scholarly journals Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a multi-institutional comparative study

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Amr A. Faddan ◽  
Mahmoud M. Shalaby ◽  
Mohamed Gadelmoula ◽  
Younis Alshamsi ◽  
Daniar K. Osmonov ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Complication Rate ◽  
Perioperative Complications ◽  
Statistical Significance ◽  
Operating Time ◽  
Perioperative Outcomes ◽  
Academic Institutions ◽  
Robot Assisted ◽  
Surgical Specimen ◽  
Significant Difference

Abstract Background The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions. Methods A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at (P < 0.05). All reported P values are two-sided. Results A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time (P < .0001), catheterization period (P < .001), hospital stay (P < .0001), and overall complications rate (P = .023). Conclusions The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.

scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

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.

Robot-Assisted Laparoscopic Radical Prostatectomy: Perioperative Outcomes of 1500 Cases

2008 ◽  
Vol 22 (10) ◽  
pp. 2299-2306 ◽  
Author(s):  
Vipul R. Patel ◽  
Kenneth J. Palmer ◽  
Geoff Coughlin ◽  
Srinivas Samavedi
Keyword(s):  
Radical Prostatectomy ◽  
Laparoscopic Radical Prostatectomy ◽  
Perioperative Outcomes ◽  
Robot Assisted

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.

scholarly journals Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiang-Nan Xu ◽  
Zhen-Yu Xu ◽  
Hu-Ming Yin
Keyword(s):  
Radical Prostatectomy ◽  
Lower Incidence ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Postoperative Continence ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Anterior Prostate

Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial.Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis.Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P &lt; 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P &lt; 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P &lt; 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function.Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.

Total Pancreatectomy is as Feasible and Safe as Pancreatico-duodenectomy

2019 ◽  
Author(s):  
Offir Ben-Ishay ◽  
Reem Abu Zhaya ◽  
Yoram Kluger
Keyword(s):  
Complication Rate ◽  
Total Pancreatectomy ◽  
Statistical Significance ◽  
Perioperative Outcomes ◽  
Exocrine Insufficiency ◽  
Mortality And Morbidity ◽  
Brittle Diabetes ◽  
Operative Outcomes ◽  
Pancreatic Exocrine ◽  
Control Study

Abstract Background For many years total pancreatectomy (TP) had a notorious reputation due to the resulting brittle diabetes and pancreatic exocrine insufficiency, recent evidence suggests otherwise. The purpose of the current study is to evaluate the comparative perioperative results of TP and pancreatico-duodenectomy (PD).Methods The current study is a single center retrospective, case control study comparing the peri-operative outcomes of TP and PD over a period of 7 years for malignant and benign diseases of the pancreas. Primary and secondary measures of outcome were peri-operative mortality and morbidity respectively.Results 214 patients underwent pancreatic resection during the study period of which 35 patients underwent TP and 179 patients underwent PD. The two groups were homogenous in terms of demographics and clinical presentation. Mortality was not different between TP and PD and stands on 2.9% and 5% respectively (p-0.58). Overall complication rate was significantly lower in the TP group (17.1% vs. 55%, p<0.001) and the rate of major complications (Dindo-Clavien >3) was lower but did not reach statistical significance (2.9% vs. 11.2%, p-0.13).Conclusions Our study suggests that total pancreatectomy is not only feasible and safe, it might have better perioperative outcomes than PD with same mortality and reduced overall complication rate.

Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

2015 ◽  
Vol 94 (4) ◽  
pp. 394-400 ◽  
Author(s):  
Ingrid Berger ◽  
Clemens Wehrberger ◽  
Anton Ponholzer ◽  
Martina Wolfgang ◽  
Thomas Martini ◽  
...  
Keyword(s):  
Multicentre Study ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Perioperative Complications ◽  
Operating Time ◽  
The Elderly ◽  
Wound Complications ◽  
Consecutive Series ◽  
Lower Complication ◽  
Muscle Invasive

