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Harley F, Fong E, Yao HH, Hashim H, O'Connell HE. What credentials are required for robotic-assisted surgery in reconstructive and functional urology? BJUI COMPASS 2023; 4:493-500. [PMID: 37636202 PMCID: PMC10447218 DOI: 10.1002/bco2.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The increasing popularity of robotic assisted surgery (RAS) as it is implemented in to sub specialities poses many challenges to ensuring standards in quality and safety. The area of Reconstructive and Functional Urology (RFU) has a wide range and largely complex heterogeneous procedures. In recent years RFU has started to incorporate RAS as the primary method to undertake these procedures due to improved vision, dexterity, and access to deep cavities. To ensure patient safety majority of institutions maintain minimal requirements to operate using RAS however across specialities and institutions these greatly vary. Methods A narrative review of all the relevant papers known to the author was conducted. Results Specific challenges facing RFU is the inability to rely on case numbers as a surrogate means to measure competency as well the ongoing consideration of how to differentiate between surgeons with robotic training and those with the clinical experience specific to RFU. Conclusion This review explores current models of training and credentialling and assess how it can be adapted to suggest a standardised guideline for RFU to ensure the highest standards of patient care.
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Affiliation(s)
- Frances Harley
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Eva Fong
- Department of UrologyUrology InstituteAucklandNew Zealand
| | - Henry Han‐I Yao
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Hashim Hashim
- Bristol Urological InstituteSouthmead Hospital, North Bristol NHS TrustBristolUK
| | - Helen E. O'Connell
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Pérez-Marchán M, Pérez-Brayfield M. Comparison of laparoscopic pyeloplasty vs. robot-assisted pyeloplasty for the management of ureteropelvic junction obstruction in children. Front Pediatr 2022; 10:1038454. [PMID: 36425398 PMCID: PMC9679786 DOI: 10.3389/fped.2022.1038454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) is a commonly observed abnormality in pediatric urology. Minimally invasive approaches have gained popularity in recent years. Studies have demonstrated excellent results with both laparoscopic pyeloplasty (LAP) and robot-assisted pyeloplasty (RAP). Few studies have compared the experience of both procedures performed in a single institution. Our objective is to compare laparoscopic pyeloplasty and robot-assisted pyeloplasty in the Puerto Rican pediatric population. METHODS We conducted a retrospective cohort study using our clinic's database on patients with UPJO that were operated by the same surgeon (MPB) from 2008 to 2019. Statistical analysis was conducted of demographics, preoperative studies, perioperative data and complications of both procedures. This study was approved by our local IRB committee. RESULTS A total of 86 patients that underwent pyeloplasty with at least 3 years of follow up were recorded for this study. Laparoscopic pyeloplasty and robot-assisted pyeloplasty were performed in 44 (51.1%) and 42 (48.8%) patients, respectively. Patient age ranged between 4 months and 17 years (LAP group - mean age of 6.19 years/RAP group - mean age of 7.07 years). Success rates was high in this series (LAP - 100% and RAP -95%). Using Wilcoxon signed rank test and Mann whitney sum test, significant differences between preoperative and postoperative hydronephrosis grading were observed in both LAP and RAP groups. However, no significant difference was seen regarding reduction of hydronephrosis grading when comparing both groups. No intraoperative complications were seen on either group. CONCLUSION Both LAP and RAP are safe and effective procedures that can properly manage UPJO. Our study shows that, under experienced hands, pure laparoscopic pyeloplasty achieves comparable results to robotic assisted laparoscopic pyeloplasty. Pediatric urologists should be comfortable offering either of these approaches as they demonstrate high success rates in our pediatric population. Selection of LAP vs. RAP approach depends on the Surgeon's preference or experience, and on institutional availability. Minimally invasive therapies will continue to gain popularity with future advances in laparoscopic and robotic technology.
