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Anaplioti E, Gkeka K, Katsakiori P, Peteinaris A, Tatanis V, Faitatziadis S, Pagonis K, Natsos A, Obaidat M, Vagionis A, Spinos T, Tsaturyan A, Vrettos T, Liatsikos E, Kallidonis P. How long do we need to reach sufficient expertise with the avatera® robotic system? Int Urol Nephrol 2024; 56:1577-1583. [PMID: 38175386 DOI: 10.1007/s11255-023-03914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To investigate the learning curve in four basic surgical skills in laparoscopic and robotic surgeries, and evaluate the approximate time needed to reach sufficient expertise in performing these tasks with the avatera® system. METHODS Twenty urology residents with no previous experience in dry-lab and robotic surgery were asked to complete four basic laparoscopic tasks (peg transfer, circle cutting, needle guidance, and suturing) laparoscopically and robotically. All participants were asked to complete the tasks first after watching the Uroweb educational material and, second, after undertaking a 2-hour training in robotic and laparoscopic dry-lab. Thereafter, all trainees continued to undertake 2-hour training programs until being able to complete the tasks with the avatera® robot at the desired time. Paired t test and one-way ANOVA test were used to analyze time differences between the groups. RESULTS Time needed to complete all tasks either robotically or laparoscopically was significantly less in the second compared to the first attempt for all Groups in each Task. In the robotic dry-lab, time needed to complete the tasks was significantly less than in the laparoscopic dry-lab. A significant effect of previous laparoscopic experience of the participants on the training time needed to achieve most of the goal times was detected. CONCLUSION The results of the study highlight the role of previous laparoscopic experience in the training time needed to achieve the performance time goals and demonstrate that the learning curve of basic surgical skills using the avatera® system is steeper than the laparoscopic one.
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Affiliation(s)
- Eirini Anaplioti
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Kristiana Gkeka
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Paraskevi Katsakiori
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Angelis Peteinaris
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Solon Faitatziadis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Mohammed Obaidat
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Athanasios Vagionis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Theodoros Spinos
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
- Department of Urology, Erebouni Medical Center, Yerevan, Armenia
| | - Theofanis Vrettos
- Department of Anesthesiology, University Hospital of Rion, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece.
- Medical University of Vienna, Vienna, Austria.
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras School of Medicine, University Hospital of Rion, 26504, Rio, Patras, Greece
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Peteinaris A, Tatanis V, Katsakiori P, Spinos T, Faitatziadis S, Gkeka K, Natsos A, Vrettos T, Liatsikos E, Kallidonis P. Endoscopic enucleation of the prostate with Thulium Fiber Laser (ThuFLEP). A retrospective single-center study. Arch Ital Urol Androl 2024; 96:12228. [PMID: 38363229 DOI: 10.4081/aiua.2024.12228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE The aim of the present, retrospective study was to describe our initial experience and early outcomes of Thulium Fiber Laser enucleation of the prostate (ThuFLEP) with the use of the FiberDust™ (Quanta System, Samarate, Italy) in patients with benign prostate hyperplasia. METHODS From June 2022 to April 2023, all patients who underwent endoscopic enucleation of the prostate at Urology Department of the University Hospital of Patras were included. A single surgeon utilizing the same standardized operative technique performed all the surgeries. The primary endpoints included the uneventful completion of the operation, the surgical time and any minor or major complication observed intra- or post-operatively. RESULTS Twenty patients with benign prostate hyperplasia were treated with ThuFLEP. All the surgeries were completed successfully and uneventfully. The enucleation phase of the operation was completed in a mean time of 45±9.1 min, while the average time needed for the morcellation was 17.65±3.42 min. No significant complications were observed intra- or post-operatively. The average hemoglobin drop was calculated to be 0.94±0.71 g/dL. CONCLUSIONS All the operations were successfully and efficiently completed with the use of the FiberDust™ (Quanta System, Samarate, Italy) in ThuFLEP. Significant blood loss or major complications were not observed.
