scholarly journals Does Changeover by an Experienced Open Prostatic Surgeon from Open Retropubic to Robot-Assisted Laparoscopic Prostatectomy Mean a Step Forward or Backward?

ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Michael Musch ◽  
Ulla Roggenbuck ◽  
Virgilijus Klevecka ◽  
Heinrich Loewen ◽  
Maxim Janowski ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Operating Time ◽  
Surgical Margin ◽  
Patient Characteristics ◽  
Positive Surgical Margin ◽  
Laparoscopic Prostatectomy ◽  
Surgery Patient ◽  
Equivalent Number ◽  
Estimated Blood Loss ◽  
Patient Reported

We assessed whether changeover from open retropubic [RRP] to robotic-assisted laparoscopic prostatectomy [RALP] means a step forward or backward for the initial RALP patients. Therefore the first 105 RALPs of an experienced open prostatic surgeon and robotic novice—with tutoring in the initial 25 cases—were compared to the most recent 105 RRPs of the same surgeon. The groups were comparable with respect to patient characteristics and postoperative tumor characteristics (all P>0.09). The only disadvantage of RALP was a longer operating time; the advantages were lower estimated blood loss, fewer anastomotic leakages, earlier catheter removal, shorter hospital stay (all P<0.04), and less major complications within 90 days postoperatively (P<0.01). Positive surgical margin rates were comparable both overall and stratified for pT stage in both groups (all P<0.08). In addition, an equivalent number of lymph nodes were removed (P>0.07). Twelve months after surgery, patient reported continence and erectile function were comparably good (all P>0.11). Our study indicates that an experienced open prostatic surgeon and robotic novice who switches to RALP can achieve favorable surgical results despite the initial RALP learning curve. At the same time neither oncological nor functional outcomes are compromised.

scholarly journals NeuroSAFE robot-assisted laparoscopic prostatectomy versus standard robot-assisted laparoscopic prostatectomy for men with localised prostate cancer (NeuroSAFE PROOF): protocol for a randomised controlled feasibility study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028132 ◽  
Author(s):  
Eoin Dinneen ◽  
Aiman Haider ◽  
Clare Allen ◽  
Alex Freeman ◽  
Tim Briggs ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Feasibility Study ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Laparoscopic Prostatectomy ◽  
Patient Reported ◽  
Randomised Controlled

IntroductionRobot-assisted laparoscopic prostatectomy (RALP) offers potential cure for localised prostate cancer but is associated with considerable toxicity. Potency and urinary continence are improved when the neurovascular bundles (NVBs) are spared during a nerve spare (NS) RALP. There is reluctance, however, to perform NS RALP when there are concerns that the cancer extends beyond the capsule of the prostate into the NVB, as NS RALP in this instance increases the risk of a positive surgical margin (PSM). The NeuroSAFE technique involves intraoperative fresh-frozen section analysis of the posterolateral aspect of the prostate margin to assess whether cancer extends beyond the capsule. There is evidence from large observational studies that functional outcomes can be improved and PSM rates reduced when the NeuroSAFE technique is used during RALP. To date, however, there has been no randomised controlled trial (RCT) to substantiate this finding. The NeuroSAFE PROOF feasibility study is designed to assess whether it is feasible to randomise men to NeuroSAFE RALP versus a control arm of ‘standard of practice’ RALP.MethodsNeuroSAFE PROOF feasibility study will be a multicentre, single-blinded RCT with patients randomised 1:1 to either NeuroSAFE RALP (intervention) or standard RALP (control). Treatment allocation will occur after trial entry and consent. The primary outcome will be assessed as the successful accrual of 50 men at three sites over 15 months. Secondary outcomes will be used to aid subsequent power calculations for the definitive full-scale RCT and will include rates of NS; PSM; biochemical recurrence; adjuvant treatments; and patient-reported functional outcomes on potency, continence and quality of life.Ethics and disseminationNeuroSAFE PROOF has ethical approval (Regional Ethics Committee reference 17/LO/1978). NeuroSAFE PROOF is supported by National Institute for Healthcare Research Research for Patient Benefit funding (NIHR reference PB-PG-1216-20013). Findings will be made available through peer-reviewed publications.Trial registration numberNCT03317990.

scholarly journals Comparison of robotic and laparoscopic partial nephrectomy for small renal tumours