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Affiliation(s)
- Marcos Pérez-Marchán
- Department of Surgery at the University of Puerto Rico School of Medicine, Urology Section, San Juan, Puerto Rico
| | - Marcos Pérez-Brayfield
- Urology Section, Department of Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.,Section of Pediatric Urology, HIMA San Pablo Caguas Hospital, Caguas, Puerto Rico
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Pakkasjärvi N, Taskinen S. Introduction of Pediatric Robot-Assisted Pyeloplasty in A Low-Volume Centre. Clin Pract 2021; 11:143-150. [PMID: 33804292 PMCID: PMC7931116 DOI: 10.3390/clinpract11010020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: This study investigated the introduction of pediatric robot-assisted pyeloplasty in a low-volume centre with reference to open pyeloplasty with regards to operative times, length of stay (LOS) and outcomes and cost analysis. (2) Methods: Data from 10 consecutive robot-assisted pyeloplasties was compared retrospectively to an age and weight matched cohort of open pyeloplasties operated on during two previous years. Operative times were analyzed in conjunction with LOS, outcomes and cost-analysis from patient records. (3) Results: Operative times remain longer in robot-assisted pyeloplasties (168 (IQR 68) vs. 141 (IQR 51) min), but patients are discharged from the hospital earlier and may return to daily activities earlier. In our hospital, the difference in LOS levels to some degree the cost difference between operations. (4) Conclusions: Robot-assisted pyeloplasty can be safely and economically introduced and maintained in a low-volume centre.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children’s Hospital, Helsinki University Hospital, Stenbäckinkatu 9, 00029 HUS Helsinki, Finland;
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4
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Zaliznyak M, Chen A, Kuhlmann P, Weinberger J, Zhao H, Tobis S, Wu G, Houman J. Optimal instrument length for transumbilical laparoendoscopic single site (U-LESS) surgery. J Robot Surg 2021; 16:53-58. [PMID: 33566275 DOI: 10.1007/s11701-021-01208-5] [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: 12/28/2020] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
The aim of our study was to recommend a novel method for measuring the distance from the umbilicus to intra-abdominal organs, as well as recommend an instrument length that would accommodate transumbilical laparoendoscopic single-site (U-LESS) surgeries to these areas. From CT scans of 50 men and 50 women, we calculated the distance from the umbilicus to 11 intra-abdominal points of interest using two triangles oriented perpendicular to each other. Using known lengths of the triangles, we used the Pythagorean theorem to calculate distances with and without insufflation. Distances were measured from the umbilicus to the xyphoid process, superior most aspect of the spleen, neck of the gallbladder, bifurcation of the descending aorta, adrenal glands, superior pole(s) of the kidneys, inferior most aspect of the inguinal canal, suprapubic margin, and the apex of the prostate (or female bladder neck). We found that an instrument working length of 43 cm would be sufficient to facilitate U-LESS surgery for all of our patients to each of the measured points of interest. The technique described in this paper serves as a useful method by which to measure the distance from the umbilicus to any intra-abdominal point of interest. These measurements would allow surgeons to correctly select instruments with adequate length when planning to perform U-LESS surgery.
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Affiliation(s)
- Michael Zaliznyak
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Andrew Chen
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Paige Kuhlmann
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - James Weinberger
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
| | - Hanson Zhao
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Scott Tobis
- Sansum Clinic, Santa Barbara, CA, 93102, USA
| | - Guan Wu
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Justin Houman
- Tower Urology, 8635 W 3rd Street #1W, Los Angeles, CA, 90048, USA.
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Farouk A, Tawfick A, Reda M, Saafan AM, Mousa W, Tawfeek AM, Shaker H. Fibrin glue as a sealant in stentless laparoscopic pyeloplasty: A randomised controlled trial. Arab J Urol 2019; 17:228-233. [PMID: 31489240 PMCID: PMC6711147 DOI: 10.1080/2090598x.2019.1611990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 12/05/2022] Open
Abstract
Objective: To evaluate the value of adding fibrin glue, as a sealant material, to the anastomotic line during stentless laparoscopic pyeloplasty (LPP). Patients and methods: In all, 92 patients with pelvi-ureteric junction obstruction (PUJO), scheduled for LPP, were randomised into two groups (46 in each group). Group A, underwent transperitoneal stentless LLP sealed with fibrin glue, whilst Group B underwent the same procedure without fibrin glue. Results: Both groups were similar for patient demographics and presentation. Despite that, we found a significant statistical difference between the groups for operative time and blood loss. The total number of patients that had a urinary leak was 10 and 24 patients, in groups A and B respectively (P = 0.002). A prolonged leak lasting for >5 days, which stopped spontaneously occurred in three patients (7.14%) in Group A and six (14.3%) in Group B (P = 0.265). A persistent 14-day leak that needed intervention developed in two patients (4.3%) in Group A and five (10.9%) in Group B (P = 0.434). One patient in Group B developed urinoma 1 week after discharge, and another patient in the same group developed deep venous thrombosis. There was no significant difference between the groups for postoperative complications in the early 3-month period. The success rate was 39 (92.86%) and 36 patients (85.7%), in groups A and B respectively (P = 0.265). Conclusion: Adding fibrin glue to seal the anastomosis decreased urinary leakage but did not have a significant impact on outcomes. Abbreviations: CONSORT: Consolidated Standards of Reporting Trials; DTPA: diethylene-triamine-penta-acetic acid; LPP: laparoscopic pyeloplasty; PUJO: PUJ obstruction; T½: clearance halftime (renogram)
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Affiliation(s)
- Ahmed Farouk
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed Tawfick
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Mahmoud Reda
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed M Saafan
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Waleed Mousa
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed M Tawfeek
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Hassan Shaker
- Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
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Robotic Surgery as Applied to Functional and Reconstructive Urology. Eur Urol Focus 2019; 5:322-328. [DOI: 10.1016/j.euf.2019.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022]
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Morales-López RA, Pérez-Marchán M, Pérez Brayfield M. Current Concepts in Pediatric Robotic Assisted Pyeloplasty. Front Pediatr 2019; 7:4. [PMID: 30733937 PMCID: PMC6353791 DOI: 10.3389/fped.2019.00004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
Robotic surgery in pediatric urology has been gaining popularity since its introduction almost two decades ago. Robotic assisted pyeloplasty is the most common robotic procedure performed in pediatric urology. Advances in robotic technology, instrumentation, patient care and surgical expertise have allowed the correction of ureteropelvic junction (UPJ) obstruction in most patients using this minimally invasive technique. The excellent experience with robotic assisted pyeloplasty has challenged other approaches as a new standard for the treatment of UPJ obstruction. In this review, we will describe the technique as it relates to the different robotic platforms, review the surgical experience and compare its results to other surgical approaches. Also, we will discuss patient and parent satisfaction, cost and financial considerations, along with evaluating the future of robotic surgery in the treatment of UPJ obstruction.
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Affiliation(s)
- Ramphis A Morales-López
- Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR, United States.,HIMA-San Pablo Group, Caguas, PR, United States
| | - Marcos Pérez-Marchán
- Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR, United States.,HIMA-San Pablo Group, Caguas, PR, United States
| | - Marcos Pérez Brayfield
- Division of Urology, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR, United States.,HIMA-San Pablo Group, Caguas, PR, United States
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Li K, Hu C, Huang W, Si-Tu J, Lu L, Mao Y, Zhang H, Qiu J, Wang D. A modification with threading cannula needle-assisted 4-point suspension fixation for retroperitoneal laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: a cohort study in single center. Int Urol Nephrol 2018; 51:193-199. [PMID: 30519979 PMCID: PMC6394441 DOI: 10.1007/s11255-018-2048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/03/2018] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate the effect and safety of modifying a threading cannula needle-assisted suspension fixation in retroperitoneal laparoscopic dismembered pyeloplasty (LDP) for children with congenital ureteropelvic junction obstruction (UPJO). Methods Between December 2012 and December 2017, 45 children (< 14 years of age) with congenital UPJO were divided into two groups. In Group A, children underwent conventional “no-suspension fixation” LDP; and in Group B, “4-point suspension fixation” LDP was performed to lower difficulties and shorten operative time. The perioperative clinical data were recorded and analyzed. Results No statistical difference was found between two groups in preoperative characteristics. The duration of surgery, operative time for completion of anastomosis and the length of postoperative hospital stay in Group B was remarkably shortened than that in Group A, respectively (P < 0.05 for all). There was no significant difference between two groups in terms of postoperative renal pelvic diameter (RPD) decreasing, extubation time and success rates of surgery (P > 0.05 for all). In addition, no recurrent stenosis and urine leakage in both groups, and the postoperative RPD remained at the low level in both groups during the period of follow-up. Conclusions Our modification of the 4-point suspension fixation for retroperitoneal LDP is an effective and safe method for children with UPJO. It can simplify the surgical procedures, lower difficulties (especially in precise anastomotic suturing) and shorten the learning curve. This modification might be of particular interest to urologists for improving treatment of children with UPJO.
