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Saxena S, Billah MS, Cadiente A, Implicito C, Thiemann D, Brink S, Kourouma A, Sanchez de la Rosa R, Stifelman MD, Ahmed M. Use of peritoneal window and abdominal binder to reduce fluid collection after single-port robotic radical prostatectomy. J Robot Surg 2025; 19:151. [PMID: 40220042 PMCID: PMC11993434 DOI: 10.1007/s11701-025-02330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Accepted: 04/03/2025] [Indexed: 04/14/2025]
Abstract
Fluid collections are common after robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND). Literature about surgical techniques to reduce fluid collections after extraperitoneal single-port (SP) RARP is limited. This study evaluates the proposed technique of bilateral peritoneal windows and abdominal binder to reduce postoperative fluid collections in extraperitoneal SP RARP. An analysis of extraperitoneal SP RARP cases (January 2019-May 2024) was conducted using IRB-approved retrospective and prospective databases. Two surgeons implemented the bilateral peritoneal windows plus abdominal binder intervention. Patients were divided into pre-intervention and post-intervention groups. Outcomes, demographics, and complications between groups were compared. One hundred ninety-five pre-intervention and 194 post-intervention SP RARP patients were analyzed. Post-intervention patients had higher BMI (28.9 kg/m2 vs. 27.7 kg/m2, p = 0.018) and lymph node dissection rates (92.0% vs. 88.7%, p = 0.002), with shorter operating times (126.3 vs. 145.1 min, p < 0.001). Fluid collection rates decreased post-intervention (5.64% vs. 2.1%, p = 0.11), with fewer symptomatic cases (5.1% vs. 2.1%) and drainage requirements (2.0% vs. 1.54%). Non-fluid complications were significantly lower post-intervention during hospital stays (5.1% vs. 0%, p = 0.001). This study demonstrates that bilateral peritoneal windows and abdominal binder in extraperitoneal SP RARP may reduce incidence of postoperative fluid collection. The technique proved safe and efficient, with no bowel-related complications and shorter operating times. These findings highlight the efficacy of this approach and minimize patient burden due to this common complication.
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Affiliation(s)
- Sonam Saxena
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Mubashir S Billah
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | | | - Sarah Brink
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Aisha Kourouma
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | - Mutahar Ahmed
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
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2
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Norton JC, Compher T, Shumaker L, Burns Z, Nix JW, Parmar AD, Rais-Bahrami S. Incidence of Incisional Hernias after Single-Port Versus Multi-Port Robotic Radical Prostatectomy. J Endourol 2025; 39:2-9. [PMID: 39612166 DOI: 10.1089/end.2024.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2024] Open
Abstract
Purpose: To determine if single-port robotic-assisted radical prostatectomy (SP-RARP) has higher rates of incisional hernias when compared with multi-port robotic-assisted radical prostatectomies (MP-RARP). Materials and Methods: A retrospective, single-institution review of all consecutive robotic prostatectomy cases between January 2017 and December 2022. Analyzed multi-port and single-port robotic prostatectomies performed by two high-volume surgeons. Measured primary outcome for the development of incisional hernias, as defined by computed tomography imaging and clinical documentation. Multivariable logistic regression was used to determine the effect of the single-port approach on incisional hernia outcomes. Results: A total of 493 patients were included in the study (320 SP-RARPs and 173 MP-RARPs). The overall incisional hernia rate was 8.5% (SP-RARP 8.1% vs MP-RARP 9.2%, p = 0.669). A median follow-up time was 16.6 months and a median time from procedure to hernia diagnosis was 7.4 months. SP-RARP had shorter OR time than the MP-RARP (236 minutes vs 276 minutes, p < 0.001). Patients who developed hernias had higher body mass index (BMIs) than those who did not (30.7 vs 29, p = 0.009). Multivariable logistic regression analysis revealed that patients with higher BMI (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.14) and a history of prior operation (OR 2.23, 95% CI 1.71-4.29) were more likely to develop incisional hernias. Cox regression analysis accounting for the difference in follow-up period demonstrated that SP-RARP 3.4× more likely to develop incisional hernias than MP-RARP (hazard ratio 3.38, 95% CI 1.50-7.58). Conclusions: Patients with higher BMIs and prior history of abdominal surgeries are at increased risk of developing postoperative incisional hernias. SP-RARP procedures confer a higher risk of postoperative incisional hernias.
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Affiliation(s)
- J Corbin Norton
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tyler Compher
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luke Shumaker
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zachary Burns
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abhishek D Parmar
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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de Pinho JHS, Riscado LVS, Manzano JP. Peritoneal interposition flap reduces symptomatic lymphocele following transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection: An updated meta-analysis. Curr Urol 2024; 18:167-176. [PMID: 39219635 PMCID: PMC11337984 DOI: 10.1097/cu9.0000000000000205] [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] [Received: 09/19/2022] [Accepted: 01/25/2023] [Indexed: 09/04/2024] Open
Abstract
Abstract
Background
Robot-assisted radical prostatectomy with intraoperative pelvic lymph node dissection is the criterion standard for surgical treatment of nonmetastatic intermediate- and high-risk prostate cancer. However, this method is associated with symptomatic lymphocele (SLC), which is an important morbidity factor. To overcome this complication, several modifications of the technique have been developed, including the peritoneal interposition flap (PIF). We performed an updated systematic review and meta-analysis to investigate the efficacy and safety of this technique for preventing SLC and lymphocele (LC) formation.
Materials and methods
Searches were performed using databases and references from included studies and previous systematic reviews. Only randomized controlled trials and nonrandomized cohorts were included. Primary outcomes were the incidence of SLC and LC formation, and safety outcomes were defined as operation time, estimated blood loss, length of hospital stay, and urinary incontinence. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool. Pooled treatment effects were estimated using odds ratios with 95% confidence intervals (CIs) for binary endpoints. Heterogeneity was examined using Cochran's Q test and I
2 statistics; p values < 0.10 and I
2 > 25% were considered significant for heterogeneity. We used Mantel-Haenszel fixed-effect models in the analyses with low heterogeneity. Otherwise, the DerSimonian and Laird random-effects model was used.
Results
The initial search yielded 510 results. After the removal of duplicate records and application of the exclusion criterion, 9 studies were fully reviewed for eligibility. Three randomized controlled trials and 5 retrospective cohorts met all the inclusion criteria, comprising 2261 patients, of whom 1073 (47.4%) underwent PIF. Six studies reported a significant reduction in SLC in the PIF group, and 3 of the 4 studies reported LC formation yielded significant results in preventing this complication. The incidence of SLC and LC formation in a follow-up of ≥3 months was significantly different between the PIF and no PIF group (odds ratio, 0.34 [95% CI, 0.16–0.74; p = 0.006] and 0.48 [95% CI, 0.31–0.74; p = 0.0008]), respectively. The safety outcomes did not differ significantly between the 2 groups.
Conclusions
These results suggest that PIF is an effective and safe technique for preventing LC and SLC in patients undergoing transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection.
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Affiliation(s)
| | | | - João Pádua Manzano
- Faculty of Medicine of the Federal University of São Paulo, São Paulo, Brazil
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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] [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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5
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Jiang Y, Liu Y, Qin S, Zhong S, Huang X. Perioperative, function, and positive surgical margin in extraperitoneal versus transperitoneal single port robot-assisted radical prostatectomy: a systematic review and meta-analysis. World J Surg Oncol 2023; 21:383. [PMID: 38087327 PMCID: PMC10714462 DOI: 10.1186/s12957-023-03272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Extraperitoneal and transperitoneal approaches are two common modalities in single-port (SP) robot-assisted radical prostatectomy (RARP), but differences in safety and efficacy between the two remain controversial. This study aimed to compare the perioperative, function, and positive surgical margin of extraperitoneal with transperitoneal approaches SP-RARP. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, this study is registered with PROSPERO (CRD 42023409667). We systematically searched databases including PubMed, Embase, Web of Science, and Cochrane Library to identify relevant studies published up to February 2023. Stata 15.1 software was used to analyze and calculate the risk ratio (RR) and weighted mean difference (WMD). RESULTS A total of five studies, including 833 participants, were included in this study. The SP-TPRP group is superior to the SP-EPRP group in intraoperative blood loss (WMD: - 43.92, 95% CI - 69.81, - 18.04; p = 0.001), the incidence of postoperative Clavien-Dindo grade II and above complications (RR: 0.55, 95% CI - 0.31, 0.99; p = 0.04), and postoperative continence recovery (RR: 1.23, 95% CI 1.05, 1.45; p = 0.04). Conversely, the hospitalization stays (WMD: 7.88, 95% confidence interval: 0.65, 15.1; p = 0.03) for the SP-EPRP group was shorter than that of the SP-TPRP group. However, there was no significant difference in operation time, postoperative pain score, total incidence of postoperative complications, and positive surgical margin (PSM) rates between the two groups (p > 0.05). CONCLUSIONS This study demonstrates that both extraperitoneal and extraperitoneal SP-RARP approaches are safe and effective. SP-TPRP is superior to SP-EPRP in postoperative blood loss, the incidence of postoperative Clavien-Dindo grade II and above complications, and postoperative continence recovery, but it is accompanied by longer hospital stays.