2017 ◽  
Vol 89 (2) ◽  
pp. 93 ◽  
Author(s):  
Abdulmuttalip Simsek ◽  
Abdullah Hizir Yavuzsan ◽  
Yunus Colakoglu ◽  
Arda Atar ◽  
Selcuk Sahin ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Laparoscopic Partial Nephrectomy ◽  
Positive Surgical Margin ◽  
Robotic Partial Nephrectomy ◽  
Asa Score ◽  
Estimated Blood Loss ◽  
Renal Tumours ◽  
Significant Difference

Objective: To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal tumours. Materials and methods: Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20) or RPN (n = 22) by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes. Results: There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001). Warm ischemia time was similar in both groups (p = 0.58). Estimated blood loss (EBL) was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin. Conclusions: RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.

scholarly journals Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

2013 ◽  
Vol 7 (9-10) ◽  
pp. 326 ◽  
Author(s):  
Naif Al-Hathal ◽  
Assaad El-Hakim
Keyword(s):  
High Risk ◽  
Functional Outcomes ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Transfusion Rate ◽  
Estimated Blood Loss ◽  
Surgeon Experience ◽  
The Mean

Background: Robotic-assisted radical prostatectomy (RARP) is being increasingly done in Canada. Despite this, the Canadian literature lacks publications on the oncologic and functional outcomes of RARP. The objective of this study is to report the longest single surgeon experience in the province of Quebec.Methods: We collected prospective data from 250 consecutive patients who underwent RARP by a single fellowship trained surgeon (AEH) from October 2006 to October 2012. Mean follow-up was 28 months (range: 1-72). The D’Amico risk stratification distribution was 34% in low-risk, 48% in intermediate-risk and 18% in high-risk groups.Results: The mean operation time (±SD) was 194 ± 60.6 minutes, and estimated blood loss 318 ± 179 mL. The transfusion rate was only 0.4%. All procedures were completed robotically. The mean hospital stay was 1.2 days, and 88% of patients were discharged on postoperative day 1. The mean catheterization time was 7 days (range: 6-13). There were 2% major (Clavien III-IV) and 7.2% minor (Clavien I-II) postoperative complications, and no mortalities. On final pathology, 76% of patients were organ-confined and 70% specimen-confined. Pathological Gleason sum ≥7 accounted for 86%. Return of urinary continence (0-pads) at 3, 6, 12, and 24 months was 73.3%, 83.5%, 92.3%, 96.5%, respectively. Potency rate (successful penetration with or without medication) at 6,12, and 24 months was 49.3%, 85%, and 95.3%, respectively. Operative time and positive surgical margin (PSM) in organ-confined disease (pT2) decreased significantly after 50 cases. Seventeen patients (6.8%) had no undetectable prostate-specific antigen (PSA) at first visit (PSA <0.1 ng/mL). Of the remaining 233 patients, biochemical recurrence (PSA >0.2 ng/mL) was 4.7% (11 patients), and another 3.4% (8 patients) received early salvage radiotherapy (rising PSA, but <0.2 ng/mL). No patients with undetectable PSA required salvage treatments within 6 months postoperatively.Conclusions: Our results compare favourably with high-volume RARP programs, despite mainly intermediate- to high-risk disease. Initial learning curve was estimated to be 50 cases. Fellowship training was instrumental in achieving adequate functional and oncological outcomes, while maintaining low complications rate.

scholarly journals Comparison of early experience laparoscopic versus open partial nephrectomy in terms of clinical, oncological and renal functional outcomes

2021 ◽  
pp. 116-123
Author(s):  
Mert Kılıç ◽  
Meftun Çulpan ◽  
Asıf Yıldırım ◽  
Turhan Çaşkurlu
Keyword(s):  
Local Recurrence ◽  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Renal Tumors ◽  
Positive Surgical Margin ◽  
Open Partial Nephrectomy ◽  
Renal Functions ◽  
Estimated Blood Loss ◽  
Zero Ischemia