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Affiliation(s)
- Ke Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Cheng Hu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Wentao Huang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Jie Si-Tu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Li Lu
- Department of Urology, The Sixth Affiliated Hospital of Sun Yat-sen University, Yuancun Erheng Road 26, Guangzhou, 510655 Guangdong China
| | - Yunhua Mao
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Huimin Zhang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital of Sun Yat-sen University, Yuancun Erheng Road 26, Guangzhou, 510655 Guangdong China
| | - Dejuan Wang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
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Kassite I, Braik K, Villemagne T, Lardy H, Binet A. The learning curve of robot-assisted laparoscopic pyeloplasty in children: a multi-outcome approach. J Pediatr Urol 2018; 14:570.e1-570.e10. [PMID: 30177385 DOI: 10.1016/j.jpurol.2018.07.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/21/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Few studies have evaluated the learning curve (LC) for robot-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction in children. It was attempted to assess the LC of this procedure using a multi-outcome approach, accounting for patient complexity. MATERIAL AND METHODS Data on the first series of children undergoing RALP between November 2007 and December 2017 at the study institution were prospectively collected. Patient complexity factors and peri-operative data including operative time (OT) were retrospectively analyzed. The LC was analyzed using cumulative sum (CUSUM) methodology for OT and a composite parameter (combination of 3 parameters: OT adjusted for patient complexity factors (AOT), complications, and surgical success). RESULTS Two surgeons without any experience in robotic surgery performed 42 consecutive RALP in 41 patients. Median age at surgery was 5 years (6 months-15 years), and mean OT was 200 ± 72.8 min. Cumulative sum chart demonstrated biphasic LC for OT and multiphasic LC for composite factor. Based on the CUSUM analysis for composite outcome, the LC for RALP could be divided into three different phases: phase 1, the learning period (1-12 cases); phase 2, the consolidation period (13-22 cases); and phase 3, representing the period of increased competence (23-39 cases). Interphase comparison showed a significant reduction in OT, length of stay, and postoperative pain (P = 0.0001; P = 0.0076; P = 0.039, respectively) CONCLUSION: Numerous distinctly shaped LCs depending on the outcome measures and well-defined learning phase transition points were demonstrated. Patient complexity factors were accounted for, which can influence surgical outcomes. Because there is no perfect indicator of proficiency, a multi-outcome approach was adopted to provide a comprehensive view of the learning process for RALP. More than 41 cases are needed to achieve mastery.
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Affiliation(s)
- I Kassite
- Pediatric Surgery Department, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, 37000 Tours, France.
| | - K Braik
- Pediatric Surgery Department, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - T Villemagne
- Pediatric Surgery Department, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - H Lardy
- Pediatric Surgery Department, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - A Binet
- Pediatric Surgery Department, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
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Laparoscopic-Assisted Extracorporeal Pyeloplasty: A Minimally Invasive Approach to Pediatric Ureteropelvic Junction Obstruction. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.83823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sharifiaghdas F, Mirzaei M, Daneshpajooh A, Abbaszadeh S. Minimally invasive open dismembered pyeloplasty technique: Miniature incision, muscle-splitting dissection, and nopelvis reduction in children. Asian J Urol 2018; 6:290-293. [PMID: 31297321 PMCID: PMC6595094 DOI: 10.1016/j.ajur.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/18/2017] [Accepted: 09/27/2017] [Indexed: 12/01/2022] Open
Abstract
Objective To report the outcomes and complications of open dismembered Anderson-Hynes pyeloplasty with miniature incision in treating children's ureteropelvic junction obstruction. Methods Between March 2007 and April 2011, 109 children with a mean age of 2 years and 8 months old with ureteropelvic junction obstruction underwent open dismembered pyeloplasty. Clinical manifestations, radiographic assessments, incision size, surgery time, hospital stay, and complication rate were recorded. All patients had a documented ureteropelvic junction obstruction (having T1/2 more than 20 min in diethylenetriaminepentaacetic acid [DTPA] scan) with symptomatic stenosis or decreased kidney function (differential function <40%). Pyeloplasty was done by a retroperitoneal flank approach with miniature incision without pelvis reduction. One surgeon did all the surgeries. Success rate and complications were assessed in a 3-year follow-up. Results Mean surgery time was 52 min (47–60 min). Incision size was 18–28 mm. Mean hospital stay was 3 days (2–8 days). The surgery was successful in 98.2% of patients with a mean follow-up time of 36 months (success was defined as disappearance of symptoms, if present, with improved ultrasound imaging results or Reno graphic parameters). The complication rate was 7.33%, including urinary leakage, double-J urethral stent dislocation and infection. Conclusion Open dismembered pyeloplasty is a safe, technically feasible and effective therapy in treatment of children's ureteropelvic junction obstruction. It takes a short time to do, requires a small incision and has few complications and a short recovery period.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology-Nephrology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Mirzaei
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Azar Daneshpajooh
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahin Abbaszadeh
- Urology-Nephrology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Luk ACO, Pandian RMK, Heer R. Laparoscopic renal surgery is here to stay. Arab J Urol 2018; 16:314-320. [PMID: 30140467 PMCID: PMC6104665 DOI: 10.1016/j.aju.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/23/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives To review the current literature comparing the outcomes of renal surgery via open, laparoscopic and robotic approaches. Materials and methods A comprehensive literature search was performed on PubMed, MEDLINE and Ovid, to look for studies comparing outcomes of renal surgery via open, laparoscopic, and robotic approaches. Results Limited good-quality evidence suggests that all three approaches result in largely comparable functional and oncological outcomes. Both laparoscopic and robotic approaches result in less blood loss, analgesia requirement, with a shorter hospital stay and recovery time, with similar complication rates when compared with the open approach. Robotic renal surgeries have not shown any significant clinical benefit over a laparoscopic approach, whilst the associated cost is significantly higher. Conclusion With the high cost and lack of overt clinical benefit of the robotic approach, laparoscopic renal surgery will likely continue to remain relevant in treating various urological pathologies.