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Affiliation(s)
- Yu Jiang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shize Qin
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shuting Zhong
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaohua Huang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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6
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Jiang XL, OuYang K, Yang R, Sun JN, Zhang F, Zhao HW. The application of Foley catheter traction technique in extraperitoneal robot-assisted radical prostatectomy. BMC Urol 2023; 23:201. [PMID: 38053112 DOI: 10.1186/s12894-023-01377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES To describe a technique to improve exposure of prostate during extraperitoneal robot-assisted radical prostatectomy (EP-RARP). MATERIAL AND METHODS From March 2020 to June 2022, a total of 41 patients with prior intra-abdominal surgery underwent EP-RARP. Twenty-three patients improved exposure by traction of prostate through urinary catheter. The catheter traction prostatectomy (CTP) group was compared with the standard prostatectomy (SP) group using three robotic arms (18 patients) in terms of estimated blood loss (EBL), operative time, positive surgical margin rate, the recovery rate of urinary continence, Gleason score and postoperative hospital stays. Differences were considered significant when P < 0.05. RESULTS The operative time was lower in the CTP group (109.63 min vs. 143.20 min; P < 0.001). EBL in the CTP group was 178.26 ± 30.70 mL, and in the standard prostatectomy group, it was 347.78 ± 53.53 mL (P < 0.001). No significant differences with regard to postoperative hospital stay, recovery rate of urinary continence, catheterization time and positive surgical margin were observed between both groups. No intraoperative complications occurred in all the patients. After 6 months of follow-up, the Post-op Detectable prostate specific antigen was similar between the two groups. CONCLUSION CTP is a feasible, safe, and valid procedure in EP-RARP. Application of CTP improved the exposure of prostate, reduced operative time and blood loss in comparison with the conventional procedure.
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Affiliation(s)
- Xiao-Lu Jiang
- Medical College of Qingdao University, Qingdao, Shandong, China
| | - Kui OuYang
- Medical College of Qingdao University, Qingdao, Shandong, China
| | - Rui Yang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Jia-Ning Sun
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Feng Zhang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Hong-Wei Zhao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, Shandong, 264000, China.
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7
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Yang JW, Kunpeng-Li, Yang L. Comment on: "perioperative results of single-port vs multi-port robotic-assisted radical prostatectomy via peritoneal approach: a meta-analysis" by Lv, et al. J Robot Surg 2023; 17:3049-3050. [PMID: 37584855 DOI: 10.1007/s11701-023-01692-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Jian-Wei Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Kunpeng-Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.
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8
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Soputro NA, Ferguson EL, Ramos-Carpinteyro R, Sauer Calvo R, Nguyen J, Moschovas MC, Wilder S, Chavali JS, Okhawere KE, De La Rosa RS, Saini I, Peabody J, Badani KK, Rogers C, Joseph J, Patel V, Stifelman M, Ahmed M, Crivellaro S, Kim M, Nix J, Kaouk J. Low Risk of Postoperative Hernia Following Single-port Robot-assisted Radical Prostatectomy: A Report From the Single-port Advanced Research Consortium (SPARC). Urology 2023; 180:151-159. [PMID: 37454768 DOI: 10.1016/j.urology.2023.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To evaluate the risk of postoperative hernia following different approaches of single-port robot-assisted radical prostatectomy (SP-RARP). METHODS A retrospective review was performed on patients who underwent SP-RARP between February 2019 and December 2022. Demographic and clinical information was collected from the multi-institutional, prospectively-maintained Single-Port Advanced Research Consortium (SPARC) database. Data were analyzed using IBM Statistical Packaging for Social Sciences (SPSS) version 29.0 with descriptive statistics as presented. RESULTS A total of 1103 patients were identified, consisting of 244 (22.1%), 712 (64.6%), and 147 (13.3%) cases performed via transperitoneal, extraperitoneal (EP), and transvesical (TV) approaches, respectively. During a median follow-up time of 11 months (interquartile range 5.7-17.1 months), only two cases of incisional hernia were reported. Both cases occurred following transperitoneal SP-RARP with one patient requiring surgical repair. There remains no evidence of postoperative hernia following EP and TV SP-RARP at the completion of our review. CONCLUSION SP-RARP was associated with low risk for postoperative hernia. The risk was lower following TV and EP SP-RARP where the peritoneum is preserved.
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Affiliation(s)
- Nicolas A Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | | - Jaya S Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | | | | | | | | | | | - Jean Joseph
- University of Rochester Medical Center, Rochester, NY
| | - Vipul Patel
- AdventHealth Medical Group Urology, Celebration, FL
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack, NJ; Hackensack Meridian School of Medicine, Nutley, NJ
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ; Hackensack Meridian School of Medicine, Nutley, NJ
| | | | - Moses Kim
- Orange County Urology Associates, Laguna Hills, CA
| | - Jeffrey Nix
- University of Alabama at Birmingham, Birmingham, AL
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Appel R, Shih L, Gimenez A, Bay C, Chai CYH, Maricevich M. Robotic Rectus Abdominis Harvest for Pelvic Reconstruction after Abdominoperineal Resection. Semin Plast Surg 2023; 37:188-192. [PMID: 38444961 PMCID: PMC10911893 DOI: 10.1055/s-0043-1771236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The use of robotic surgical systems to perform abdominoperineal resection (APR) has recently become more prevalent. This minimally invasive approach produces fewer scars and potentially less morbidity for the patient. The rectus abdominis muscle is often used for reconstruction after APR if primary closure is not feasible or the surgical site is at high risk of wound complications. Since the traditional open harvest of this flap creates large incisions that negate the advantages of minimally invasive APR, there has been growing interest in harvesting the rectus abdominis in a similarly robotic fashion. This article reviews the technique, benefits, and limitations of this robotic technique. Compared to the traditional open harvest, robotic harvest of the rectus abdominis leaves smaller scars, provides technical benefits for the surgeon, and offers possible morbidity benefits for the patient. These advantages should be weighed against the added expense and learning curve inherent to robotic surgery.
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Affiliation(s)
- Richard Appel
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Linden Shih
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Alejandro Gimenez
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Caroline Bay
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Marco Maricevich
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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10
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Romito I, Giannarini G, Rossanese M, Mucciardi G, Simonato A, Ficarra V. Incidence of Rectal Injury After Radical Prostatectomy: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2023; 52:85-99. [PMID: 37213241 PMCID: PMC10192923 DOI: 10.1016/j.euros.2023.03.017] [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: 03/19/2023] [Indexed: 05/23/2023] Open
Abstract
Context Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe infection/sepsis, and late sequelae, such as a rectourethral fistula (RUF). Considering its traditionally low incidence, uncertainty remains as to predisposing risk factors and management. Objective To examine the incidence of RI after RP in contemporary series and to propose a pragmatic algorithm for its management. Evidence acquisition A systematic literature search was performed using the Medline and Scopus databases. Studies reporting data on RI incidence were selected. Subgroup analyses were conducted to assess the differential incidence by age, surgical approach, salvage RP after radiation therapy, and previous benign prostatic hyperplasia (BPH)-related surgery. Evidence synthesis Eighty-eight, mostly retrospective noncomparative, studies were selected. The meta-analysis obtained a pooled RI incidence of 0.58% (95% confidence interval [CI] 0.46-0.73) in contemporary series with significant across-study heterogeneity (I2 = 100%, p < 0.00001). The highest RI incidence was found in patients undergoing open RP (1.25%; 95% CI 0.66-2.38) and laparoscopic RP (1.25%; 95% CI 0.75-2.08) followed by perineal RP (0.19%; 95% CI 0-276.95) and robotic RP (0.08%; 95% CI 0.02-0.31). Age ≥60 yr (0.56%; 95% CI 0.37-06) and salvage RP after radiation therapy (6.01%; 95% CI 3.99-9.05), but not previous BPH-related surgery (4.08%, 95% CI 0.92-18.20), were also associated with an increased RI incidence. Intraoperative versus postoperative RI detection was associated with a significantly decreased risk of severe postoperative complications (such as sepsis and bleeding) and subsequent formation of a RUF. Conclusions RI is a rare, but potentially devastating, complication following RP. RI incidence was higher in patients ≥60 yr of age, and in those who underwent open/laparoscopic approach or salvage RP after radiation therapy. Intraoperative RI detection and repair apparently constitute the single most critical step to significantly decrease the risk of major postoperative complications and subsequent RUF formation. Conversely, intraoperatively undetected RI can lead more often to severe infective complications and RUF, the management of which remains poorly standardised and requires complex procedures. Patient summary Accidental rectum tear is a rare, but potentially devastating, complication in men undergoing prostate removal for cancer. It occurs more often in patients aged 60 yr or older as well as in those who underwent prostate removal via an open/laparoscopic approach and/or prostate removal after radiation therapy for recurrent disease. Prompt identification and repair of this condition during the initial operation are the key to reduce further complications such as the formation of an abnormal opening between the rectum and the urinary tract.