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Gkeka K, Kallidonis P, Peteinaris A, Katsakiori P, Tatanis V, Faitatziadis S, Spinos T, Vagionis A, Vrettos T, Stolzenburg JU, Liatsikos E. Robot-assisted radical prostatectomy using the avatera system™: a prospective pilot study. Minerva Urol Nephrol 2024; 76:52-59. [PMID: 38015550 DOI: 10.23736/s2724-6051.23.05545-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Robot-assisted radical prostatectomy is a minimally invasive, safe procedure preferred in the management of localized prostate cancer. In this study, we present our initial experience with the avatera™ system (avateramedical GmbH, Jena, Germany) in robot-assisted radical prostatectomy. METHODS A total of fourteen patients underwent robot-assisted radical prostatectomy using this newly introduced system in our department from June 2022 to October 2022. The primary endpoints of the study were the time and the successful completion of the operation, the hemoglobin drop and the presence of complications. The pathologic tumor stage and the presence of positive surgical margins were also recorded. Follow-up of the patients for the functional outcomes over a period of 3 months took place. RESULTS The completion of all the surgeries was successful. The median draping and docking times were 9.5 minutes (7-13) and 10 minutes (5-40), respectively. The median console time was 103.5 minutes (90-121). No conversion to laparoscopic or open prostatectomy was necessary. The median hemoglobin drop was 1.95 g/dL (0.3-2.7), while positive surgical margins were present in two patients postoperatively. No major complications or need for transfusion were noticed. Six months after the procedure, 78.6% of the participants were continent while 77.7% of the nerve-sparing patients reported erections adequate for intercourse. CONCLUSIONS All the operations were completed successfully without major complications or significant blood loss. The functional outcomes were acceptable according to the literature. Based on the early outcomes, robot-assisted radical prostatectomy with the avatera™ system (avateramedical GmbH) could be considered feasible, safe, and efficient.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Theofanis Vrettos
- Intensive Care Unit, Department of Anesthesiology, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece -
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Natsos A, Tatanis V, Kontogiannis S, Waisbrod S, Gkeka K, Obaidad M, Peteinaris A, Pagonis K, Papadopoulos C, Kallidonis P, Liatsikos E, Drettas P. Grafts in Peyronie's surgery without the use of prostheses: a systematic review and meta-analysis. Asian J Androl 2024:00129336-990000000-00152. [PMID: 38265253 DOI: 10.4103/aja202358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/07/2023] [Indexed: 01/25/2024] Open
Abstract
ABSTRACT Peyronie's disease (PD) is characterized by abnormal penile curvature, and various surgical methods have been developed using different graft materials. However, there is currently no universal agreement on which type of graft is the best. The objective of this review was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD. A literature search was conducted using electronic databases, including PubMed, Scopus, and the Cochrane Library. The patients, intervention, comparison, and outcome (PICO) approach was used to define the eligibility of studies. Two authors independently selected studies, evaluated them, and extracted data. Random-effect models using the DerSimonian-Laird method were used. Most studies were single-arm studies and had a high risk of bias. Buccal mucosa grafts (BMG) were found to result in the highest penile straightening rates and were associated with the least de novo erectile dysfunction. TachoSil grafts demonstrated a high success rate in straightening despite a higher mean preoperative curvature, while Tutoplast grafts had a higher incidence of postoperative erectile dysfunction. BMG had the highest percentage of postoperative penile straightening. Overall, the TachoSil graft showed the best performance when preoperative curvature is taken into account. Based on the available literature, BMG appear to be the most effective for penile curvature correction in PD, but this is offset by the requirement for low preoperative curvature. The TachoSil graft shows the best overall performance when preoperative curvature is considered. Comparative randomized clinical trials are still needed to determine graft superiority.
