1
|
Sasaki Y, Takahashi M, Hashimoto K, Fukuta K, Shiozaki K, Daizumoto K, Ueno Y, Tsuda M, Kusuhara Y, Fukawa T, Yamaguchi K, Yamamoto Y, Izaki H, Kanayama H. Efficacy of the Mercedes-Benz closure technique for vaginal reconstruction in female robot-assisted radical cystectomy. Asian J Endosc Surg 2023; 16:23-27. [PMID: 35842843 DOI: 10.1111/ases.13109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Vaginal reconstruction using the posterior vaginal wall is required following radical cystectomy in women with resection of the uterus, adnexa, and anterior vaginal wall. Roll closure and clamshell closure are two widely known techniques. Of these, clamshell closure is recommended because roll closure has a high likelihood of breakdown or a resultant canal that is too narrow for sexual intercourse. In clamshell closure, however, folding the posterior vaginal wall anteriorly can be difficult. Therefore, we devised Mercedes-Benz closure, in which the vaginal wall is sutured from three directions to form a Mercedes-Benz shape, for anastomosis without tension on the vaginal wall. The present study was performed to investigate the efficacy of this alternative surgical technique for vaginal reconstruction. METHODS Twenty-six patients who underwent vaginal reconstruction following robot-assisted radical cystectomy were divided into two groups: 15 underwent clamshell closure and 11 underwent Mercedes-Benz closure. The patients' characteristics and surgical outcomes were compared between the two groups. RESULTS There were no significant differences in clinical characteristics, including age, body mass index, and prior abdominal surgery between the two groups. The median vaginal reconstruction time tended to be longer in the Mercedes-Benz closure group than in the clamshell closure group (35.0 vs. 27.0 min, p = 0.102). No complications associated with vaginal reconstruction were identified. CONCLUSION The surgical outcomes were comparable between Mercedes-Benz closure and clamshell closure. If vaginal reconstruction with clamshell closure is difficult, Mercedes-Benz closure is a valuable alternative technique.
Collapse
Affiliation(s)
- Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Keisuke Hashimoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kyotaro Fukuta
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Keito Shiozaki
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshiteru Ueno
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Megumi Tsuda
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirofumi Izaki
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Hiroomi Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| |
Collapse
|
2
|
Lampe B, Luengas-Würzinger V, Weitz J, Roth S, Rawert F, Schuler E, Classen-von Spee S, Fix N, Baransi S, Dizdar A, Mallmann P, Schaser KD, Bogner A. Opportunities and Limitations of Pelvic Exenteration Surgery. Cancers (Basel) 2021; 13:6162. [PMID: 34944783 PMCID: PMC8699210 DOI: 10.3390/cancers13246162] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The practice of exenterative surgery is sometimes controversial and has garnered a certain scepticism. Surgical studies are difficult to conduct due to insufficient data. The aim of this review is to present the current standing of pelvic exenteration from a surgical, gynaecological and urological point of view. METHODS This review is based upon a literature review (MEDLINE (PubMed), CENTRAL (Cochrane) and EMBASE (Elsevier)) of retrospective studies on exenterative surgery from 1993-2020. Using MeSH (Medical Subject Headings) search terms, 1572 publications were found. These were evaluated and screened with respect to their eligibility using algorithms and well-defined inclusion and exclusion criteria. Therefore, the guidelines for systematic reviews (PRISMA) were used. RESULTS A complete tumour resection (R0) often represents the only curative option for advanced pelvic carcinomas and their recurrences. A recent systematic review showed significant symptom relief in 80% of palliative patients after pelvic exenteration. Surgical limitations (distant metastases, involvement of the pelvic wall, etc.) are diminished by adequate surgical expertise and close interdisciplinary cooperation. While the mortality rate is low (2-5%), the still relatively high morbidity rate (32-84%) can be minimized by optimizing the perioperative setting. Following exenterations, roughly 79-82% of patients report satisfying results according to PROs (patient-reported outcomes). CONCLUSION Due to multimodality treatment strategies combined with extended surgical expertise and patients' preferences, pelvic exenteration can be offered nowadays with low mortality and acceptable postoperative quality of life. The possibilities of surgical treatment are often underestimated. A multi-centre database (PelvEx Collaborative) was established to collect data and experiences to optimize the research in this field.