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Affiliation(s)
- Ilaria Romito
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Urology Section, University of Palermo, Palermo, Italy
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
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11
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Robotics in Plastic Surgery. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-022-00337-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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12
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Popescu ER, Geantă M, Brand A. Mapping of clinical research on artificial intelligence in the treatment of cancer and the challenges and opportunities underpinning its integration in the European Union health sector. Eur J Public Health 2022; 32:443-449. [PMID: 35238918 PMCID: PMC9159319 DOI: 10.1093/eurpub/ckac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although current efforts are made to diminish the incidence and burden of disease, cancer is still widely identified late at stage. This study aims to conduct a systematic review mapping the existent and emerging clinical research on artificial intelligence (AI) in the treatment of cancer and to underpin its integration challenges and opportunities in the European Union (EU) health sector. METHODS A systematic literature review (SLR) evaluating global clinical trials (CTs; published between 2010 and 2020 or forthcoming) was concluded. Additionally, a horizon scanning (HS) exercise focusing on emerging trends (published between 2017 and 2020) was conducted. RESULTS Forty-four CTs were identified and analyzed. Selected CTs were divided into three research areas: (i) potential of AI combined with imaging techniques, (ii) AI's applicability in robotic surgery interventions and (iii) AI's potential in clinical decision making. Twenty-one studies presented an interventional nature, nine papers were observational and 14 articles did not explicitly mention the type of study performed. The papers presented an increased heterogeneity in sample size, type of tumour, type of study and reporting of results. In addition, a shift in research is observed and only a small fraction of studies were completed in the EU. These findings could be further linked to the current socio-economic, political, scientific, technological and environmental state of the EU in regard to AI innovation. CONCLUSION To overcome the challenges threatening the EU's integration of such technology in the healthcare field, new strategies taking into account the EU's socio-economic and political environment are deemed necessary.
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Affiliation(s)
| | - Marius Geantă
- Center for Innovation in Medicine, Bucharest, Romania
- KOL Medical Media, Bucharest, Romania
- United Nations University—Maastricht Economic and Social Research Institute on Innovation and Technology, Maastricht, The Netherlands
| | - Angela Brand
- United Nations University—Maastricht Economic and Social Research Institute on Innovation and Technology, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Public Health Genomics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
- Dr. TMA Pai Endowment Chair in Public Health Genomics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
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13
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Robinson IS, Blasdel G, Bluebond-Langner R, Zhao LC. The Management of Intra-abdominal Complications Following Peritoneal Flap Vaginoplasty. Urology 2022; 164:278-285. [PMID: 35150666 DOI: 10.1016/j.urology.2022.01.036] [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: 12/06/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the authors' experience diagnosing and managing intra-abdominal complications following robotic peritoneal flap vaginoplasty. The peritoneal flap vaginoplasty is a technique used to achieve consistent vaginal depth regardless of available natal tissue. Intra-abdominal complications following robotic peritoneal flap creation are rare but prompt diagnosis and management is critical to preventing patient harm. Given the infancy of the technique there is limited data on associated complications and their management. METHODS Retrospective chart review identified patients undergoing robotically assisted peritoneal flap vaginoplasty by the senior authors between 2017 and 2020 who subsequently developed intra-abdominal complications requiring readmission and/or return to the operating room. Patient charts were analyzed for preoperative demographics, medical comorbidities, intraoperative details, postoperative complication presentation, diagnosis, management, and long-term outcomes. RESULTS Out of 274 patients undergoing peritoneal flap vaginoplasty during the study period, six patients were identified who developed intra-abdominal complications (2.2%). One patient developed a postoperative hematoma requiring return to the operating room for diagnostic laparoscopy and hematoma evacuation. Two patients developed intraabdominal abscesses requiring diagnostic laparoscopy and abscess drainage. One patient developed recurrent episodes of small bowel obstructions that resolved with bowel rest. Two patients developed incarcerated internal hernias requiring diagnostic laparoscopy and internal hernia reduction. In one case, the hernia occurred at the peritoneal flap closure site, and in the other case the hernia occurred at the peritoneal flap donor site. CONCLUSIONS Intra-abdominal complications following robot assisted peritoneal flap vaginoplasty are rare. In addition to hematoma and abscess, small bowel incarceration and internal hernias are potential complications of peritoneal flap vaginoplasty that require prompt attention.
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Affiliation(s)
- Isabel S Robinson
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | | | | | - Lee C Zhao
- Department of Urology, NYU Langone Health, New York, NY.
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14
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Waigankar SS, Yuvaraja TB, Dev P, Agarwal V, Pednekar AP, Kulkarni B. Robotic Freyer's prostatectomy: Operative technique and single-center experience. Indian J Urol 2021; 37:247-253. [PMID: 34465954 PMCID: PMC8388344 DOI: 10.4103/iju.iju_78_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/11/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Transurethral resection of prostate replaced open surgery and remained the gold standard in surgical management of benign prostatic hyperplasia (BPH). Holmium laser enucleation and bipolar resection of prostate managed even larger glands. Open simple prostatectomy remains an option for large glands and concurrent pathologies. Minimally invasive laparoscopic simple prostatectomy lacks general acceptance. Surgeons have now started exploring the robotic platform due to its advantages. Herein, we present the technique and initial outcomes of robotic Freyer's prostatectomy (RFP). Materials and Methods: Thirteen transperitoneal RFPs were performed using the DaVinci Xi platform. We evaluated perioperative characteristics and functional outcomes. Results: Median patient age was 67.8 years and the mean prostate volume was 105.8 ml. The median International Prostate Symptom Score (IPSS) and American Urological Association quality of life (AUA-QoL) score was 19.6 and 5.3. There were no intraoperative complications or conversion to open surgery. The mean console time and estimated blood loss were 107.30 min and 92.5 ml, respectively. One patient required redo-surgery by robotic technique due to urine leak (Clavien-Dindo Grade 3b complication). Mean hospital stay and catheter duration were 4.9 days and 5.2 days, respectively. Change (preoperative vs. postoperative) in IPSS (19.6 vs. 4.67 points), maximum flow rate (6.8 vs. 15.1 ml/s), AUA-QoL score (5.3 vs. 2.2 points) and PVR (179.4 vs 7.1 ml) were significant (P < 0001). Conclusions: RFP is a safe and effective option for managing BPH, especially for large glands. It confers minimally invasive surgery benefits with good functional outcomes.
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Affiliation(s)
- Santosh S Waigankar
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Thyavihally B Yuvaraja
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Preetham Dev
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Varun Agarwal
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Abhinav P Pednekar
- Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Bijal Kulkarni
- Department of Pathology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
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15
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Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis. J Robot Surg 2021; 16:257-264. [PMID: 33905056 DOI: 10.1007/s11701-021-01245-0] [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: 03/15/2021] [Accepted: 04/19/2021] [Indexed: 12/29/2022]
Abstract
We aim to evaluate the differences in peri-operative characteristics, surgical complications, and oncological and functional control between the extraperitoneal RARP (EP-RARP) and transperitoneal RARP (TP-RARP). A comprehensive database search was performed up to March 2021 for eligible studies comparing outcomes between EP-RARP versus TP-RARP. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of 16 studies were included with 3897 patients, including 2201 (56.5%) EP-RARPs and 1696 (43.5%) TP-RARPs. When compared to TP-RARP, EP-RARP offers faster operative time (MD - 14.4 min; 95% CI - 26.3, - 2.3), decreased length of post-operative stay (MD - 0.9 days, 95% CI - 1.3, - 0.4), and decreased rates of post-operative ileus (RR 0.2, 95% CI 0.1, 0.7) and inguinal hernia formation (RR 0.2, 95% CI 0.1, 0.5). There were no significant differences in total complications, estimated blood loss, positive surgical margins, or continence at 6 months. In this review, EP-RARP delivered similar oncological and functional outcomes, while also offering faster operative time, decreased length of post-operative stay, and decreased rates of post-operative ileus and inguinal hernia formation when compared to TP-RARP. These findings provide evidence-based data for surgical approach optimization and prompts future research to examine whether these findings hold true with recent advances in single-port RARP and outpatient RARP.
