scholarly journals 1141 Robotic Assisted Surgery in Horseshoe Kidneys: A Safety and Feasibility Multicentre Case Series

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ng ◽  
A Nathan ◽  
N Campain ◽  
Y Yuminaga ◽  
F Mumtaz ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Anatomical Variation ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Robot Assisted ◽  
Renal Masses ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Estimated Blood Loss

Abstract Introduction Horseshoe kidneys (HSK) are the most common renal fusion abnormality. However, they are only present in 0.2% of the population. Due to anatomical variation in vasculature, ectopia and malrotation, surgery has traditionally been performed via an open approach. We aimed to assess the safety and feasibility of robot-assisted surgery for HSK. Method Six patients (four female, two male) with HSKs were operated on between 2016 and 2019 across two high-volume centres by high-volume surgeons. All operations were robot-assisted, with three partial nephrectomies and one nephroureterectomy for renal masses and two benign nephrectomies for non-functioning kidneys. 3D reconstruction using CT renal angiograms was used to help identify vasculature and tumour location (where appropriate). Results The median age was 53 years (IQR 47-58.3) and the median BMI was 25 (IQR 25-25.8). Median tumour size in the four patients with renal masses was 35.5 mm (IQR 25.3-44.8). Median console time was 120 minutes (IQR 117-172.5) and the median estimated blood loss was 150 mL (IQR 112.5-262.5). The median pre-operative eGFR was 76 (IQR 70-86.5) and median post-operative eGFR was 65.5 (IQR 59.3-80.8). All operations were uneventful, there were no perioperative transfusions and no complications reported. Length of stay was two days for all patients. Conclusions We report the largest series of mixed robotic-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in high-volume centres with acceptable perioperative outcomes. Further prospective, longer-term, multi-centre studies are required to evaluative if robotic surgery for HSK is superior to open surgery.

Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy

2021 ◽  
pp. 155698452097822
Author(s):  
Byron D. Patton ◽  
Daniel Zarif ◽  
Donna M. Bahroloomi ◽  
Iam C. Sarmiento ◽  
Paul C. Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Safe Procedure ◽  
Open Approach ◽  
Robotic Approach ◽  
Robotic Group ◽  
Robot Assisted ◽  
Estimated Blood Loss

Objective In the tide of robot-assisted minimally invasive surgery, few cases of robot-assisted pneumonectomy exist in the literature. This study evaluates the perioperative outcomes and risk factors for conversion to thoracotomy with an initial robotic approach to pneumonectomy for lung cancer. Methods This study is a single-center retrospective review of all pneumonectomies for lung cancer with an initial robotic approach between 2015 and 2019. Patients were divided into 2 groups: surgeries completed robotically and surgeries converted to thoracotomy. Patient demographics, preoperative clinical data, surgical pathology, and perioperative outcomes were compared for meaningful differences between the groups. Results Thirteen total patients underwent robotic pneumonectomy with 8 of them completed robotically and 5 converted to thoracotomy. There were no significant differences in patient characteristics between the groups. The Robotic group had a shorter operative time ( P < 0.01) and less estimated blood loss ( P = 0.02). There were more lymph nodes harvested in the Robotic group ( P = 0.08) but without statistical significance. There were 2 major complications in the Robotic group and none in the Conversion group. Neither tumor size nor stage were predictive of conversion to thoracotomy. Conversions decreased over time with a majority occurring in the first 2 years. There were no conversions for bleeding and no mortalities. Conclusions Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With meticulous technique, major bleeding can be avoided and most procedures can be completed robotically. Larger studies are needed to elucidate any advantages of a robotic versus open approach.

Navigating the Pathway to Robotic Competency in General Thoracic Surgery

2013 ◽  
Vol 8 (3) ◽  
pp. 184-189 ◽  
Author(s):  
Christopher W. Seder ◽  
Stephen D. Cassivi ◽  
Dennis A. Wigle
Keyword(s):  
Robotic Surgery ◽  
Thoracic Surgery ◽  
Skill Acquisition ◽  
Perioperative Complications ◽  
Lung Resection ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Robot Assisted ◽  
Robotic Skills ◽  
Competency Based