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Affiliation(s)
| | | | | | | | - Kristiana Gkeka
- Department of Urology, University of Patras, Patras 26500, Greece
| | - Mohamed Obaidad
- Department of Urology, University of Patras, Patras 26500, Greece
| | | | | | | | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras 26500, Greece
- Department of Urology, Medical University of Vienna, Vienna 1090, Austria
| | - Petros Drettas
- Department of Urology, University of Patras, Patras 26500, Greece
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Peteinaris A, Gkeka K, Katsakiori P, Tatanis V, Anaplioti E, Faitatziadis S, Spinos T, Obaidat M, Vagionis A, Polyzonis S, Michalopoulos F, Liatsikos E, Kallidonis P. Replicating Florence Intracorporeal Neobladder Technique in Laparoscopic Radical Cystectomy: A Retrospective Study. Urology 2024; 183:106-110. [PMID: 37981058 DOI: 10.1016/j.urology.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To evaluate retrospectively the feasibility of Florence robotic intracorporeal neobladder technique in laparoscopic radical cystectomy. METHODS Fourteen patients with muscle-invasive bladder cancer underwent laparoscopic radical cystectomy and Florence robotic intracorporeal neobladder between September 2021 and February 2023. Patients' characteristics, pathology data, perioperative outcomes, postoperative complications, and follow-up data were collected. RESULTS All operations were successfully completed laparoscopically. The median total operative time was 343 minutes, and the median estimated blood loss was 169.5 mL. No intraoperative complications were observed. The median hospitalization time was 7days, while the median time to regular diet was 3days. Clavien Dindo Grade < III complications appeared in five patients within 30days postoperation. No other complications were noted over the 90days follow-up. Organ-confined disease was confirmed in 11 patients and locally advanced disease in three patients. At 3months follow-up, eight and four patients were daytime and night-time continent, respectively. CONCLUSION Replicating Florence robotic intracorporeal neobladder in laparoscopic radical cystectomy is safe, feasible, and repeatable, based on the encouraging perioperative, oncological, and functional outcomes of our study. However, further prospective studies on a larger scale are required to prove its long-term results.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Medical University of Vienna, Vienna, Austria.
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Faitatziadis S, Tatanis V, Katsakiori P, Peteinaris A, Gkeka K, Vagionis A, Spinos T, Tsaturyan A, Vrettos T, Kallidonis P, Stolzenburg JU, Liatsikos E. Feasibility study of a novel robotic system for transperitoneal partial nephrectomy: An in vivo experimental animal study. Arch Ital Urol Androl 2023; 95:11852. [PMID: 38058288 DOI: 10.4081/aiua.2023.11852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE To evaluate the safety and feasibility of partial nephrectomy with the use of the novel robotic system in an in vivo animal model. METHODS Right partial nephrectomy was performed in female pigs by a surgical team consisting of one surgeon and one bedside assistant. Both were experienced in laparoscopic surgery and trained in the use of the novel robotic system. The partial nephrectomies were performed using four trocars (three trocars for the robotic arms and one as an assistant trocar). The completion of the operations, set-up time, operation time, warm ischemia time (WIT) and complication events were recorded. The decrease in all variables between the first and last operation was calculated. RESULTS In total, eight partial nephrectomies were performed in eight female pigs. All operations were successfully completed. The median set-up time was 19.5 (range, 15-30) minutes, while the estimated median operative time was 80.5 minutes (range, 59-114). The median WIT was 23.5 minutes (range, 17-32) and intra- or postoperative complications were not observed. All variables decreased in consecutive operations. More precisely, the decrease in the set-up time was calculated to 15 minutes between the first and third attempts. The operative time was reduced by 55 minutes between the first and last operation, while the WIT was decreased by 15 minutes during the consecutive attempts. No complications were noticed in any operation. CONCLUSIONS Using the newly introduced robotic system, all the advantages of robotic surgery are optimized and incorporated, and partial nephrectomies can be performed in a safe and effective manner.
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Affiliation(s)
| | | | | | | | | | | | | | - Arman Tsaturyan
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Erebouni Medical Center, Yerevan.
| | | | | | | | - Evangelos Liatsikos
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Patras, Patras.