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16
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Tas S, Eren AE, Islamoğlu E, Polat S, Ateş M, Savaş M. Should Peritoneal Re-Approximation be Performed After Transperitoneal Robot-Assisted Radical Prostatectomy? J Laparoendosc Adv Surg Tech A 2021; 32:265-269. [PMID: 33661035 DOI: 10.1089/lap.2021.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The aim of the study is to examine the effect of peritoneal re-approximation or non-approximation on the postoperative course of patients at the end of transperitoneal robot-assisted radical prostatectomy (tRARP).It is also aimed to examine the relationship between peritoneal re-approximation or non-approximation and drain removal time, need for analgesics, passage of flatus, and length of hospital stay. Methods: A total of 247 patients who underwent tRARP by 2 different experienced surgeons were included in the study. At the end of the tRARP procedure, 1 surgeon performed peritoneal re-approximation (Group 1, n = 108), whereas the other performed peritoneal non-approximation (Group 2, n = 139). The effect of the procedures on drain removal time, passage of flatus, need for analgesics, and length of hospital stay were compared between the groups. Results: There was no significant difference between the groups in terms of preoperative parameters including age, body mass index, and preoperative prostate-specific antigen levels (P > .05) (P = .622, P = .126 and P = .591, respectively). No statistically significant difference was found between the two groups in terms of comorbidity, Gleason score, clinical stage, and lymph node dissection (P = .086, P = .344, P = .318, P = .587, respectively). There was no statistically significant difference between the groups in terms of drain removal time, need for analgesics, passage of flatus, and length of hospital stay (P = .095, P = .142, P = 95, P = .389, respectively). Conclusion: This study did not demonstrate any additional postoperative benefit of peritoneal re-approximation. It has been shown that peritoneal re-approximation has no effect on the length of hospital stay, the need for pain relievers, and passage of flatus, drain duration, day. Therefore, we do not recommend re-approximation of the peritoneum.
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Affiliation(s)
- Selim Tas
- Department of Urology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ali Erhan Eren
- Department of Urology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ekrem Islamoğlu
- Department of Urology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Salih Polat
- Department of Urology, Amasya University, Amasya, Turkey
| | - Mutlu Ateş
- Department of Urology, Antalya Education and Research Hospital, Antalya, Turkey
| | - Murat Savaş
- Department of Urology, Antalya Education and Research Hospital, Antalya, Turkey
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17
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Boğa MS, Sönmez MG, Karamık K, Yılmaz K, Savaş M, Ateş M. The effect of peritoneal re-approximation on lymphocele formation in transperitoneal robot-assisted radical prostatectomy and extended pelvic lymphadenectomy. Turk J Urol 2020; 46:460-467. [PMID: 32833618 DOI: 10.5152/tud.2020.20255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the effect of peritoneal re-approximation at the end of the procedure in transperitoneal robot-assisted radical prostatectomy (tRARP) and extended pelvic lymphadenectomy (ePLND) on operative, oncologic, and symptomatic lymphocele rates. MATERIAL AND METHODS A total of 79 patients were included in the study who underwent tRARP and bilateral ePLND performed by two different experienced surgeons. One of the surgeons performed the peritoneal re-approximation (Group 1, n=41) and the other did not re-approximate the peritoneum (Group 2, n=38) at the end of the procedure in tRARP and ePLND. Operative parameters and symptomatic lymphocele rates were compared between the groups. RESULTS There were no significant differences between the preoperative parameters age, body mass index, and preoperative prostate-specific antigen values (p>0.05). The perioperative parameters were as follows: the operation time and estimated blood loss (EBL) was less, and the number of removed lymph nodes was higher in Group 2. However, only the difference in the EBL was statistically significant (p=0.03). Hospitalization time, symptomatic lymphocele, intervention requiring lymphocele, and complication rates were found to be less in Group 2, but only hospitalization time was statistically significant (p=0.04). Pathological parameters were similar for both groups. There was a significant correlation between lymph node positivity and the presence of symptomatic lymphocele in the correlation analysis (p=0.05). CONCLUSION It has been shown in this study that the re-approximation of the peritoneum does not provide any additional benefit in terms of complications. Considering that this process also increases the operation time and lymphocele formation, we think there is no need for re-approximation after robot-assisted radical prostatectomy and pelvic lymphadenectomy.
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Affiliation(s)
- Mehmet Salih Boğa
- Department of Urology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Giray Sönmez
- Department of Urology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Kaan Karamık
- Department of Urology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Kayhan Yılmaz
- Department of Urology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Murat Savaş
- Department of Urology, Private Memorial Antalya Hospital, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
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18
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Urethral realignment with maximal urethral length and bladder neck preservation in robot-assisted radical prostatectomy: Urinary continence recovery. PLoS One 2020; 15:e0227744. [PMID: 31929596 PMCID: PMC6957161 DOI: 10.1371/journal.pone.0227744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate early recovery of urinary continence after robot-assisted radical prostatectomy (RARP) with urethral realignment using bladder neck preservation (BNP) and maximal urethral length preservation (MULP). Methods Patients who underwent RARP between 2014 and 2017 owing to prostate cancer with a Gleason score ≤ 7 (3+4), ≤ cT2c stage, and prostate-specific antigen level < 20 ng/ml were investigated. Patients with tumors of the bladder neck or apex on magnetic resonance imaging were excluded. A total of 266 patients underwent the operation using the standard method between 2014 and 2015 (group 1), while 305 patients underwent urethral realignment between 2016 and 2017 (group 2). Continence was defined as wearing no pad or one security pad. Results The continence rates immediately after Foley catheter removal, at 2 weeks, and at 1, 3, 6, and 12 months after operation in group 2 were 46.9%, 63.0%, 73.4%, 90.1%, 94.8%, and 98.7%, respectively. The continence rate at 1 month in group 2 was significantly higher than that in group 1 (65.4% versus 73.4%, p = 0.037). The multivariate regression analysis showed that age and surgical method were factors affecting early continence recovery. The positive surgical margin rates were 18.0% and 14.8% in groups 1 and 2, respectively (p = 0.288). Biochemical recurrence occurred in 14.7% and 8.2% in groups 1 and 2, respectively (p = 0.015). Conclusion Urethral realignment using BNP and MULP resulted in rapid continence recovery and good oncological results after RARP in young patients with a Gleason score ≤ 7 and organ-confined disease.
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19
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Motterle G, Morlacco A, Zanovello N, Ahmed ME, Zattoni F, Karnes RJ, Dal Moro F. Surgical Strategies for Lymphocele Prevention in Minimally Invasive Radical Prostatectomy and Lymph Node Dissection: A Systematic Review. J Endourol 2019; 34:113-120. [PMID: 31797684 DOI: 10.1089/end.2019.0716] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: Pelvic lymph node dissection is an important step during robotic radical prostatectomy. The collection of lymphatic fluid (lymphocele) is the most common complication with potentially severe impact; therefore, different strategies have been proposed to reduce its incidence. Materials and Methods: In this systematic review, EMBASE, MEDLINE, Cochrane Library, and NIH Registry of Clinical Trials were searched for articles including the following interventions: transperitoneal vs extraperitoneal approach, any reconfiguration of the peritoneum, the use of pelvic drains, and the use of different sealing techniques and sealing agents. The outcome evaluated was the incidence of symptomatic lymphocele. Randomized, nonrandomized, and/or retrospective studies were included. Results: Twelve studies were included (including one ongoing randomized clinical trial). Because of heterogeneity of included studies, no meta-analysis was performed. No significant impact was reported by different sealing techniques and agents or by surgical approach. Three retrospective, nonrandomized studies showed a potential benefit of peritoneal reconfiguration to maximize the peritoneal surface of reabsorption. Conclusion: Lymphocele formation is a multistep and multifactorial event; high-quality literature analyzing risk factors and preventive measures is rather scarce. Peritoneal reconfiguration could represent a reasonable option that deserves further evaluation; no other preventive measure is supported by current evidence.
