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mohamad Allaf
- James Buchanan Brady Urological Institute, John Hopkins University, Baltimore, MD, USA
| | - Sam Bhayani
- Division of Urology, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Craig Rogers
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI
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20
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Karadag MA, Cecen K, Demir A, Bagcioglu M, Kocaaslan R, Kadioglu TC. Gastrointestinal complications of laparoscopic/robot-assisted urologic surgery and a review of the literature. J Clin Med Res 2015; 7:203-10. [PMID: 25699115 PMCID: PMC4330011 DOI: 10.14740/jocmr2090w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 01/10/2023] Open
Abstract
Gastrointestinal injuries that occur during or after laparoscopic and robot-assisted surgery are serious side effects that affect patient outcome. In this review, we attempt to highlight the identification, incidence and management of gastrointestinal and visceral complications of laparoscopic and robot-assisted surgery. A search of Medline and PubMed databases was performed using the following terms: gastrointestinal complications of laparoscopy, laparoscopic, kidney and robotic surgery. A total of 1,072 papers related to the subject were analyzed. Forty-six of these papers were included in the present review. These papers reported high numbers of participants and had a high level of evidence. Gastrointestinal complications during laparoscopic and robot-assisted surgery are rare, but similar, and can occur at any time between access and closure. Despite their infrequency, these complications can result in mortality. The early recognition and management of gastrointestinal complications is very important. Unrecognized or delayed identification of gastrointestinal complications may cause sepsis and death.
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Affiliation(s)
- Mert Ali Karadag
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Kursat Cecen
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Aslan Demir
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Murat Bagcioglu
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Ramazan Kocaaslan
- Department of Urology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Teoman Cem Kadioglu
- Department of Urology, Istanbul University, Medical Faculty of Istanbul, Istanbul, Turkey
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21
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Robot-assisted laparoscopic partial nephrectomy in patients with previous abdominal surgery: single center experience. Int J Med Robot 2015; 11:389-94. [DOI: 10.1002/rcs.1633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/30/2014] [Accepted: 12/03/2014] [Indexed: 01/06/2023]
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22
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Wang L, Lee BR. Robotic partial nephrectomy: current technique and outcomes. Int J Urol 2013; 20:848-59. [PMID: 23635467 DOI: 10.1111/iju.12177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/21/2013] [Indexed: 01/20/2023]
Abstract
Over the past decade, management of the T1 renal mass has focused on nephron-sparing surgery. Robotic partial nephrectomy has played an increasing role in the technique of preserving renal function by decreasing warm ischemia time, as well as optimizing outcomes of hemorrhage and fistula. Robot-assisted partial nephrectomy is designed to provide a minimally-invasive nephron-sparing surgical option utilizing reconstructive capability, decreasing intracorporeal suturing time, technical feasibility and safety. Ultimately, its benefits are resulting in its dissemination across institutions. Articulated instrumentation and three-dimensional vision facilitate resection, collecting system reconstruction and renorrhaphy, leading to decreased warm ischemia time while preserving oncological outcomes. The aim of the present review was to present our surgical sequence and technique, as well as review the current status of robot-assisted partial nephrectomy.