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Gkeka K, Symeonidis EN, Tsampoukas G, Moussa M, Issa H, Kontogianni E, Almusafer M, Katsouri A, Mykoniatis I, Dimitriadis F, Papatsoris A, Buchholz N. Recurrent miscarriage and male factor infertility: diagnostic and therapeutic implications. A narrative review. Cent European J Urol 2023; 76:336-346. [PMID: 38230311 PMCID: PMC10789276 DOI: 10.5173/ceju.2023.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction Recurrent miscarriage is defined as 2 or more failed clinical pregnancies, typically known as repeated pregnancy loss, occurring before 20 gestational weeks, and further categorized into primary and secondary types. It represents a common and distressing condition to deal with in the field of reproductive medicine, usually affecting <5% of couples, with up to 50% of cases lacking a clearly defined aetiology. The epidemiology also varies depending on maternal age. Remarkably, the situation significantly afflicts expecting parents, whereas maternal factors, such as age and previous pregnancy loss rate, are commonly reported as risk factors. Although previously underestimated, existing evidence suggests the male factor is a possible cause of recurrent pregnancy loss. Material and methods A non-systematic literature review was conducted in the PubMed and Scopus databases for articles written in English investigating the possible association of the male factor in recurrent pregnancy loss. The eligible studies were synthesized in a narrative review format upon discussion and consensus among the authors after being previously independently assessed and selected. Results Lifestyle, obesity, genetic predisposition, chromosomal anomalies, endocrine dysfunction, anatomical abnormalities, immunological factors, infections, and oxidative stress can result in poor embryo development and recurrent miscarriage. Although professional organizations currently recognize male gender as a possible risk factor, specific recommendations on the diagnostic and therapeutic field are still lacking, and the condition necessitates a high level of suspicion and case-by-case management. Conclusions In this review, we delve deeper into the contribution of the male factor in the concept of recurrent miscarriage.
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Affiliation(s)
- Kristiana Gkeka
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - Evangelos N Symeonidis
- 1 Department of Urology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Georgios Tsampoukas
- U-merge Scientific Office, U-merge Ltd., London-Athens-Dubai, United Arab Emirates
- Department of Urology, Oxford University Hospital NHS Trust, Oxford, United Kingdom
| | - Mohammad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Centre, Lebanese University, Beirut, Lebanon
| | - Hussein Issa
- Department of Urology, Al Zahraa Hospital, University Medical Centre, Lebanese University, Beirut, Lebanon
| | | | - Murtadha Almusafer
- Department of Surgery, College of Medicine, University of Basrah, Basrah, Iraq
| | - Antigoni Katsouri
- Department of Pharmacy, Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom
| | - Ioannis Mykoniatis
- 1 Department of Urology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Fotios Dimitriadis
- 1 Department of Urology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Athanasios Papatsoris
- U-merge Scientific Office, U-merge Ltd., London-Athens-Dubai, United Arab Emirates
- Department of Urology, University Hospital of Athens, Athens, Greece
| | - Noor Buchholz
- U-merge Scientific Office, U-merge Ltd., London-Athens-Dubai, United Arab Emirates
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Ballesta Martinez B, Kallidonis P, Tsaturyan A, Peteinaris A, Faitatziadis S, Gkeka K, Tatanis V, Vagionis A, Pagonis K, Obaidat M, Anaplioti E, Haney C, Vrettos T, Liatsikos E. Transfer of acquired practical skills from dry lab into live surgery using the avatera robotic system: An experimental study. Actas Urol Esp 2023; 47:611-617. [PMID: 37574013 DOI: 10.1016/j.acuroe.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. MATERIAL AND METHODS An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 h dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. RESULTS All procedures were completed successfully by all groups except the pyeloplasty by group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. CONCLUSIONS Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.
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Affiliation(s)
- B Ballesta Martinez
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Hospital Vinalopó, Elche, Spain
| | - P Kallidonis
- Department of Urology, University of Patras, Patras, Greece
| | - A Tsaturyan
- Department of Urology, University of Patras, Patras, Greece
| | - A Peteinaris
- Department of Urology, University of Patras, Patras, Greece
| | - S Faitatziadis
- Department of Urology, University of Patras, Patras, Greece
| | - K Gkeka
- Department of Urology, University of Patras, Patras, Greece
| | - V Tatanis
- Department of Urology, University of Patras, Patras, Greece
| | - A Vagionis
- Department of Urology, University of Patras, Patras, Greece
| | - K Pagonis
- Department of Urology, University of Patras, Patras, Greece
| | - M Obaidat
- Department of Urology, University of Patras, Patras, Greece
| | - E Anaplioti
- Department of Urology, University of Patras, Patras, Greece
| | - C Haney
- Department of Urology, University Hospital of Leipzig, Leipzig, Germany
| | - T Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - E Liatsikos
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Medical University of Vienna, Vienna, Austria.