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Affiliation(s)
- Giovanni Motterle
- Dipartimento di Scienze Oncologiche, Chirurgiche e Gastroenterologiche, UOC Urologia, Universita' degli Studi di Padova, Padova.,Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Alessandro Morlacco
- Dipartimento di Scienze Oncologiche, Chirurgiche e Gastroenterologiche, UOC Urologia, Universita' degli Studi di Padova, Padova
| | - Nicola Zanovello
- Dipartimento di Scienze Oncologiche, Chirurgiche e Gastroenterologiche, UOC Urologia, Universita' degli Studi di Padova, Padova
| | | | - Filiberto Zattoni
- Dipartimento di Scienze Oncologiche, Chirurgiche e Gastroenterologiche, UOC Urologia, Universita' degli Studi di Padova, Padova
| | | | - Fabrizio Dal Moro
- Dipartimento di Scienze Oncologiche, Chirurgiche e Gastroenterologiche, UOC Urologia, Universita' degli Studi di Padova, Padova.,Clinica Urologica di Udine, Azienda Sanitaria Universitaria Integrata di Udine, Italy
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20
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Extraperitoneal vs. transperitoneal robot-assisted laparoscopic radical prostatectomy—analysis of perioperative outcomes, a single surgeon’s experience. J Robot Surg 2018; 13:275-281. [DOI: 10.1007/s11701-018-0850-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/09/2018] [Indexed: 11/25/2022]
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21
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Du Y, Long Q, Guan B, Mu L, Tian J, Jiang Y, Bai X, Wu D. Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis. Med Sci Monit 2018; 24:272-287. [PMID: 29332100 PMCID: PMC5776881 DOI: 10.12659/msm.907092] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Robot-assisted radical prostatectomy (RARP) is increasingly used worldwide, but comparisons of perioperative, functional, and oncologic outcomes among RARP, laparoscopic radical prostatectomy (LRP), and open radical prostatectomy (ORP) remain inconsistent. Material/Methods Systematic literature searches were conducted using EMBASE, PubMed, the Cochrane Library, CNKI, and Science Direct/Elsevier up to April 2017. A meta-analysis was conducted using Review Manager and Stata software. Results We included 33 studies. Meta-analysis revealed that blood loss, transfusion rate, and positive surgical margin (PSM) rate were significantly lower following RARP compared with LRP (SMD (95% confidence interval [CI]) 0.31 [0.01, 0.61]; combined ORs (95% CI) 5.32 [1.29, 21.98]; 1.27 [1.10, 1.46]) and ORP (SMD (95% CI) 0.75 [0.30, 1.21]; and combined ORs (95% CI) 3.44 [1.21, 9.79]); positive surgical margin (PSM) rates were significantly lower following RARP compared with LRP (combined ORs (95% CI) 1.27 [1.10, 1.46]), but not ORP. Operation time was also shorter for RARP than for LRP. The rates of nerve-sparing, recovery of complete urinary continence, and recovery of erectile function were significantly higher following RARP compared with LRP (combined ORs (95% CI) 0.55 [0.31, 0.95]; 0.66 [0.55, 0.78]; 0.46 [0.30, 0.71]) and ORP (combined ORs (95% CI) 0.36 [0.21, 0.63]; 0.33 [0.15, 0.74]; 0.65 [0.37, 1.14]). Conclusions This meta-analysis demonstrates that RARP results in better overall outcomes than LRP and ORP in terms of blood loss, transfusion rate, nerve sparing, urinary continence and erectile dysfunction recovery, and suggests that RARP offers better results than LRP and ORP in treatment of prostate cancer. However, studies with larger sample sizes and long-term results are needed.
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Affiliation(s)
- Yuefeng Du
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Qingzhi Long
- Department of Urology, Department of Urology, Xi'an, Shaanxi, China (mainland)
| | - Bin Guan
- Department of Urology, Department of Urology, Xi'an, Shaanxi, China (mainland)
| | - Lijun Mu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Juanhua Tian
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Yumei Jiang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xiaojing Bai
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Dapeng Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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22
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Dal Moro F, Zattoni F. P.L.E.A.T.—Preventing Lymphocele Ensuring Absorption Transperitoneally: A Robotic Technique. Urology 2017; 110:244-247. [DOI: 10.1016/j.urology.2017.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/15/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
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Kurokawa S, Umemoto Y, Mizuno K, Okada A, Nakane A, Nishio H, Hamamoto S, Ando R, Kawai N, Tozawa K, Hayashi Y, Yasui T. New steps of robot-assisted radical prostatectomy using the extraperitoneal approach: a propensity-score matched comparison between extraperitoneal and transperitoneal approach in Japanese patients. BMC Urol 2017; 17:106. [PMID: 29162068 PMCID: PMC5696780 DOI: 10.1186/s12894-017-0298-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/13/2017] [Indexed: 01/23/2023] Open
Abstract
Background Robot-assisted radical prostatectomy (RARP) is commonly performed using the transperitoneal (TP) approach with six trocars over an 8-cm distance in the steep Trendelenburg position. In this study, we investigated the feasibility and the benefit of using the extraperitoneal (EP) approach with six trocars over a 4-cm distance in a flat or 5° Trendelenburg position. We also introduced four new steps to the surgical procedure and compared the surgical results and complications between the EP and TP approach using propensity score matching. Methods Between August 2012 and August 2016, 200 consecutive patients without any physical restrictions underwent RARP with the EP approach in a less than 5° Trendelenburg position, and 428 consecutive patients underwent RARP with the TP approach in a steep Trendelenburg position. Four new steps to RARP using the EP approach were developed: 1) arranging six trocars; 2) creating the EP space using laparoscopic forceps; 3) holding the separated prostate in the EP space outside the robotic view; and 4) preventing a postoperative inguinal hernia. Clinicopathological results and complications were compared between the EP and TP approaches using propensity score matching. Propensity scores were calculated for each patient using multivariate logistic regression based on the preoperative covariates. Results All 200 patients safely underwent RARP using the EP approach. The mean volume of estimated blood loss and duration of indwelling urethral catheter use were significantly lower with the EP approach than the TP approach (139.9 vs 184.9 mL, p = 0.03 and 5.6 vs 7.7 days, p < 0.01, respectively). No significant differences in the positive surgical margin were observed. None of the patients developed an inguinal hernia postoperatively after we introduced this technique. Conclusions The EP approach to RARP was safely performed regardless of patient physique or contraindications to a steep Trendelenburg position. Our method, which involved using the EP approach to perform RARP, can decrease the amount of perioperative blood loss, the duration of indwelling urethral catheter use, and the incidence of postoperative inguinal hernia development.
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Affiliation(s)
- Satoshi Kurokawa
- Department of Urology, Nagoya Tokushukai General Hospital, 2-52, Kouzouji-cho-kita, Kasugai, 487-0016, Japan. .,Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Yukihiro Umemoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kentaro Mizuno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Akihiro Nakane
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hidenori Nishio
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Keiichi Tozawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Yutaro Hayashi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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24
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Jang WS, Kim MS, Jeong WS, Chang KD, Cho KS, Ham WS, Rha KH, Hong SJ, Choi YD. Does robot-assisted radical prostatectomy benefit patients with prostate cancer and bone oligometastases? BJU Int 2017; 121:225-231. [DOI: 10.1111/bju.13992] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Won Sik Jang
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Myung Soo Kim
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Won Sik Jeong
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Ki Don Chang
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Kang Su Cho
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Won Sik Ham
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Koon Ho Rha
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Sung Joon Hong
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
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25
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Kallidonis P, Rai BP, Qazi H, Ganzer R, Do M, Dietel A, Liatsikos E, Ghulam N, Kyriazis I, Stolzenburg JU. Critical appraisal of literature comparing minimally invasive extraperitoneal and transperitoneal radical prostatectomy: A systematic review and meta-analysis. Arab J Urol 2017; 15:267-279. [PMID: 29234528 PMCID: PMC5717458 DOI: 10.1016/j.aju.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/03/2017] [Accepted: 07/22/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives To systematically review studies comparing extraperitoneal (E-RP) and transperitoneal minimally invasive radical prostatectomy (T-RP). Methods The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in September 2015. Several databases were searched including Medline and Scopus. Only studies comparing E-RP and T-RP (either laparoscopic or robot-assisted approach) were evaluated. The follow-up of the included patients had to be ≥6 months. Results In all, 1256 records were identified after the initial database search. Of these 20 studies (2580 patients) met the inclusion criteria. The hospital stay was significantly lower in the E-RP cohort, with a mean difference of −0.30 days (95% confidence interval [CI] −0.35, −0.24) for the laparoscopic group and 1.09 days (95% CI −1.47, −0.70) for the robotic group (P < 0.001). Early continence rates favoured the E-RP group, although this was statistically significant only in the laparoscopic group (odds ratio [OR] 2.52, 95% CI 1.72, 3.70; P < 0.001). There was no statistically significant difference between the E-RP and T-RP cohorts for 12-month continence rates for both the laparoscopic (OR 1.55, 95% CI 0.89, 2.69; P = 0.12) and robotic groups (OR 3.03, 95% CI 0.54, 16.85; P = 0.21). The overall complication and ileus rates were significantly lower in the E-RP cohort for both the laparoscopic and robotic groups. The symptomatic lymphocele rate favoured the T-RP cohort, although this was statistically significant only in the laparoscopic group (OR 8.69, 95% CI 1.60, 47.17; P = 0.01). Conclusion This review suggests that the extraperitoneal approach is associated with a shorter hospital stay, lower overall complication rate, and earlier return to continence when compared to the transperitoneal approach. The transperitoneal approach has a lower lymphocele rate.