Objective Although robotic technology has addressed many of the limitations of traditional videoscopic surgery, robotic surgery has not gained widespread acceptance in the general thoracic community. We report our initial robotic surgery experience and propose a structured, competency-based pathway for the development of robotic skills. Methods Between December 2008 and February 2012, a total of 79 robot-assisted pulmonary, mediastinal, benign esophageal, or diaphragmatic procedures were performed. Data on patient characteristics and perioperative outcomes were retrospectively collected and analyzed. During the study period, one surgeon and three residents participated in a triphasic, competency-based pathway designed to teach robotic skills. The pathway consisted of individual preclinical learning followed by mentored preclinical exercises and progressive clinical responsibility. Results The robot-assisted procedures performed included lung resection (n = 38), mediastinal mass resection (n = 19), hiatal or para-esophageal hernia repair (n = 12), and Heller myotomy (n = 7), among others (n = 3). There were no perioperative mortalities, with a 20% complication rate and a 3% readmission rate. Conversion to a thoracoscopic or open approach was required in eight pulmonary resections to facilitate dissection (six) or to control hemorrhage (two). Fewer major perioperative complications were observed in the later half of the experience. All residents who participated in the thoracic surgery robotic pathway perform robot-assisted procedures as part of their clinical practice. Conclusions Robot-assisted thoracic surgery can be safely learned when skill acquisition is guided by a structured, competency-based pathway.

Selecting the surgical approach in complex reoperative partial nephrectomies: Does robotics have a role?

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 658-658
Author(s):  
Sandeep Gurram ◽  
Siobhan Telfer ◽  
Winston Li ◽  
Heather Chalfin ◽  
W. Marston Linehan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Robotic Surgery ◽  
Surgical Approach ◽  
Open Surgery ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Renal Surgery ◽  
Estimated Blood Loss ◽  
Operative Complications ◽  
Post Operative Complications

658 Background: Minimally invasive surgery (MIS) has shown equal oncologic efficacy as the open approach for treating small renal masses but results in improved perioperative parameters. Surgical principles also dictate that the open technique should be considered when facing difficult surgeries though this is experience and not evidenced based. The goal of our study is to explore differences in outcomes amongst open or robotic approaches in complex reoperative partial nephrectomies. Methods: 194 patients who had prior renal surgery from 2008 to 2019 were identified, the majority of which presented with multiple tumors due to known or suspected hereditary kidney cancer syndrome. Patients were stratified into the following cohorts based on surgical history: open after open surgery, open after MIS, robotic after open surgery, and robotic after MIS. Perioperative outcomes were compared amongst cohorts. Results: Significant differences were noted in estimated blood loss (EBL), number of tumors resected, and postoperative complications as assessed by Clavien score. Univariate regression analysis of EBL showed that the number of tumors resected (p <.0001, coefficient: 111 ml), number of prior renal procedures (p=.012, coefficient: 419 ml), hilar clamping (p = .015, coefficient: 840 ml), and intended surgical approach (p = .001; coefficient: 905 ml) were significant. On multivariate analysis, number of tumors resected (p<.0001, coefficient: 97 ml) was the only significant factor. Univariate analysis on post-operative complications showed that number of prior surgeries (p = 0.03, OR: 1.5) and final intended approach (p < .0001, OR: 4.6) were significant. On multivariate analysis, the final intended surgical approach (p = .001, OR: 4.3) was shown to be significant. Conclusions: These data show that the surgical approach of prior procedures is not a significant factor that affects perioperative outcomes, but the use of robotic surgery was associated with decreased post-operative complications in reoperative renal surgery . While open surgery will likely continue to be the standard of care for complex reoperative procedures, these data suggest that robotic surgery is safe and well tolerated in select cases.

scholarly journals Outcomes of Robot-Assisted Laparoscopic Prostatectomy with a Posterior Approach to the Seminal Vesicle in 300 Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Takahiro Yasui ◽  
Keiichi Tozawa ◽  
Atsushi Okada ◽  
Satoshi Kurokawa ◽  
Hiroki Kubota ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Robotic Surgery ◽  
Postoperative Complications ◽  
Seminal Vesicle ◽  
Posterior Approach ◽  
Specific Antigen ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
The Mean

Background. The goal of this study was to analyze the perioperative outcomes of robot-assisted laparoscopic radical prostatectomies (RALPs) performed at our center. Methodology. We retrospectively reviewed 300 consecutive patients with clinically localized prostate cancer who underwent RALP with a posterior dissection approach to the seminal vesicle between May 2011 and November 2013. The mean patient age was 67.2±5.5 years (range: 41–78 years), and the mean prostate-specific antigen (PSA) concentration, at diagnosis of prostate cancer, was 9.16±6.50 ng/mL (range: 2.20–55.31 ng/mL). Results. The median duration of robotic surgery was 160 min (mean: 165±40 min; range: 75–345 min). Median estimated blood loss, including that in urine, was 200 mL (mean: 277±324 mL; range: 4–3250 mL). Intraoperative and immediate postoperative complications occurred in 3.0% of patients; 4 patients required allogeneic blood transfusion. As a measure of patient continence, 82.4% did not use more than 1 absorbent pad in 24 h, at 6 months postoperatively. Conclusion. RALP with an initial posterior dissection to the seminal vesicle was a safe and efficient method for controlling prostate cancer, even in these initial cases.