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Kallidonis P, Tatanis V, Peteinaris A, Katsakiori P, Gkeka K, Faitatziadis S, Vagionis A, Vrettos T, Stolzenburg JU, Liatsikos E. Robot-assisted pyeloplasty for ureteropelvic junction obstruction: initial experience with the novel avatera system. World J Urol 2023; 41:3155-3160. [PMID: 37668715 DOI: 10.1007/s00345-023-04586-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE This pilot study was designed to interpret the technically specific features of the avatera robotic system and present our initial experience with this novel platform in robot-assisted pyeloplasty (RAP). METHODS A single-center prospective study was conducted including all patients who underwent RAP with the avatera robotic system from June 2022 to October 2022 in our Department. Transperitoneal robot-assisted dismembered pyeloplasty was performed in all cases. The trocar placement and the surgical technique were similar in all patients. The successful completion of the procedures, operation time (including draping, docking and console time), decrease in hemoglobin postoperatively, and presence of any complications were the study's primary endpoints. RESULTS In total, nine patients underwent RAP using the avatera system. All procedures were successfully completed. The draping of the robotic unit was completed in a median time of 10 min (range 7-15), while the median docking time was 17 min (range 10-24). The median console time was 88 min (range 78-116) and no complications were noticed. The median hemoglobin drop was calculated to 0.7 g/dL (range 0.4-1). During the mean follow-up of 9.33 ± 2.78 months, no late postoperative complications were noticed. CONCLUSION The early outcomes of the use of the novel avatera system in RAP are presented. All operations were successfully completed with safety and efficacy, without complications or significant blood loss.
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Affiliation(s)
| | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.
- Department of Urology, Medical University of Vienna, Vienna, Austria.
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
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Tatanis V, Natsos A, Tsaturyan A, Vagionis A, Peteinaris A, Faitatziadis S, Gkeka K, Pagonis K, Obaidat M, Anaplioti E, Koumoundourou D, Bravou V, Vrettos T, Kallidonis P, Liatsikos E. How Safe Are the Laparoscopic and Robotic Graspers? Evaluation of the Novel Avatera Robotic Surgical System: An Acute In Vivo Study on a Porcine Model. Urol Res Pract 2023; 49:387-391. [PMID: 37971390 PMCID: PMC10765195 DOI: 10.5152/tud.2023.23127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/24/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To evaluate the tissue injury caused by the force applied by the roboticassisted graspers of avatera robotic surgical system on bowel tissue. METHODS An experimental in vivo porcine model with 1 pig was conducted. After a standard transperitoneal setup of the avatera robotic surgical system, different laparoscopic and robotic graspers were used on the bowel with maximum force applied each time. Robotic atraumatic grasper, laparoscopic right angle grasper, laparoscopic curved grasper, and laparoscopic atraumatic grasper were used. After using all graspers, the pig was sacrificed. The bowel segments were resected and sent for histological analysis. RESULTS The pathologist reported that all the graspers caused signs of acute inflammation without any irreversible damage or signs compatible with ischemia of the tissue. No significant difference in histology was observed between the graspers. CONCLUSION No permanent damage was caused by graspers, except for acute, reversible inflammation. Concluding, the avatera grasper could be safe to use on bowel segments, independent of the applied pressure.