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Key Words
- (L)(LESS-)DN, (laparoscopic) (laparoendoscopic single-site-) donor nephrectomy
- (L)(O)(RA)PN, (laparoscopic) (open) (robot-assisted) partial nephrectomy
- (L)(O)(RA)PY, (laparoscopic) (open) (robot-assisted) pyeloplasty
- (L)(O)(RA)RN, (laparoscopic) (open) (robot-assisted) radical nephrectomy
- BMI, body mass index
- Donor nephrectomy
- LOS, length of hospital stay
- Laparoscopic/open/robotic renal surgery
- NOTES, natural orifice transluminal endoscopic surgery
- PUJO, PUJ obstruction
- Partial nephrectomy
- Pyeloplasty
- RCT, randomised controlled trial
- Radical nephrectomy
- WIT, warm ischaemia time
- eGFR, estimated GFR
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Affiliation(s)
- Angus Chin On Luk
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | | | - Rakesh Heer
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
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Reinhardt S, Ifaoui IB, Thorup J. Robotic surgery start-up with a fellow as the console surgeon. Scand J Urol 2017; 51:335-338. [PMID: 28398104 DOI: 10.1080/21681805.2017.1302990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Owing to the encouraging data on fellowship training in robotic pyeloplasty and the documented benefits of robotic pyeloplasty, the aim of this study was to test the feasibility of starting up pediatric urological robotic surgery in a center with a limited case volume. MATERIALS AND METHODS The operative parameters and clinical outcome of the first 25 robotic pyeloplasties performed were compared to data on open and laparoscopic procedures from the previous 5 year period. The fellow was the only console surgeon. An experienced non-robotic pediatric urologist was supervising at the patient site. RESULTS The learning curve was in accordance with previously published data on fellows. The median operating time in robotic surgery was 182 min and was significantly shorter than in laparoscopic surgery (median 250 min) and the postoperative inpatient length of stay was significantly shorter after robotic surgery (median 1 day) than after both laparoscopic (median 2 days) and open surgery (median 3.5 days). For robotic cases, postoperative renography showed either stable or increased function of the hydronephrotic kidney. The only complication was in one case with ureteral orifice edema after JJ-stent removal, requiring nephrostomy for 6 weeks. CONCLUSIONS The benefits of overall shorter postoperative hospital stay after robotic pyeloplasty and faster operating time compared to the laparoscopic procedure are clearly in accordance with data from the recent literature. The fast learning curve for robotic pyeloplasty will allow pediatric urology fellowship programs to be integrated in the start-up phase of a pediatric robotic program even though the case material is limited. Operative success rates were in accordance with the gold standard of open surgery.
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Affiliation(s)
- Susanne Reinhardt
- a Department of Pediatric Surgery, Surgical Clinik C , Rigshospitalet , Copenhagen , Denmark
| | - Inge Boetker Ifaoui
- a Department of Pediatric Surgery, Surgical Clinik C , Rigshospitalet , Copenhagen , Denmark
| | - Jorgen Thorup
- a Department of Pediatric Surgery, Surgical Clinik C , Rigshospitalet , Copenhagen , Denmark.,b Faculty of Medical and Health Sciences , University of Copenhagen , Copenhagen , Denmark
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