Collapse
Affiliation(s)
- Björn Lampe
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Verónica Luengas-Würzinger
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (J.W.); (A.B.)
| | - Stephan Roth
- Department of Urology and Pediatric Urology, Helios Faculty of Medicine Wuppertal, Universität Witten/Herdecke, Heusnerstraße 40, 42283 Wuppertal, Germany;
| | - Friederike Rawert
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Esther Schuler
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Sabrina Classen-von Spee
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Nando Fix
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Saher Baransi
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Anca Dizdar
- Department of Gynecology & Obstetrics, Florence Nightingale Hospital, Kreuzbergstr. 79, 40489 Düsseldorf, Germany; (B.L.); (F.R.); (E.S.); (S.C.-v.S.); (N.F.); (S.B.); (A.D.)
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Klaus-Dieter Schaser
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Andreas Bogner
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (J.W.); (A.B.)
| |
Collapse
|
3
|
Port-site metastasis and atypical recurrences after robotic-assisted radical cystectomy (RARC): an updated comprehensive and systematic review of current evidences. J Robot Surg 2020; 14:805-812. [PMID: 32152900 DOI: 10.1007/s11701-020-01062-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
The objective of this systematic review is to evaluate the current evidence regarding atypical metastases in patients undergoing robotic-assisted radical cystectomy (RARC). A review of the current literature was conducted through the Medline and NCBI PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases in October 2019. From the literature search using the cited keys and after a careful evaluation of the full texts, we included 31 articles in the study. Fourteen studies (45.2%) reported at least an atypical recurrence during the follow-up period with a rate between 4 and 40% of all the recurrences. Overall, 105 (1.63%) of the 6720 patients who have been evaluated in the included studies developed an atypical recurrence. Sixty-three (60%) of these atypical metastases were peritoneal carcinomatosis, 16 (15.2%) extrapelvic lymph nodes metastases, 11 (10.5%) port-site metastases, 10 (9.5%) retroperitoneal nodal metastases, while 5 (3.8%) patients developed more than one type of atypical recurrence. In literature, there is a low but not negligible incidence of atypical recurrences after RARC. However, publication bias and retrospective design of most studies could influence the evidences. Further prospective randomized studies are needed to clarify the real risk of patients undergoing RARC to develop atypical metastases.
Collapse
|
4
|
Lin FC, Medendorp A, Van Kuiken M, Mills SA, Tarnay CM. Vaginal Dehiscence and Evisceration After Robotic-assisted Radical Cystectomy: A Case Series and Review of the Literature. Urology 2019; 134:90-96. [DOI: 10.1016/j.urology.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022]
|
5
|
Hayashi K, Kotake M, Kakiuchi D, Yamada S, Hada M, Kato Y, Hiranuma C, Oyama K, Hara T. Laparoscopic total pelvic exenteration using transanal minimal invasive surgery technique with en bloc bilateral lymph node dissection for advanced rectal cancer. Surg Case Rep 2016; 2:74. [PMID: 27460130 PMCID: PMC4961659 DOI: 10.1186/s40792-016-0198-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/01/2016] [Indexed: 01/22/2023] Open
Abstract
A 59-year-old man presenting with fecal occult blood visited our hospital. He was diagnosed with advanced lower rectal cancer, which was contiguous with the prostate and the left seminal vesicle. There were no metastatic lesions with lymph nodes or other organs. We performed laparoscopic total pelvic exenteration (LTPE) using transanal minimal invasive surgery technique with bilateral en bloc lateral lymph node dissection for advanced primary rectal cancer after neoadjuvant chemoradiotherapy. The total operative time was 760 min, and the estimated blood loss was 200 ml. LTPE is not well established technically, but it has many advantages including good visibility of the surgical field, less blood loss, and smaller wounds. A laparoscopic approach may be an appropriate choice for treating locally advanced lower rectal cancer, which requires TPE.