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Key Words
- (E-)(T-)RP, (extraperitoneal) (transperitoneal) radical prostatectomy
- BTR, blood transfusion rate
- EBL, estimated blood loss
- Extraperitoneal
- LOS, length of hospital stay
- Laparoscopy
- MD, mean difference
- MIRP, minimally invasive radical prostatectomy
- Minimally invasive
- OR, odds ratio
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PSM, positive surgical margin
- Prostatectomy
- Robotic
- STROBE, Reporting of Observational Studies in Epidemiology
- Transperitoneal
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Affiliation(s)
- Panagiotis Kallidonis
- Department of Urology, University of Leipzig, Leipzig, Germany.,Department of Urology, University of Patras, Patras, Greece
| | | | - Hasan Qazi
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Roman Ganzer
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Anja Dietel
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Evangelos Liatsikos
- Department of Urology, University of Leipzig, Leipzig, Germany.,Department of Urology, University of Patras, Patras, Greece
| | - Nabi Ghulam
- Department of Urology, Ninewells Hospital, Dundee, UK
| | - Iason Kyriazis
- Department of Urology, University of Leipzig, Leipzig, Germany.,Department of Urology, University of Patras, Patras, Greece
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26
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Loeb S, Meyer CP, Krasnova A, Curnyn C, Reznor G, Kibel AS, Lepor H, Trinh QD. Risk of Small Bowel Obstruction After Robot-Assisted vs Open Radical Prostatectomy. J Endourol 2016; 30:1291-1295. [DOI: 10.1089/end.2016.0206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, New York
- Department of Population Health, New York University, New York, New York
| | - Christian P. Meyer
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Krasnova
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Curnyn
- Department of Urology, New York University, New York, New York
- Department of Population Health, New York University, New York, New York
| | - Gally Reznor
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Herbert Lepor
- Department of Urology, New York University, New York, New York
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Park M, Kim SC, Chung JS, Park SH, Park SS, Oh SJ, Lee D, Rha KH, Oh CK. Simultaneous robotic low anterior resection and prostatectomy for adenocarcinoma of rectum and prostate: initial case report. SPRINGERPLUS 2016; 5:1768. [PMID: 27795910 PMCID: PMC5059363 DOI: 10.1186/s40064-016-3456-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/04/2016] [Indexed: 11/25/2022]
Abstract
Background We report a case of synchronous rectal and prostate cancer treated successfully with simultaneous da Vinci robotic-assisted low anterior resection of the rectum and robotic-assisted laparoscopic radical prostatectomy to address both cancers. Case presentation Recently, minimally invasive surgical techniques using da Vinci robot® system (Intuitive Surgical, Sunnyvale, USA) were introduced as curative surgical modality of prostate and rectal malignancies. Herein, we report an initial case of simultaneous robotic low anterior resection and robotic prostatectomy for adenocarcinoma of rectum and prostate sharing a considerable number of port sites. Conclusion Simultaneous robotic-assisted low anterior resection could be performed with robotic-assisted radical prostatectomy safely and effectively in synchronous rectal and prostate cancer.
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Affiliation(s)
- Myungchan Park
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, 248, Jwadongsunhwan-ro, Haeundae-gu, Busan, Korea
| | - Seong Cheol Kim
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, 248, Jwadongsunhwan-ro, Haeundae-gu, Busan, Korea
| | - Jae-Seung Chung
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, 248, Jwadongsunhwan-ro, Haeundae-gu, Busan, Korea
| | - Sang Hyun Park
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, 248, Jwadongsunhwan-ro, Haeundae-gu, Busan, Korea
| | - Seok San Park
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, 248, Jwadongsunhwan-ro, Haeundae-gu, Busan, Korea
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Donghoon Lee
- Department of Convergence Medical Science, Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Cheol Kyu Oh
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, 248, Jwadongsunhwan-ro, Haeundae-gu, Busan, Korea
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28
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Ku JY, Lee CH, Lee JZ, Ha HK. Comparison of functional outcomes between laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy: a propensity score-matched comparison study. Asia Pac J Clin Oncol 2016; 13:212-218. [PMID: 27667779 DOI: 10.1111/ajco.12595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
Abstract
AIM To compare the functional outcomes after laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RARP). METHODS Between September 2008 and January 2016, 712 patients underwent radical prostatectomy (RP; 614 LRP and 98 RARP). Recovery of incontinence was evaluated through a 24-h pad test. Urinary and erectile function was evaluated using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5. Follow-up interval was 1, 3, 6 and 12 months after the surgery. The propensity score matching was used to balance the preoperative characteristics. RESULTS The recovery of incontinence was similar to the two groups at 6 and 12 months after the surgery. However, patients underwent RARP restored the continence sooner than those in the LRP group in 1 and 3 months after the surgery (P < 0.001 and 0.001). For the multivariable analysis, the type of RP procedure was a uniquely meaningful contributing factor (P = 0.001, HR = 1.925; 95% CI, 1.299-2.851). In the case of urinary function, the RARP groups showed a better IPSS score than LRP groups at the 1-, 3- and 6-month visits, respectively (P = 0.008, 0.026, 0.001), and the RARP groups early improved compared with LRP groups at the 3-month visit in the case of erectile function (P = 0.018). CONCLUSION The RARP tended toward getting back the urinary continence earlier than the LRP. In addition, urinary and erectile function recovered more quickly in the RARP group than in the LRP group.
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Affiliation(s)
- Ja Yoon Ku
- Department of Urology, Pusan National University School of Medicine and, Busan, South Korea
| | - Chan Ho Lee
- Department of Urology, Pusan National University School of Medicine and, Busan, South Korea
| | - Jeong Zoo Lee
- Department of Urology, Pusan National University School of Medicine and, Busan, South Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University School of Medicine and, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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29
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Wang SC, Yang CK, Chang CP, Ou YC. Robotic simple prostatectomy: Initial single-center experience in Taiwan. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2015.11.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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30
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Horstmann M. Editorial Comment to Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy: A prospective single surgeon randomized comparative study. Int J Urol 2015. [PMID: 26213181 DOI: 10.1111/iju.12878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marcus Horstmann
- Department of Urology, Jena University Hospital, Jena, Germany. .,Department of Urology, Malteser Hospital St. Josefshospital, Krefeld, Germany.
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31
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Akand M, Erdogru T, Avci E, Ates M. Transperitoneal versus extraperitoneal robot-assisted laparoscopic radical prostatectomy: A prospective single surgeon randomized comparative study. Int J Urol 2015. [DOI: 10.1111/iju.12854] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Murat Akand
- Department of Urology; School of Medicine; Selcuk University; Konya Turkey
| | - Tibet Erdogru
- Departments of Urology and Minimally Invasive & Robotic Surgery; Memorial Atasehir Hospital; Istanbul Turkey
| | - Egemen Avci
- Departments of Urology and Minimally Invasive & Robotic Surgery; Memorial Atasehir Hospital; Istanbul Turkey
| | - Mutlu Ates
- Department of Urology; Memorial Antalya Hospital; Antalya Turkey
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32
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Agarwal G, Valderrama O, Luchey AM, Pow-Sang JM. Robotic-Assisted Laparoscopic Radical Prostatectomy. Cancer Control 2015; 22:283-90. [DOI: 10.1177/107327481502200305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Gautum Agarwal
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Oscar Valderrama
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Adam M. Luchey
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Julio M. Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Abstract
BACKGROUND The rectus abdominis muscle is a workhorse for free and pedicled muscle coverage. Traditional harvest violates the anterior rectus sheath and requires an abdominal incision. Robotic harvest can be reliably and efficiently performed using three ports and no additional incisions. METHODS Ten robotic rectus muscle harvests were performed at three institutions as free flaps for extremity coverage and pedicled flaps for minimally invasive pelvic surgery requiring soft-tissue reconstruction. Three contralateral ports and an intraperitoneal approach were used in each harvest. Demographic information, operative variables, and outcomes were recorded. RESULTS All cases were completed robotically by three surgeons at three different institutions. Four muscles were harvested as free flaps for lower extremity and six muscles were used as pedicled flaps, three for abdominopelvic defect reconstruction and two for protection of visceral repair following salvage prostatectomy or anterior pelvic exenteration. Average robotic setup time was 15 minutes. Average robotic harvest time was 45 minutes. Two 8-mm ports and one 12-mm port were used in each case. One patient developed a grade I decubitus ulcer during an extended operation. There were no other complications. All muscles were completely viable following harvest. There were no conversions to open technique, and no hernias or bulges were noted. CONCLUSIONS Robotic rectus muscle harvest is safe, efficient, and reproducible. The anterior rectus sheath can be left completely intact, eliminating incisional morbidity. The cumulative incisional length can be less than 2 inches even for extensive, multiservice pelvic procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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34
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Whelan P, Ekbal S, Nehra A. Erectile dysfunction in robotic radical prostatectomy: Outcomes and management. Indian J Urol 2014; 30:434-42. [PMID: 25378827 PMCID: PMC4220385 DOI: 10.4103/0970-1591.142078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Robot-assisted laparoscopic prostatectomy (RALP) has emerged as the most common treatment for localized prostate cancer. With improved surgical precision, RALP has produced hope of improved potency rates, especially with the advent of nerve-sparing and other modified techniques. However, erectile dysfunction (ED) remains a significant problem for many men regardless of surgical technique. To identify the functional outcomes of robotic versus open and laparoscopic techniques, new robotic surgical techniques and current treatment options of ED following RALP. A Medline search was performed in March 2014 to identify studies comparing RALP with open retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy, modified RALP techniques and treatment options and management for ED following radical prostatectomy. RALP demonstrates adequate potency rates without compromising oncologic benefit, with observed benefit for potency rates compared with RRP. Additionally, specific surgical technical modifications appear to provide benefit over traditional RALP. Phosphodiesterase-5 inhibitors (PDE5I) demonstrate benefit for ED treatment compared with placebo. However, long-term benefit is often lost after use. Other therapies have been less extensively studied. Additionally, correct patient identification is important for greatest clinical benefit. RALP appears to provide beneficial potency rates compared with RRP; however, these effects are most pronounced at high-volume centers with experienced surgeons. No optimal rehabilitation program with PDE5Is has been identified based on current data. Additionally, vacuum erection devices, intracavernosal injections and other techniques have not been well validated for post RALP ED treatment.