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Affiliation(s)
| | | | - Arman Tsaturyan
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Erebouni Medical Center, Yerevan, Armenia
| | | | | | | | | | | | | | | | | | - Vassiliki Bravou
- Department of Pathology, University Hospital of Patras, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Faria-Costa G, Tsaturyan A, Peteinaris A, Pagonis K, Faitatziadis S, Gkeka K, Natsos A, Anaplioti I, Obaidat M, Vrettos T, Liatsikos E, Kallidonis P. Location of ureteral access sheath in the ureter. Does it affect the fluid flow in different calyces? Cent European J Urol 2023; 76:233-238. [PMID: 38045785 PMCID: PMC10690379 DOI: 10.5173/ceju.2023.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/16/2023] [Accepted: 07/02/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction The aim of this study was to evaluate outflow variation in different locations of the pyelocaliceal system with the use of different ureteral access sheath (UAS) sizes and different UAS positioning. Material and methods The experimental setup included an anaesthetised porcine model, a 7.5-Fr ureteroscope with a 200-μm laser fibre inserted in the working channel, a hand-held pumping irrigating system, and UAS of different sizes, namely: 9.5/11.5 Fr, 12/14 Fr, and 14/16 Fr. Each UAS was placed just below the ureteropelvic junction (UPJ) or in the mid-ureter. The ureteroscope was placed in the renal pelvis, upper and lower calyces, and outflow measurements were obtained with 3-second interval pumping for one minute in every experimental setup. Results The UAS positioning in the mid-ureter was associated with significantly higher outflow rates in the lower calyx (p = 0.041). While the UAS was below the UPJ, we observed a trend of lower outflow rate in the lower calyx, which was completely inverted when the UAS was in the mid-ureter. Increasing the UAS size from 9.5/11.5 Fr to 12/14 Fr led to a significant increase in outflow in the renal pelvis and upper calyx (p = 0.007), but not in the lower calyx. A further increase to 14/16 Fr did not produce increased flow. Conclusions Different locations of the pyelocaliceal system have different fluid mechanics during fURS. In the renal pelvis and upper calyx increasing the diameter of the UAS improved the outflow, whereas in the lower calyx the position of the UAS seems to be the most relevant factor. These variables should be considered when performing fURS, especially with high-power laser lithotripsy.
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Affiliation(s)
- Gabriel Faria-Costa
- Department of Urology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | | | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anaesthesiology and ICU, University of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Gkeka K, Tsaturyan A, Faitatziadis S, Peteinaris A, Anaplioti E, Pagonis K, Vagionis A, Tatanis V, Vrettos T, Kallidonis P, Liatsikos E. Robot-Assisted Radical Nephrectomy Using the Novel Avatera Robotic Surgical System: A Feasibility Study in a Porcine Model. J Endourol 2023; 37:273-278. [PMID: 36274228 DOI: 10.1089/end.2022.0596] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate the feasibility and intraoperative technical parameters of the new robot-assisted surgical system Avatera by performing bilateral nephrectomy in a live porcine model. Materials and Methods: Six pigs underwent bilateral robot-assisted radical nephrectomy using the Avatera robotic system (RS). The operations were performed by experienced open (Group 1) and laparoscopic (Group 2) surgeons. The operating time, docking time, set-up time, and console time were evaluated. Data regarding intraoperative complications (major or not), injury of adjacent organs, and technical difficulties during the operation were also recorded. Results: Robot-assisted bilateral nephrectomy was completed effectively in all sample pigs. The docking time and set-up time were similar among the two groups, whereas the console time and operating time were significantly longer for the open surgeon group. Two intraoperative minor complications occurred in the open surgeon's group. An inadvertent damage of the renal vein occurred in two cases and the bleeding was controlled effectively. Other than the initial two cases, the estimated blood loss was <50 mL in both groups. Injury of the adjacent organs was not noticed. Conclusions: The study demonstrated that radical nephrectomy using the Avatera robotic surgical system is technically feasible, safe, and valid in pigs. Our results warrant the application of the Avatera RS in other urologic procedures, collecting data for further clinical trials.