scholarly journals Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Changwei Ji ◽  
Qun Lu ◽  
Wei Chen ◽  
Feifei Zhang ◽  
Hao Ji ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Laparoscopic Adrenalectomy ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Transfusion Rate ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Minimally Invasive Adrenalectomy

Abstract Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

scholarly journals MP42-01 A NOVEL TRIFECTA TO SIMPLIFY THE ASSESSMENT OF PERIOPERATIVE OUTCOMES AFTER ROBOT ASSISTED PARTIAL NEPHRECTOMY FOR CT1 RENAL MASSES: RESULTS OF A MULTICENTER SERIES

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Umberto Anceschi* ◽  
Gabriele Tuderti ◽  
Maria Consiglia Ferriero ◽  
Aldo Brassetti ◽  
Salvatore Guaglianone ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Renal Masses

scholarly journals Peri- and post-operative results of initial robot-assisted radical prostatectomies of a surgeon graduating from a structured fellowship.

2019 ◽  
Vol 13 (1) ◽  
pp. 17-21
Author(s):  
Paweł Salwa ◽  
Wojciech Kielan
Keyword(s):  
Pilot Study ◽  
Robotic Surgery ◽  
Training Program ◽  
Surgical Margins ◽  
Pelvic Surgery ◽  
Robot Assisted ◽  
Positive Surgical Margins ◽  
Intensive Training ◽  
Estimated Blood Loss ◽  
Number Of Patients

Background: No validated training curriculum for robotic surgery exists so far. International scientific societies like ERUS (EAU Robotic Urology Section) seek to validate a structured training program for robotic surgeons. In 2014, ERUS launched Pilot Study II, a 6-month structured training program to allow a surgeon without prior robotic training to perform a complete RARP (robot-assisted radical prostatectomy) independently and effectively. Aim of the study: Here we report the detailed courses and training materials, specific surgical activities and perioperative efficacy and safety results of the first 52 RARP cases performed by a single surgeon after graduating from Pilot Study II. The aim is to compare these results with the literature and show if this sophisticated training helps patients undergoing this type of surgery achieve advantageous perioperative results. Material and methods: The fellowship was conducted from January to June 2014 and consisted of lectures on technical and non-technical skills, as well as e-learning, bedside assistance (at least 20), intensive training consisting of laboratory training (i.e., virtual reality simulation, dry lab (plastic model), wet lab on animal cadavers and living anaesthetized pigs) and dual-console live surgery followed by five months of modular training, where the trainee performed different steps of the surgery at the host center. After passing the final evaluation (a full recorded video of RARP evaluated blindly by robotic experts), the trainee was deemed capable of performing efficiently and safely a full case of RARP. Here we retrospectively report the content of training and perioperative results of the surgeon’s initial 52 RARPs performed from July 2014 to April 2015. Results: After graduating from the fellowship, the surgeon performed 52 cases of RARP. The mean patient age was 65.2 years, initial PSA 12.9 ng/ml, prostate volume 43.7 ml in TRUS, BMI 27.5, and 61% of patients had a prior abdominal or pelvic surgery. Because of internal regulations, every patient had a pelvic lymphadenectomy performed, three of whom had positive lymph nodes. The average estimated blood loss was 225.7 ml, and no patient needed intraoperative blood transfusion. The average console time was 174.2 minutes. Final full-mount pathology identified 23 patients (44.2%) with a locally advanced prostate cancer (T3 or T4). Positive surgical margins were present in three cases. A further 29 patients (55.8%) had locally confined disease (T2). Positive surgical margins were observed in 2 cases. Catheters were removed on the 5th postoperative day followed by a cystogram, with no urine leakage observed in 96.2% of cases. The safety of the procedure was good with one major (Clavien 4) and 13 minor (Clavien 1 and 2, i.e., uncomplicated urinary infection, urinary retention) complications. Conclusions: The study showed that graduating from an intensive and structured learning program in robotic surgery resulted in a faster learning curve, allowing the trainee to reach high safety parameters in performed surgeries. When compared with already published series, advantageous results could be observed. The study was limited by its retrospective design, the moderate number of patients and variables such as individual motivation, dexterity and attitude of the person in training. The advantages of such training should be further evaluated in controlled, multi-center trials.

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