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Affiliation(s)
- Patrick Whelan
- Department of Urology, Rush University, Rush Medical College, Chicago, IL, USA
| | - Shahid Ekbal
- Department of Urology, Rush University, Rush Medical College, Chicago, IL, USA
| | - Ajay Nehra
- Department of Urology, Rush University, Rush Medical College, Chicago, IL, USA
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35
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Stolzenburg JU, Kallidonis P, Qazi H, Ho Thi P, Dietel A, Liatsikos EN, Do M. Extraperitoneal Approach for Robotic-assisted Simple Prostatectomy. Urology 2014; 84:1099-1105. [DOI: 10.1016/j.urology.2014.06.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 05/13/2014] [Accepted: 06/27/2014] [Indexed: 12/18/2022]
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36
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Ibrahim AE, Sarhane KA, Pederson JC, Selber JC. Robotic harvest of the rectus abdominis muscle: principles and clinical applications. Semin Plast Surg 2014; 28:26-31. [PMID: 24872776 DOI: 10.1055/s-0034-1368164] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Harvest of the rectus abdominis muscle requires an abdominal incision as well as violation of the anterior rectus sheath, creating the potential for significant surgical-site morbidity (bulges, hernias, infections, seromas). Laparoscopic or endoscopic techniques, although feasible, have not become popular among plastic surgeons due to multiple technical shortcomings. Robotic surgery on the other hand has an easier learning curve, enhanced precision, tremor elimination, motion scaling, high resolution, three-dimensional optics and an intuitive interface. As a result of these advantages, robotic surgery has permeated into the plastic surgery specialty, assuming a role in the harvest of the latissimus dorsi muscle flap and other reconstructive procedures. In this review, the authors discuss its applicability in the harvest of the rectus abdominis muscle.
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Affiliation(s)
- Amir E Ibrahim
- Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Karim A Sarhane
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John C Pederson
- Department of Plastic Surgery, Akron Plastic Surgeons, Akron, Ohio
| | - Jesse C Selber
- Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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37
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Isgoren AE, Saitz TR, Serefoglu EC. Erectile Function Outcomes after Robot‐Assisted Radical Prostatectomy: Is It Superior to Open Retropubic or Laparoscopic Approach? Sex Med Rev 2014; 2:10-23. [DOI: 10.1002/smrj.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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38
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Lee JY, Diaz RR, Cho KS, Choi YD. Meta-analysis of Transperitoneal Versus Extraperitoneal Robot-Assisted Radical Prostatectomy for Prostate Cancer. J Laparoendosc Adv Surg Tech A 2013; 23:919-25. [DOI: 10.1089/lap.2013.0265] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Richilda Red Diaz
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Clinical Trial Center for Medical Devices, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Robot and Minimal Invasive Surgery Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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39
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Cozzi G, Lorenzis ED, Palumbo C, Acquati P, Albo G, Dell'orto P, Grasso A, Rocco B. Robotic prostatectomy: an update on functional and oncologic outcomes. Ecancermedicalscience 2013; 7:355. [PMID: 24101944 PMCID: PMC3788169 DOI: 10.3332/ecancer.2013.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Indexed: 11/25/2022] Open
Abstract
Since the first procedure performed in 2000, robotic-assisted radical prostatectomy (RARP) has been rapidly gaining increasing acceptance from both urologists and patients. Today, RARP is the dominant treatment option for localised prostate cancer (PCa) in the United States, despite the absence of any prospective randomised trial comparing RARP with other procedures. Robotic systems have been introduced in an attempt to reduce the difficulty involved in performing complex laparoscopic procedures and the related steep learning curve. The recognised advantages of this kind of minimally invasive surgery are three-dimensional (3D) vision, ten-fold magnification, Endowrist technology with seven degrees of freedom, and tremor filtration. In this article, we examine this technique and report its functional (in terms of urinary continence and potency) and oncologic results. We also evaluate the potential advantages of RARP in comparison with open and laparoscopic procedures.
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Affiliation(s)
- Gabriele Cozzi
- Department of Specialist Surgical Sciences, University of Milan, Urology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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40
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Anderson C, Ayres B, Issa R, Perry M, Liatsikos E, Stolzenburg JU, Ghani KR. Extraperitoneal robot-assisted radical prostatectomy: Comparison with transperitoneal technique. World J Clin Urol 2013; 2:3-9. [DOI: 10.5410/wjcu.v2.i2.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/08/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine peri-operative, oncological, functional and safety profiles of extraperitoneal robot-assisted radical prostatectomy (eRARP) vs transperitoneal robot-assisted radical prostatectomy (tRARP) in a single centre.
METHODS: A total of 120 consecutive patients underwent 50 eRARP and 70 eRARP operations respectively by the same surgical team. Peri-operative and post-operative outcomes including blood loss, hospitalization, complications (Clavien grade), positive surgical margin (PSM) rates, continence and erectile function were compared. The performance of eRARP required several technical modifications. These included development of Retzius’ space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; cranial digital stripping of peritoneum for sucker port and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.
RESULTS: Robotic console times were shorter with eRARP vs tRARP (145.1 min vs 198.3 min, P < 0.0001). There were no significant differences in blood loss, PSM rates (eRARP 17.7% vs tRARP 22%) or complications (eRARP 8.5% vs tRARP 8%). A drain was used in all patients after tRARP and in 25/70 eRARP cases. Length of hospital stay was shorter after eRARP (mean 1.94 d vs 3.6 d, P < 0.0002). There were no differences between techniques in continence or potency at 6 mo. eRARP required several technical modifications: development of Retzius’ space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.
CONCLUSION: eRARP demonstrated advantages in surgical times, hospital stay and equivalence in PSM rates, complications and functional outcomes. eRARP is a useful alternative to tRARP especially in patients with adhesions, pre-existing inguinal hernias, or those unable to withstand steep Trendelenburg position.
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41
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Healy KA, Gomella LG. Retropubic, Laparoscopic, or Robotic Radical Prostatectomy: Is There Any Real Difference? Semin Oncol 2013; 40:286-96. [DOI: 10.1053/j.seminoncol.2013.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Kim KH, Lim SK, Shin TY, Chung BH, Hong SJ, Rha KH. Biochemical outcomes after robot-assisted radical prostatectomy in patients with follow-up more than 5-years. Asian J Androl 2013; 15:404-8. [PMID: 23524532 DOI: 10.1038/aja.2013.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In this study, we assessed biochemical outcomes after robot-assisted radical prostatectomy (RARP). Between July 2005 and November 2007, one hundred and seventy-six consecutive patients treated by RARP without neoadjuvant treatment were included in this study. All procedures were performed by a single surgeon and the median follow-up period was 60 months (interquartile range (IQR): 59-69). The median prostate specific antigen was 7.50 ng ml(-1) (IQR: 5.14-11.45) and 39.2% of the patients were classified as intermediate risk and 15.3% were classified as high risk; on final pathological examination, 35.2% of the patients had non-organ confined disease and 37.5% and 14.2% had Gleason scores of 7 and 8-10, respectively. The biochemical recurrence (BCR)-free survival rates at 3 and 5 years were 85.6% and 81.2%, respectively. The 5-year BCR-free survival rates stratified by pathologic Gleason scores were 93.1% in Gleason scores of 6 or less, 74.5% in a Gleason score of 7, and 58.1% in Gleason scores of 8 or greater, respectively (P<0.001). When stratified by pathologic stage, the BCR-free survival rates were 89.8% in pT2 patients, 66.2% in pT3a patients, and 39.3% in pT3b patients at 5 years following RARP, respectively (P<0.001). Preoperative prostate-specific antigen (PSA), pathologic stage, postoperative Gleason score and surgical margin status were independently associated with BCR in multivariate analysis. In this study, we report biochemical outcomes after RARP with the longest follow-up periods to date in Asian men. We found that robotic surgery provided satisfactory biochemical outcomes, and that RARP is a safe and effective procedure in terms of oncologic outcomes.