Collapse
Affiliation(s)
- Kengo Hayashi
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan.
| | - Masanori Kotake
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan
| | - Daiki Kakiuchi
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan
| | - Sho Yamada
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan
| | - Masahiro Hada
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan
| | - Yosuke Kato
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan
| | - Chikashi Hiranuma
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan
| | - Kaeko Oyama
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan
| | - Takuo Hara
- Department of Surgery, Koseiren Takaoka Hospital, 5-10, Eirakucho, Takaoka, Toyama, 933-8555, Japan
| |
Collapse
|
6
|
Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies. World J Surg 2015; 40:1236-43. [DOI: 10.1007/s00268-015-3364-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
7
|
Single-Incision Plus One Port Laparoscopic Total Pelvic Exenteration After Neoadjuvant Chemotherapy for Advanced Primary Rectal Cancer: A Case Report. Int Surg 2015. [DOI: 10.9738/intsurg-d-14-00298.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Limited data on laparoscopic and robotic total pelvic exenteration (TPE) for gynecologic, urologic, and rectal malignancies have been published in the literature. Single-incision laparoscopic surgery (SILS) has been successfully introduced for colon cancer. Here, we describe our experience of TPE with SILS + 1 port (SILS+1) for advanced rectal cancer. A 64-year-old man was referred to our hospital with anemia. Computed tomography (CT) revealed a rectal tumor that was contiguous with the seminal vesicle and bladder. Rectoscopy revealed an ulcerated, bleeding, and stricturing lesion in the rectum, which was defined as an adenocarcinoma with a moderate degree of differentiation on histologic examination. The patient received neoadjuvant chemotherapy using capecitabine, oxaliplatin, and bevacizumab. After 3 courses of chemotherapy, a rectovesical fistula was suspected from examination of CT images. CT demonstrated intramural gas in the urinary bladder, which suggested a diagnosis of emphysematous cystitis. Thus, we constructed a transverse loop colostomy. Two months after the last administration of chemotherapy, we performed SILS+1 TPE. The procedure involved a 35-mm incision in the right side of the umbilicus for the insertion of a single multichannel port, and insertion of a 12-mm port into the right lower quadrant. Total operating time was 751 minutes, and estimated blood loss was 1100 mL (including urine). SILS+1 TPE is a technically promising alternative method for the treatment of selected patients with advanced rectal cancer.
Collapse
|
8
|
Puntambekar S, Lawande A, Desai R, Puntambekar S, Joshi GA, Joshi SN. Initial experience of robotic anterior pelvic exenteration at a single institute. Int J Gynaecol Obstet 2014; 126:41-4. [DOI: 10.1016/j.ijgo.2013.12.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 12/13/2013] [Accepted: 03/26/2014] [Indexed: 11/16/2022]
|
9
|
Shin JW, Kim J, Kwak JM, Hara M, Cheon J, Kang SH, Kang SG, Stevenson ARL, Coughlin G, Kim SH. First report: Robotic pelvic exenteration for locally advanced rectal cancer. Colorectal Dis 2014; 16:O9-14. [PMID: 24330440 DOI: 10.1111/codi.12446] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/28/2013] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study was to present the feasibility and surgical outcome of robotic en bloc resection of the rectum and with prostate and seminal vesicle invaded by rectal cancer. METHOD The details of three consecutive cases involving male patients in their forties, with locally invasive low rectal cancers are presented. The da Vinci robotic system was used by experienced colorectal and urological surgeons to perform en bloc resection of the rectum, prostate and seminal vesicles. RESULTS In the first case, coloanal and vesico-urethral anastomoses were performed, and the second included an end colostomy and vesico-urethral anastomosis. The bladder and bulbar urethra were also removed en bloc in the third case, with robotic intracorporeal ileal conduit formation and end colostomy. There was no major complication postoperatively. In the second patient there was a minor leakage at the vesico-urethral anastomosis. The third was readmitted the following week with a urinary infection which settled with intravenous antibiotics. In the first case, the circumferential resection margin was microscopically positive but the patient is currently free of recurrence after 14 months. In the second and third cases, all margins were clear. CONCLUSION This the first report of the use of the da Vinci robotic system for pelvic exenteration in patients with locally advanced rectal cancer invading the prostate and seminal vesicles. The robot may have a potential role in selected patients requiring exenterative pelvic surgery particularly in men.