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Affiliation(s)
- Liang Wang
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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23
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Autorino R, Khalifeh A, Laydner H, Samarasekera D, Rizkala E, Eyraud R, Haber GP, Stein RJ, Kaouk JH. Repeat robot-assisted partial nephrectomy (RAPN): feasibility and early outcomes. BJU Int 2013; 111:767-72. [DOI: 10.1111/j.1464-410x.2013.11800.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Riccardo Autorino
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Ali Khalifeh
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Humberto Laydner
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Dinesh Samarasekera
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Emad Rizkala
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Remi Eyraud
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Georges-Pascal Haber
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Robert J. Stein
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Jihad H. Kaouk
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
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24
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Tanagho YS, Bhayani SB, Figenshau RS. Robot-assisted partial nephrectomy in contemporary practice. Front Oncol 2013; 2:213. [PMID: 23336101 PMCID: PMC3542789 DOI: 10.3389/fonc.2012.00213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 12/21/2012] [Indexed: 01/20/2023] Open
Abstract
Laparoscopic renal surgery is associated with reduced blood loss, shorter hospital stay, enhanced cosmesis, and more rapid convalescence relative to open renal surgery. Laparoscopic partial nephrectomy (LPN) is a minimally invasive, nephron-sparing alternative to laparoscopic radical nephrectomy (RN) for the management of small renal masses. While offering similar oncological outcomes to laparoscopic RN, the technical challenges and prolonged learning curve associated with LPN limit its wider dissemination. Robot-assisted partial nephrectomy (RAPN), although still an evolving procedure with no long-term data, has emerged as a viable alternative to LPN, with favorable preliminary outcomes. This article provides an overview of the role of RAPN in the management of renal cell carcinoma. The clinical indications and principles of surgical technique for this procedure are discussed. The oncological, renal functional, and perioperative outcomes of RAPN are also evaluated, as are complication rates.
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Affiliation(s)
- Youssef S. Tanagho
- Division of Urologic Surgery, Washington University School of MedicineSt. Louis, MO, USA
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25
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Technique, Outcomes, and Evolving Role of Extirpative Laparoscopic and Robotic Surgery for Renal Cell Carcinoma. Surg Oncol Clin N Am 2013; 22:91-109, vi. [DOI: 10.1016/j.soc.2012.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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Gohil R, Ahmed K, Kooiman G, Khan MS, Dasgupta P, Challacombe B. Current status of robot-assisted partial nephrectomy. BJU Int 2012; 110:1602-6. [PMID: 22577985 DOI: 10.1111/j.1464-410x.2012.11151.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
What's known on the subject? and What does the study add? The use of robotic assistance for the partial nephrectomy procedure has emerged as an alternative that may help some of the technical challenges of laparoscopic partial nephrectomy. The main concerns in laparoscopic partial nephrectomy relates to a steeper 'learning curve', prolonged warm ischaemia times and the potential for postoperative haemorrhage. The article delineates the dynamics of patient preparation, the surgical team, surgical technique & post-operative care to conclude that robotic-assisted partial nephrectomy is a viable alternative to both open and laparoscopic techniques. Partial nephrectomy has shown both improved overall patient survival and more effective preservation of renal function, when compared with radical nephrectomy. Robot-assisted partial nephrectomy has several potential advantages over the laparoscopic approach. Robotic assistance allows urologists to perform this complex reconstructive procedure more quickly, with improved precision and dexterity, tremor elimination and improved visualization. The present article aims to delineate the dynamics of patient preparation and surgical team, surgical technique and postoperative care. The oncological outcomes and disease-free survival of partial nephrectomy have been found to be equivalent to open partial nephrectomy [1-4].
