1
|
Sparwasser P, Epple S, Thomas A, Dotzauer R, Boehm K, Brandt MP, Mager R, Borgmann H, Kamal MM, Kurosch M, Höfner T, Haferkamp A, Tsaur I. First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique. World J Urol 2022; 40:1019-1026. [PMID: 35037964 PMCID: PMC8994743 DOI: 10.1007/s00345-021-03920-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/26/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction While various surgical techniques have been reported for open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuff has never been reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique allowing to perform robot-assisted NU by a unique retroperitoneal approach. Methods Between February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed. Results The analysis included five patients [median age: 73 years; BMI: 27.2 kg/m2; Charlson comorbidity index 5]. All five patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classification ≥ 2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postoperative complications exceeding Clavien–Dindo classification ≥ 3a. Median hospital stay was 5.4d without any 30-d readmission. Conclusion We demonstrate safety and feasibility of the first entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03920-1.
Collapse
Affiliation(s)
- P Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - S Epple
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Thomas
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Dotzauer
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - K Boehm
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M P Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - H Borgmann
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M M Kamal
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Kurosch
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - T Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - I Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| |
Collapse
|
2
|
Huang K, Wang YH. Application of retroperitoneal laparoscopy and robotic surgery in complex adrenal tumors. Artif Intell Cancer 2021; 2:42-48. [DOI: 10.35713/aic.v2.i3.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
As a surgical method for the treatment of adrenal surgical diseases, laparoscopy has the advantages of small trauma, short operation time, less bleeding, and fast postoperative recovery. It is considered as the gold standard for the treatment of adrenal surgical diseases. Retroperitoneal laparoscopy is widely used because it does not pass through the abdominal cavity, does not interfere with internal organs, and has little effect on gastrointestinal function. However, complex adrenal tumors have the characteristics of large volume, compression of adjacent tissues, and invasion of surrounding tissues, so they are rarely treated by retroperitoneal laparoscopy. In recent years, with the development of laparoscopic technology and the progress of surgical technology, robotic surgery has been gradually applied to the surgical treatment of complex adrenal tumors. This paper reviews the clinical application of retroperitoneal laparoscopic surgery and robotic surgery in the treatment of complex adrenal tumors.
Collapse
Affiliation(s)
- Kai Huang
- Department of Urology, College of Clinical Medicine, Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
| | - Ye-Hua Wang
- Department of Urology, College of Clinical Medicine, Yangzhou University, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
| |
Collapse
|
3
|
Shalaby H, Abdelgawad M, Omar Md M, Zora Md G, Alawwad S, Alameer E, Youssef M, Attia AS, Buell J, Grace L, Kandil E. Robotic and Laparoscopic Approaches for Adrenal Surgery in Obese Patients. Am Surg 2020; 87:588-594. [PMID: 33131284 DOI: 10.1177/0003134820951498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the robotic and laparoscopic adrenalectomy, particularly in obese patients. MATERIALS AND METHODS A retrospective analysis was performed on all consecutive patients undergoing adrenalectomy for benign disease by a single surgeon using either a laparoscopic or robotic approach. Adrenal surgeries for adrenal cancer were excluded. Demographics, operative time, length of hospital stays, estimated blood loss (EBL), and intraoperative and postoperative complications were evaluated. Patients were divided into 2 groups; obese and nonobese. A sub-analysis was performed comparing robotic and laparoscopic approaches in obese and nonobese patients. RESULTS Out of 120, 55 (45.83%) were obese (body mass index ≥ 30 kg/m2). 14 (25.45%) of the obese patients underwent a laparoscopic approach, and 41 (74.55%) underwent a robotic approach. Operative times were longer in the obese vs. nonobese groups (173.30 ± 72.90 minutes and 148.20 ± 61.68 minutes, P = .04) and were associated with less EBL (53.77 ± 82.48 vs. 101.30 ± 122, P = .01). The robotic approach required a longer operative time when compared to the laparoscopic approach (187 ± 72.42 minutes vs. 126.60 ± 54.55 minutes, P = .0102) in the obese but was associated with less blood loss (29.02 ± 51.05 mL vs. 138.30 ± 112.20 mL, P < .01) and shorter hospital stay (1.73 ± 1.23 days vs. 3.17 ± 1.27 days, P < .001). CONCLUSION Robot-assisted adrenal surgery is safe in obese patients and appears to be longer; however, it provides improvements in postoperative outcomes, including EBL and shorter hospital stay.
Collapse
Affiliation(s)
- Hosam Shalaby
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Abdelgawad
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Omar Md
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Ghassan Zora Md
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Saad Alawwad
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Ehab Alameer
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohanad Youssef
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Abdallah S Attia
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Joseph Buell
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Lee Grace
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA
| |
Collapse
|
4
|
Teo XL, Lim SK. Robotic assisted adrenalectomy: Is it ready for prime time? Investig Clin Urol 2016; 57:S130-S146. [PMID: 27995217 PMCID: PMC5161013 DOI: 10.4111/icu.2016.57.s2.s130] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/05/2016] [Indexed: 01/23/2023] Open
Abstract
Adrenal surgery is undergoing continuous evolution and minimally invasive surgery is increasingly being used for the surgical management of adrenal masses. With robotic-assisted surgery being a widely accepted surgical treatment for many urological conditions such as prostate carcinoma and renal cell carcinoma, the use of the robot has been expanded to include robotic-assisted adrenalectomy, offering an alternative minimally invasive platform for adrenal surgery. We performed a literature review on robotic-assisted adrenalectomy, reviewing the current surgical techniques and perioperative outcomes.
Collapse
Affiliation(s)
- Xin Ling Teo
- Department of Urology, Changi General Hospital, Singapore
| | - Sey Kiat Lim
- Department of Urology, Changi General Hospital, Singapore
| |
Collapse
|
5
|
Pisarska M, Pędziwiatr M, Budzyński A. Perioperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma. Gland Surg 2016; 5:506-511. [PMID: 27867865 DOI: 10.21037/gs.2016.09.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Perioperative hemodynamic instability still remains the biggest surgical and anesthetic challenge in surgery for pheochromocytoma. The aim of this review was to discuss pre-, intra- and postoperative factors that may impact on hemodynamic condition of a patient. It describes patients' preparation with appropriate medication, principles of surgical technique as well as risk factors for development of hemodynamic instability in postoperative period. Currently the gold standard in the treatment of pheochromocytoma is preoperative use of alpha-blockers and laparoscopic surgery. This approach allowed improving outcomes by lowering both mortality and morbidity.
Collapse
Affiliation(s)
- Magdalena Pisarska
- 2 Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland;; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland;; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland
| | - Andrzej Budzyński
- 2 Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland;; Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kraków, Poland
| |
Collapse
|