Collapse
Affiliation(s)
- J W Shin
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Primary clear cell adenocarcinoma of a urethral diverticulum treated with multidisciplinary robotic anterior pelvic exenteration. Case Rep Med 2013; 2013:387591. [PMID: 24454400 PMCID: PMC3884856 DOI: 10.1155/2013/387591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/03/2013] [Indexed: 11/18/2022] Open
Abstract
Primary urethral carcinoma is extremely rare and is marked by a variety of clinical symptoms. Primary carcinoma of a urethral diverticulum is still rarer and clear cell adenocarcinoma of the urethra is particularly uncommon (Swartz et al., 2006). Such infrequency has led to inadequate management guidance in the literature for a disease that is often late in presentation and carries substantial morbidity and mortality. This treatable but grave disease deserves definitive curative treatment. We present the first published instance in which it was treated with robotic anterior exenteration. In our case, a 47-year-old female was referred to the urology service for investigation of recurring urinary tract infections. During the workup, the patient was found to have an advanced clear cell urethral adenocarcinoma originating in a urethral diverticulum. We discuss the natural history of this condition, its consequences, and the first instance of its treatment using robotic anterior pelvic exenteration.
Collapse
|
11
|
Mukai T, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, Ikeda A, Yamaguchi T. Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer. Asian J Endosc Surg 2013; 6:314-7. [PMID: 24308593 DOI: 10.1111/ases.12047] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 12/11/2022]
Abstract
Total pelvic exenteration (TPE) may be the only procedure that can cure T4 rectal cancer that directly invades the urinary bladder or prostate. Here, we describe our experience of laparoscopic TPE with en bloc lateral lymph node dissection for advanced primary rectal cancer. A 62-year-old man diagnosed with advanced lower rectal cancer (T4bN0M0) underwent laparoscopic TPE with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy. Ligation of the dorsal vein complex was performed under direct visualization through the perineal approach, and the large perineal defect was reconstructed using bilateral V-Y advancement of the gluteus maximus musculocutaneous flaps. The ileal conduit was constructed extracorporeally through an extended umbilical port that was extended to 4 cm. The total operative time was 831 min and estimated blood loss was 600 mL. Laparoscopic TPE appears to be safe and feasible in selected patients.
Collapse
Affiliation(s)
- Toshiki Mukai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Liss MA, Kader AK. Robotic-assisted laparoscopic radical cystectomy: history, techniques and outcomes. World J Urol 2013; 31:489-97. [PMID: 23512230 DOI: 10.1007/s00345-013-1053-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/04/2013] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Robotic-assisted radical cystectomy (RARC) is a less invasive means of performing the radical cystectomy operation, which holds promise for improved patient morbidity. We review the history, technique and current literature pertaining to RARC and place the current results in context with the open procedure. METHODS All articles regarding RARC found in PubMed after January 2000 were examined. We selected articles that appeared in high-impact journals, had large patient population size (>80 patients), or were novel in technique or findings. We chose key laparoscopic articles to give reference to the history in transition to robotic radical cystectomy. In addition, we chose classic articles from open radical cystectomy to give reference regarding the newer robotic perioperative outcomes. RESULTS Studies suggest that a 20-patient learning curve is needed to reach an operative time of 6.5 h, with 30 surgeries performed to reach lymph node counts in excess of 20 (International Robotic Cystectomy Consortium). The only randomized surgical trial comparing open and robotic techniques showed equivalent lymph node yield, which may be surgeon and volume dependent. Literature demonstrates lower estimated blood loss, transfusion rates, early return of bowel function and decreased complications in early small series. CONCLUSION RARC and urinary diversion are still early in development and limited to centers with extensive robotic experience and volume, although adoption of the robotic approach is becoming more common. Early studies have shown promise to reduce complications with equivalent oncologic results.
Collapse
Affiliation(s)
- Michael A Liss
- Division of Urology, Department of Surgery, UC San Diego Health System, San Diego, CA, USA.
| | | |
Collapse
|
13
|
Current trends in minimally invasive reconstructive urology. J Robot Surg 2012; 6:179-87. [PMID: 27638270 DOI: 10.1007/s11701-011-0322-3] [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: 08/12/2011] [Accepted: 10/09/2011] [Indexed: 10/15/2022]
Abstract
This paper is a systematic review of the current literature in minimally invasive reconstructive urological surgery. It focuses on the commonest reconstructive procedures in both the upper and lower urinary tracts including laparoscopic and robotic pyeloplasty for ureteropelvic junction obstruction, laparoscopic and robotic bladder diverticulectomy, laparoscopic and robotic partial cystectomy with urinary diversion, laparoscopic and robotic cystoplasty, repair of colovesical fistula, and, in urogynaecology, repair of vesicovaginal fistula. To evaluate the development, current status, feasibility, and safety of minimally invasive surgery (MIS) in reconstructive urology the literature on the topic was collated and reviewed.
Collapse
|