Objective: Although laparoscopic partial nephrectomy (LPN) is minimally invasive, it is also a technically challenging procedure. Currently, open partial nephrectomy (OPN) remains the only alternative in many centers for T1 kidney tumors. We reported our initial experience of LPN compared to OPN regarding clinical, oncological findings and renal functions. Material and Methods: Between 2004-2013, 81 patients who underwent OPN (n=55) or LPN (n=26) for clinically T1 renal tumors were included. Perioperative and postoperative data were compared, retrospectively. Follow-up times for OPN and LPN groups were 72.9± 41.1 and 47.6± 32.4 months, respectively (p<0.05). Results: The mean tumor size and RENAL nephrometry scores were similar for both groups.  Zero-ischemia was performed in all of the LPN and 15% of the OPN procedures. Estimated blood loss and perioperative transfusion rates were higher in OPN group. Complications including grade < 3 and  ≥ 3 did not differ significantly between the groups. The decrease in creatinine-clearance at 6th month was statistically significant in OPN group, while stable in LPN. Positive surgical margin rates were 6.6% for OPN and 17.6% for LPN, p=0.19. One patient in LPN developed local recurrence and underwent nephrectomy. In OPN group,one local recurrence and one distant metastasis were observed in two independent patients. Both patients recieved tyrosine kinase inhibitor. Conclusion: Although LPN is accepted as a technically challenging procedure, LPN provided comparable outcomes to OPN including clinical, oncological findings and renal functions, even in the early learning phase. Zero-ischemia technique for LPN was feasible and safe with favorable perioperative and renal functional outcomes. Keywords: laparoscopy; learning curve; partial nephrectomy; renal cancer; surgical margins; zero-ischemia.

scholarly journals Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: The largest Canadian 5-year experience

2014 ◽  
Vol 8 (5-6) ◽  
pp. 195 ◽  
Author(s):  
Kevin Christopher Zorn ◽  
Côme Tholomier ◽  
Marc Bienz ◽  
Pierre-Alain Hueber ◽  
Quoc Dien Trinh ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
High Volume ◽  
Oncologic Outcomes ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Transfusion Rate ◽  
Robotic Assisted Radical Prostatectomy

Introduction: While RARP (robotic-assisted radical prostatectomy) has become the predominant surgical approach to treat localized prostate cancer, there is little Canadian data on its oncological and functional outcomes. We describe the largest RARP experience in Canada.Methods: Data from 722 patients who underwent RARP performed by 7 surgeons (AEH performed 288, TH 69, JBL 23, SB 17, HW 15, QT 7, and KCZ 303 patients) were collected prospectively from October 2006 to December 2013. Preoperative characteristics, as well as postoperative surgical and pathological outcomes, were collected. Functional and oncological outcomes were also assessed up to 72 months postoperative.Results: The median follow-up (Q1-Q3) was 18 months (9-36). The D’Amico risk stratification distribution was 31% low, 58% intermediate and 11% high-risk. The median operative time was 178 minutes (142-205), blood loss was 200 mL (150-300) and the postoperative hospital stay was 1 day (1-23). The transfusion rate was only 1.0%. There were 0.7% major (Clavien III-IV) and 10.1% minor (Clavien I-II) postoperative complications, with no mortality. Pathologically, 445 men (70%) were stage pT2, of which 81 (18%) had a positive surgical margin (PSM). In addition, 189 patients (30%) were stage pT3 and 87 (46%) with PSM. Urinary continence (0-pads/day) returned at 3, 6, and 12 months for 68%, 80%, and 90% of patients, respectively. Overall, the potency rates (successful penetration) for all men at 6, 12, and 24 months were 37%, 52%, and 59%, respectively. Biochemical recurrence was observed in 28 patients (4.9%), and 14 patients (2.4%) were referred for early salvage radiotherapy. In total, 49 patients (8.4%) underwent radiotherapy and/or hormonal therapy.Conclusions: This study shows similar results compared to other high-volume RARP programs. Being the largest RARP experience in Canada, we report that RARP is safe with acceptable oncologic outcomes in a Canadian setting.

Does the day or season of operation predict biochemical recurrence after radical prostatectomy?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16162-e16162
Author(s):  
A. L. Hirsh ◽  
D. J. Lee ◽  
G. Hruby ◽  
M. C. Benson ◽  
J. M. McKiernan
Keyword(s):  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Cox Regression ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Urologic Oncology ◽  
Mortality And Morbidity ◽  
Estimated Blood Loss ◽  
Day Of The Week ◽  
The Mean