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Affiliation(s)
- Kristiana Gkeka
- Department of Urology and University of Patras, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology and University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology and University of Patras, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria
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Faitatziadis S, Tsaturyan A, Peteinaris A, Haney C, Gkeka K, Tatanis V, Vagionis A, Obaidat M, Pagonis K, Anaplioti E, Natsos A, Vrettos T, Kallidonis P, Stolzenburg J, Liatsikos E. Feasibility study of novel avatera system for transperitoneal partial nephrectomy: An in vivo experimental animal study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Peteinaris A, Kallidonis P, Tsaturyan A, Pagonis K, Faitatziadis S, Gkeka K, Vagionis A, Natsos A, Obaidat M, Anaplioti E, Tatanis V, Vrettos T, Liatsikos E. The feasibility of robot-assisted radical cystectomy: an experimental study. World J Urol 2023; 41:477-482. [PMID: 36577927 DOI: 10.1007/s00345-022-04266-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/04/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To investigate the feasibility of the avatera system for performing robot-assisted radical cystectomy (RARC) followed by intracorporeal reconstruction of ileal neobladder. METHODS Six anesthetized female pigs were used to perform RARC and formation of the intracorporeal orthotopic ileal neobladder. Three surgeons with different level of expertise in the use of robotic systems performed RARC after a short instructional lecture and a 2-h hands-on training. The urinary diversion phase was performed only by the experienced surgeon. The successful completion of the procedure, operative time for demolitive and reconstructive phases, intraoperative blood loss and malfunction of the robotic system were evaluated. RESULTS An improvement of the operative time was observed for each surgeon. The experienced surgeon, the fellow and the resident improved their time by 11, 15, and 22 min, respectively, between the first and the second RARC performed. The most significant time difference was demonstrated by the resident, who had no previous experience in using robotic systems. The time difference between the first and the last orthotopic ileal neobladder creation for the experienced surgeon was 51 min. CONCLUSION The feasibility of avatera system for performing complex surgical procedure such as RARC with intracorporeal neobladder formation was demonstrated by this experimental study. No major bleeding or severe malfunctions were observed during the procedures. Significant improvement in operative time was demonstrated with the increasing experience from 1st to 6th case.
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Affiliation(s)
- Angelis Peteinaris
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Panagiotis Kallidonis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Solon Faitatziadis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Kristiana Gkeka
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Athanasios Vagionis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Mohammed Obaidat
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Eirini Anaplioti
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University Hospital of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras Medical School, Rio, 26500, Patras, Greece. .,Department of Urology, Medical University of Vienna, Vienna, Austria.
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Tsampoukas G, Gkeka K, Dellis A, Brown D, Katsouri A, Alneshawy A, Moussa M, Papatsoris A, Buchholz N. Vitamins as primary or adjunctive treatment in infertile men with varicocele: A systematic review. Arab J Urol 2021; 19:264-273. [PMID: 34552778 PMCID: PMC8451598 DOI: 10.1080/2090598x.2021.1932124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the usage and the efficacy of vitamins as primary or adjuvant treatment in infertile men with varicocele. METHODS A systematic search in PubMed, the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane Library with the terms (varicocele) AND (vitamins) was performed. We searched for studies: a) reporting the administration of vitamins (individually or as part of a complex) in men with varicocele and infertility, b) primarily or adjuvant to invasive treatment, and c) reporting the impact on semen parameters and/or pregnancy rates. Exclusion criteria were animal, adolescent and non-English studies, grey literature and trials reporting abstracts only. RESULTS Seven studies were identified eligible for qualitative analysis. All studies were randomised except one (case series). Vitamins were administered dominantly as part of antioxidant complex and only two studies used vitamins (C and E, respectively) as sole agent. In two studies, vitamin monotherapy resulted in improvement in semen quality, but the effect on pregnancy rates is unknown. One study reported no efficacy of adjuvant multivitamin treatment after embolisation in terms of both semen quality and pregnancy rates. Finally, four studies reported a positive effect of vitamins on semen parameters after varicocelectomy, but the effect on pregnancy rates is conflicting; one study reported improved pregnancy rates with adjuvant treatment, two studies did not evaluate the pregnancy rates, and in one study the outcome was unclear due to missing data. CONCLUSIONS Vitamins have been used mostly as part of an antioxidant panel for the management of infertile men with varicocele. Most studies have found a positive impact on semen parameters in selected men with varicocele and infertility, as primary or adjuvant treatment. However, the clinical benefit of vitamins administration on pregnancy rate is under-evaluated and should be the target of future research.
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Affiliation(s)
- Georgios Tsampoukas
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
| | - Kristiana Gkeka
- Department of Urology, General Hospital of Patras, Patras, Greece
| | - Athanasios Dellis
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Department of Urology, Aretaieion Academic Hospital, Athens, Greece
| | - Dominic Brown
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
| | | | - Ahmed Alneshawy
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
| | - Mohamad Moussa
- Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Papatsoris
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Second Department of Urology, University Hospital of Athens, Athens, Greece
| | - Noor Buchholz
- U-merge Ltd. (Urology for Emerging Countries), London, UK
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