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Affiliation(s)
- Rishma Gohil
- MRC Centre for Transplantation, King's College London, London, UK
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27
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Robot-assisted Laparoscopic Partial Nephrectomy: Step-by-step Contemporary Technique and Surgical Outcomes at a Single High-volume Institution. Eur Urol 2012; 62:553-61. [DOI: 10.1016/j.eururo.2012.05.021] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 05/08/2012] [Indexed: 02/06/2023]
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Aboumarzouk OM, Stein RJ, Eyraud R, Haber GP, Chlosta PL, Somani BK, Kaouk JH. Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 2012; 62:1023-33. [PMID: 22771266 DOI: 10.1016/j.eururo.2012.06.038] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 06/19/2012] [Indexed: 02/08/2023]
Abstract
CONTEXT Centres worldwide have been performing partial nephrectomies laparoscopically for greater than a decade. With the increasing use of robotics, many centres have reported their early experiences using it for nephron-sparing surgery. OBJECTIVE To review published literature comparing robotic partial nephrectomy (RPN) with laparoscopic partial nephrectomy (LPN). EVIDENCE ACQUISITION An online systematic review of the literature according to Cochrane guidelines was conducted from 2000 to 2012 including studies comparing RPN and LPN. All studies comparing RPN with LPN were included. The outcome measures were the patient demographics, tumour size, operating time, warm ischaemic time, blood loss, transfusion rates, length of hospital stay, conversion rates, and complications. A meta-analysis of the results was conducted. For continuous data, a Mantel-Haenszel chi-square test was used; for dichotomous data, an inverse variance was used. Each was expressed as a risk ratio with a 95% confidence interval p<0.05 considered significant. EVIDENCE SYNTHESIS A total of 717 patients were included, 313 patients in the robotic group and 404 patients in the laparoscopic group (seven studies). There was no significant difference between the two groups in any of the demographic parameters except for age (age: p=0.006; sex: p=0.54; laterality: p=0.05; tumour size: p=0.62, tumour location: p=57; or confirmed malignant final pathology: p=0.79). There was no difference between the two groups regarding operative times (p=0.58), estimated blood loss (p=0.76), or conversion rates (p=0.84). The RPN group had significantly less warm ischaemic time than the LPN group (p=0.0008). There was no difference regarding postoperative length of hospital stay (p=0.37), complications (p=0.86), or positive margins (p=0.93). CONCLUSIONS In early experience, RPN appears to be a feasible and safe alternative to its laparoscopic counterpart with decreased warm ischaemia times noted.
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Nepple KG, Sandhu GS, Rogers CG, Allaf ME, Kaouk JH, Figenshau RS, Stifelman MD, Bhayani SB. Description of a multicenter safety checklist for intraoperative hemorrhage control while clamped during robotic partial nephrectomy. Patient Saf Surg 2012; 6:8. [PMID: 22471921 PMCID: PMC3342085 DOI: 10.1186/1754-9493-6-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 04/02/2012] [Indexed: 11/10/2022] Open
Abstract
Background The adoption of robotic assistance has contributed to the increased utilization of partial nephrectomy for the management of renal tumors. However, partial nephrectomy can be technically challenging because of intraoperative hemorrhage, which limits the ability to identify the tumor margin and may necessitate the conversion to open surgery or radical nephrectomy. To our knowledge, a comprehensive safety checklist does not exist to guide surgeons on the management of hemorrhage during robotic partial nephrectomy. We developed such an safety checklist based on the cumulative experiences of high volume robotic surgeons. Methods A treatment safety checklist for the management of hemorrhage during robotic partial nephrectomy was collaboratively developed based on prior experiences with intraoperative hemorrhage during robotic partial nephrectomy. Results Reducing the risk of hemorrhage during robotic partial nephrectomy begins with reviewing the preoperative imaging for renal vasculature and tumor anatomy, with a focus on accessory vessels and renal tumor proximity to the renal hilum. During hilar exposure, an attempt is made to identify additional accessory renal arteries. The decision is then made on whether to clamp the hilum (artery +/- vein). If bleeding is encountered during resection, management is based on whether the bleeding is suspected to be arterial or from venous backbleeding. Operative maneuvers that may increase the chance of success are highlighted in safety checklists for arterial and venous bleeding. Conclusions Safely performing robotic partial nephrectomy is dependent on attention to prevention of hemorrhage and rapid response to the challenge of intraoperative bleeding. Preparation is essential for maximizing the chance of success during robotic partial nephrectomy.
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Current World Literature. Curr Opin Anaesthesiol 2012; 25:260-9. [DOI: 10.1097/aco.0b013e3283521230] [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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Reyes JM, Smaldone MC, Uzzo RG, Viterbo R. Current Status of Robot-Assisted Partial Nephrectomy. Curr Urol Rep 2011; 13:24-37. [DOI: 10.1007/s11934-011-0223-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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