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Affiliation(s)
- Kwang Hyun Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Lee JY, Diaz RR, Cho KS, Yu HS, Chung JS, Ham WS, Choi YD. Lymphocele after extraperitoneal robot-assisted radical prostatectomy: a propensity score-matching study. Int J Urol 2013; 20:1169-76. [PMID: 23521086 DOI: 10.1111/iju.12144] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the incidence of lymphocele and determine the risk factors for postoperative lymphocele after extraperitoneal robot-assisted radical prostatectomy by using propensity score-matching. METHODS A total of 483 patients underwent extraperitoneal robot-assisted radical prostatectomy for prostate cancer between January 2009 and August 2011. Of these, 200 patients underwent pelvic lymph node dissection during robot-assisted radical prostatectomy. All patients underwent magnetic resonance imaging or computed tomography postoperatively to detect lymphocele after robot-assisted radical prostatectomy. Propensity scores for an established control group were calculated for each patient using multivariate logistic regression based on the following covariates: age, body mass index, preoperative prostate-specific antigen level, prostate volume calculated by transrectal ultrasound, biopsy Gleason sum and clinical tumor stage. RESULTS Lymphocele was identified in 41 patients (20.5%). There were no statistical differences in variables used in propensity score-matching. Operation time, estimated blood loss, catheterization and surgical margin positivity did not show differences between the two groups. Seminal vesicle invasion (P = 0.015) and tumor volume (P = 0.042) between the two groups were significantly different. In the multivariate logistic regression model, extracapsular extension (P = 0.017, odds ratio 4.231), seminal vesicle invasion (P = 0.028, odds ratio 2.643) and the number of positive lymph nodes (P = 0.041, odds ratio 3.532) were independent risk factors for lymphocele development after extraperitoneal robot-assisted radical prostatectomy with pelvic lymph node dissection. CONCLUSIONS Lymphocele might preferentially develop in cases with seminal vesicle invasion and large tumor volume. Additionally, extracapsular extension, seminal vesicle invasion, and the number of positive lymph nodes are independent risk factors for postoperative lymphocele after extraperitoneal robot-assisted radical prostatectomy.
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Affiliation(s)
- Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Systematic Review and Meta-analysis of Studies Reporting Potency Rates After Robot-assisted Radical Prostatectomy. Eur Urol 2012; 62:418-30. [DOI: 10.1016/j.eururo.2012.05.046] [Citation(s) in RCA: 535] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 11/21/2022]
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Systematic Review and Meta-analysis of Studies Reporting Urinary Continence Recovery After Robot-assisted Radical Prostatectomy. Eur Urol 2012; 62:405-17. [DOI: 10.1016/j.eururo.2012.05.045] [Citation(s) in RCA: 789] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 01/25/2023]
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Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, Graefen M, Guazzoni G, Shariat SF, Stolzenburg JU, Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Wilson TG. Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy. Eur Urol 2012; 62:431-52. [DOI: 10.1016/j.eururo.2012.05.044] [Citation(s) in RCA: 333] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 02/07/2023]
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Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M, Guazzoni G, Menon M, Patel VR, Shariat SF, Tewari AK, Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Rosen RC, Wilson TG. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 2012; 62:382-404. [PMID: 22749851 DOI: 10.1016/j.eururo.2012.05.047] [Citation(s) in RCA: 360] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite the large diffusion of robot-assisted radical prostatectomy (RARP), literature and data on the oncologic outcome of RARP are limited. OBJECTIVE Evaluate lymph node yield, positive surgical margins (PSMs), use of adjuvant therapy, and biochemical recurrence (BCR)-free survival following RARP and perform a cumulative analysis of all studies comparing the oncologic outcomes of RARP and retropubic radical prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). EVIDENCE ACQUISITION A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK) and Stata 11.0 SE software (StataCorp, College Station, TX, USA). EVIDENCE SYNTHESIS We retrieved 79 papers evaluating oncologic outcomes following RARP. The mean PSM rate was 15% in all comers and 9% in pathologically localized cancers, with some tumor characteristics being the most relevant predictors of PSMs. Several surgeon-related characteristics or procedure-related issues may play a major role in PSM rates. With regard to BCR, the very few papers with a follow-up duration >5 yr demonstrated 7-yr BCR-free survival estimates of approximately 80%. Finally, all the cumulative analyses comparing RARP with RRP and comparing RARP with LRP demonstrated similar overall PSM rates (RARP vs RRP: odds ratio [OR]: 1.21; p=0.19; RARP vs LRP: OR: 1.12; p=0.47), pT2 PSM rates (RARP vs RRP: OR: 1.25; p=0.31; RARP vs LRP: OR: 0.99; p=0.97), and BCR-free survival estimates (RARP vs RRP: hazard ratio [HR]: 0.9; p=0.526; RARP vs LRP: HR: 0.5; p=0.141), regardless of the surgical approach. CONCLUSIONS PSM rates are similar following RARP, RRP, and LRP. The few data available on BCR from high-volume centers are promising, but definitive comparisons with RRP or LRP are not currently possible. Finally, significant data on cancer-specific mortality are not currently available.
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Stolzenburg JU, Andrikopoulos O, Kallidonis P, Kyriazis I, Do M, Liatsikos E. Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE): technique and outcome. Asian J Androl 2011; 14:278-84. [PMID: 22179509 DOI: 10.1038/aja.2011.53] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure's established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.
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Horstmann M, Vollmer C, Schwab C, Kurz M, Padevit C, Horton K, John H. Single-centre evaluation of the extraperitoneal and transperitoneal approach in robotic-assisted radical prostatectomy. ACTA ACUST UNITED AC 2011; 46:117-23. [DOI: 10.3109/00365599.2011.637957] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Marcus Horstmann
- Department of Urology,
Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christian Vollmer
- Department of Urology,
Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christoph Schwab
- Department of Urology,
Kantonsspital Winterthur, Winterthur, Switzerland
| | - Michael Kurz
- Department of Urology,
Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christian Padevit
- Department of Urology,
Kantonsspital Winterthur, Winterthur, Switzerland
| | - Kevin Horton
- Department of Urology,
Kantonsspital Winterthur, Winterthur, Switzerland
| | - Hubert John
- Department of Urology,
Kantonsspital Winterthur, Winterthur, Switzerland
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Jacobs BL, Montgomery JS, Dunn RL, Weizer AZ, Miller DC, Wood DP, Wolf JS, Zhang Y, Wei JT, Hollenbeck BK. A comparison of extraperitoneal and intraperitoneal approaches for robotic prostatectomy. Surg Innov 2011; 19:268-74. [PMID: 22170893 DOI: 10.1177/1553350611429028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study compared oncologic and health-related quality-of-life outcomes among patients undergoing intraperitoneal or extraperitoneal robotic prostatectomy. METHODS Of 215 patients undergoing robotic prostatectomy, the approach was intraperitoneal in 48 and extraperitoneal in 167. Cancer control was evaluated using margin status. Recovery after surgery and functional health was assessed using the convalescence and recovery evaluation and expanded prostate cancer index composite questionnaires, respectively. RESULTS Positive surgical margin rates were similar between approaches (14% extraperitoneal, 10% intraperitoneal; P = .63). Functional outcomes were slightly improved for those with the extraperitoneal approach (i.e., higher urinary irritation/obstruction scores at 3 months). The extraperitoneal group demonstrated higher activity (91.8 vs 83.3, P = .03) and cognitive scores (94.9 vs. 91.7, P = .04) at 6 weeks as well as higher gastrointestinal scores at 2 weeks (94.2 vs. 90.8, P = .05). CONCLUSIONS These data support efforts to broaden the adoption of the extraperitoneal approach for robotic prostatectomy.
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Affiliation(s)
- Bruce L Jacobs
- Department of Urology, University of Michigan, Ann Arbor, MI 48109-2800, USA.
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