e16162 Background: Outcomes in hospital based medicine are associated with the experience and availability of the medical staff, as mortality and morbidity rates increase each summer with new medical graduates. Hospital staff members are thought to be more fatigued and less available towards the end of the week and on weekends. However it is not known if there is a difference of outcomes based on the season or day of the week. We sought to identify if different seasons or surgical days of the week can predict poor outcomes and biochemical recurrence (BCR) in radical prostatectomy (RP). Methods: A retrospective analysis of the Columbia Urologic Oncology database was performed. 1865 consecutive men underwent RP from 1991 to 2008 by three surgeons. Data was collected in an institutional review board approved registry, with median follow up of 36 months. BCR was defined as two consecutive PSA levels > 0.2 ng/ml. Stratified cox regression methods were used to model the relationship between surgeon, preoperative variables, season, day of the week, and BCR. Winter was defined as December through February, spring as March through May, summer as June through August, and fall as September through November. Results: The mean age of the men undergoing RP was 61.2 years (37–79), with a mean preoperative PSA of 8.12. 424 men (22.7%) had positive surgical margins, and the mean estimated blood loss (EBL) was 1119cc. Patient age (p=0.68), preoperative PSA (p=0.32), EBL (p=0.51), and positive surgical margin rate (p=0.78) were not significantly different between each day. Men undergoing RP did not have different rates of BCR according to the day of the operation (p=0.58) or season (p=0.997). The particular season and day of the operation were not significantly associated with BCR, and were not independent predictors of BCR in a multivariable model after adjusting for preoperative PSA, Gleason sum, tumor stage, and surgeon. Conclusions: Patient surgical outcomes and BCR rates after RP are not associated with the particular season or day of the week of the procedure. These findings suggest that men undergoing RP do not need to be concerned about the particular season or day when scheduling the procedure. No significant financial relationships to disclose.

Obesity and metabolic syndrome correlate with a higher risk of biochemical recurrence in high risk and intermediate risk prostate cancer patients who underwent robotic-assisted laparoscopic prostatectomy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 5580-5580
Author(s):  
Shifeng Mao ◽  
Ralph Miller ◽  
John Lyne ◽  
Jeffrey Cohen ◽  
Arash Samiei
Keyword(s):  
Prostate Cancer ◽  
Metabolic Syndrome ◽  
Biochemical Recurrence ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Obese Patients ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Increased Risk ◽  
Significant Difference

5580 Background: Obesity and metabolic syndrome (MS) is prevalent in our society, and have been linked to a higher incidence of prostate cancer (PCa). The relationship of obesity or MS and cancer control has yielded mixed results in previous studies. We examined the correlation between the incidence of biochemical recurrence (BCR) with MS and BMI in a cohort of patients with PCa who underwent robotic-assisted laparoscopic prostatectomy (RALP). Methods: A retrospective study of patients who underwent RALP at a single center from 2007 to 2015 was conducted. Parameters including preoperative BMI, fasting glucose, lipid profile, blood pressure, PSA, Gleason score, pathologic stage, time to BCR, and surgical margin status were analyzed. Patients were categorized in high (HR), intermediate (IR), and low-risk (LR) groups based on the National Comprehensive Cancer Network (NCCN) guidelines. WHO classification was used for MS criteria, and BCR was defined as two consecutive postoperative PSA volume of ≥ 0.2 ng/mL. Obesity is defined as BMI ≥30 kg/m2. Results: A total of 726 patients with 189 in HR, 471 in IR and 66 patients in LR groups were included in this study with the median age of 59 (interquartile range [IQR] 55-64) years old. The median follow-up from surgery was 38 (IQR 22-46) months. More obese patients were found in the HR group compared to IR/LR group (46.5% vs. 33.1%, p<0.01). There were also more patients with MS in the HR group compared to IR/LR group (36.5% vs. 12.0%, p<0.01). Obese patients had a higher rate of BCR across risk groups in comparison to non-obese patients 32.1% vs. 15.4% (P<0.001), specifically 68% vs. 40%(p<0.01) in HR group and 21.3% vs. 12.7% (p=0.035) in the IR group. Similarly, patients with MS had a higher rate of BCR in HR and IR groups in comparison to the patients without MS, 39.1% vs. 18.7% (P<0.01); specifically, 67.7% vs. 42.2% (p<0.01) in HR and 29% vs. 11.6% (p<0.01) in the IR group. No correlation between MS or obesity and BCR was observed in LR group. There was no statistically significant difference in the positive surgical margin rate between obese and non-obese cohorts in each risk group. Conclusions: Among HR and IR-PCa patietns who underwent RALP, both obesity and MS correlate with increased risk of BCR. There were significantly more obesity and MS in HR-PCa patients, suggesting a potential pathophysiologic interplay between obesity or MS and cancer progression.

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