Objective: A potential strategy to decrease the high complication rate of radical cystectomy (RC) in the elderly is to avoid the use of bowel for urinary diversion. The aim of this study was to address this issue in a multicentre study of patients aged ≥75 years. Patients and Methods: We performed a retrospective, multicentre study of a consecutive series of patients aged ≥75 years who underwent RC for muscle-invasive bladder cancer between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification. Results: A total of 256 patients (68% men, mean age 79.6 years) were analysed. 204 (80%) patients received a urinary diversion with use of bowel and 52 (20%) a ureterocutaneostomy (UC). Patients with UC were older (82.0 vs. 78.9 years, p < 0.001) and had a higher ASA score (2.6 vs. 2.3, p = 0.007), while the mean Charlson score was lower (4.2 vs. 5.6, p < 0.001). Patients with UC had a shorter operating time (279 vs. 311 min, p = 0.002) and a shorter period in the intensive care unit (0.9 vs. 2.2 days). The overall rate of severe complications graded as Clavien III-V was significantly lower in the UC group (11.5%) as compared to patients receiving bowel for urinary diversion (25.0%) (p = 0.003). Severe (Clavien grade III-V) medical (3.9 vs. 10.3%) and surgical (2.1 vs. 14.1%) complications were all less frequent in the UC group. Inpatient, 30- and 90-day mortality was 5.8, 7.7 and 17.3% in the UC group as compared to 3.9, 5.9 and 6.9% in the bowel cohort, respectively. Conclusion: UC following RC is associated with a lower complication rate in geriatric patients. The constantly increasing cohort of geriatric, multimorbid patients requiring cystectomy might justify reconsideration of this form of diversion.

scholarly journals Impact of Robotic Fellowship Experience on Perioperative Outcomes of Robotic-Assisted Laparoscopic Partial Nephrectomy

2015 ◽  
Vol 9 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Michael A. Moriarty ◽  
Kenneth G. Nepple ◽  
Chad R. Tracy ◽  
Michael E. Strigenz ◽  
Daniel K. Lee ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Perioperative Complications ◽  
Positive Margin ◽  
Warm Ischemia ◽  
Laparoscopic Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Initial Experience ◽  
Robotic Assisted ◽  
Nephrometry Score ◽  
Significant Difference

Background: We analyzed differences in patient selection and perioperative outcomes between robotic-fellowship trained and non-fellowship trained surgeons in their initial experience with robotic-assisted laparoscopic partial nephrectomy. Methods: Data through surgeon case 10 was analyzed. Forty patients were identified from two fellowship trained surgeons (n = 20) and two non-fellowship trained surgeons (n = 20). Results: Fellowship trained surgeons performed surgery on masses of higher nephrometry score (8.0 vs. 6.0, p = 0.007) and more posterior location (60 vs. 25%, p = 0.03). Retroperitoneal approach was more common (50 vs. 0%, p = 0.0003). Fellowship trained surgeons trended toward shorter warm ischemia time (25.5 vs. 31.0 min, p = 0.08). There was no significant difference in perioperative complications (35 vs. 35%, p = 0.45) or final positive margin rates (0 vs. 15%, p = 0.23). Conclusion: Fellowship experience may allow for treating more challenging and posterior tumors in initial practice and significantly more comfort performing retroperitoneal robotic-assisted laparoscopic partial nephrectomy.

scholarly journals The Role of M1 and M2 Macrophages in Prostate Cancer in relation to Extracapsular Tumor Extension and Biochemical Recurrence after Radical Prostatectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
M. Lanciotti ◽  
L. Masieri ◽  
M. R. Raspollini ◽  
A. Minervini ◽  
A. Mari ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
M2 Macrophage ◽  
Causal Connection ◽  
Tumor Extension ◽  
Significant Difference

Introduction. The aim of our work was to investigate the causal connection between M1 and M2 macrophage phenotypes occurrence and prostate cancer, their correlation with tumor extension (ECE), and biochemical recurrence (BR).Patient and Methods. Clinical and pathological data were prospectively gathered from 93 patients treated with radical prostatectomy. Correlations of commonly used variables were evaluated with uni- and multivariate analysis. The relationship between M1 and M2 occurrence and BR was also assessed with Kaplan-Meier survival analysis.Results. Above all in 63.4% there was a M2 prevalence. M1 occurred more frequently in OC disease, while M2 was more represented in ECE. At univariate analysis biopsy and pathologic GS and M2 were statistically correlated with ECE. Only pathologic GS and M2 confirmed to be correlated with ECE. According to macrophage density BCR free survival curves presented a statistically significant difference. When we stratified our population for M1 and M2,we did not find any statistical difference among curves. At univariate analysis GS, pTNM, and positive margins resulted to be significant predictors of BCR, while M1 and M2 did not achieve the statistical significance. At multivariate analysis, only GS and pathologic stage were independent predictors of BR.Conclusion. In our study patients with higher density of M count were associated with poor prognosis; M2 phenotype was significantly associated with ECE.

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