scholarly journals Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Adnan Şimşir ◽  
Fuat Kızılay ◽  
Bayram Aliyev ◽  
Serdar Kalemci
Keyword(s):  
Radical Prostatectomy ◽  
Early Period ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Initial Experience ◽  
Robotic Group ◽  
Open Radical Prostatectomy ◽  
Estimated Blood Loss ◽  
Operation Rate

Objective: In this study, we aimed to make a comprehensive comparison of the first hundred robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) cases of a single surgeon in a high-volume center. Methods: Preoperative, perioperative and postoperative data were collected retrospectively. Perioperative, oncological data and functional results in the first year were compared between the two groups. There were 204 RARPs between January 1, 2014 and December 31, 2019, and 755 RRPs between April 1, 2007 and December 31, 2019. Results: While the operation time was in favor of the open group (117 vs 188 min, p<0.001), the estimated blood loss (328 vs 150 ml, p<0.001), blood transfusion rate (12 vs 2, p=0.021), and re-operation rate (6 vs 0, p=0.001) were in favor of the robotic group. Mean length of hospital stay (5.4 vs 3.1, p<0.001), urine leak rate (11 vs 2, p=0.033), complication rate (37 vs 16, p=0.018), and the 12th month continence rate (67 vs 85, p=0.002) were better in the robotic group. Conclusions: RARP may provide better perioperative outcomes and lower complication rates after the surgeon factor is eliminated in the early period. Since our case group includes the initial 100 patients, studies with larger patient groups with longer follow-up are needed to adapt these early results to general outcomes.\ doi: https://doi.org/10.12669/pjms.37.1.2719 How to cite this:Simsir A, Kizilay F, Aliyev B, Kalemci S. Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon. Pak J Med Sci. 2021;37(1):167-174. doi: https://doi.org/10.12669/pjms.37.1.2719 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A meta-analysis comparing positive surgical margin and complication rates of 110,016 patients undergoing open retropubic, laparoscopic, and robotic-assisted radical prostatectomy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 103-103
Author(s):  
P. Sooriakumaran ◽  
D. Bloch ◽  
A. Hebert ◽  
U. Seshadri-Kreaden ◽  
P. Wiklund ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Meta Analysis ◽  
Surgical Margin ◽  
Length Of Hospital Stay ◽  
Positive Surgical Margin ◽  
Blood Transfusions ◽  
Complication Rates ◽  
Open Approach ◽  
Robotic Group ◽  
Estimated Blood Loss

103 Background: There is no clear evidence to support one form of surgical approach over another with regards radical prostatectomy. The aim of this study was to analyze the literature available between 2002 and 2008 and compare positive surgical margin and complication rates for open retropubic, laparoscopic, and robotic radical prostatectomy. Methods: A total of 110,016 patients formed the basis of this meta-analysis, representing the largest compilation of radical prostatectomy patients in the literature. Summary data were abstracted on year of publication, pre-operative patient characteristics, positive surgical margins, estimated blood loss, blood transfusions, conversions, length of hospital stay, and total intra- and peri-operative complications, with a further 21 individual perioperative complications selected a priori for abstraction and analysis. Results: The open and laparoscopic surgical groups had similar overall positive surgical margin rates, with the robotic group having lower rates. Both minimally invasive approaches showed significantly lower estimated blood loss and rate of blood transfusions, and a shorter length of hospital stay when compared to an open approach. A further decrease in these parameters was seen when robotic assistance was used. Total complication rates were highest for the open approach, intermediate for the laparoscopic cohort, and lowest for the robotic group. For the individual complication analysis, the rates for death, readmission, reoperation, ureteral, bladder, and rectal injury, ileus, pneumonia, fistula, and wound infection showed significant differences between groups. Conclusions: Robotic assisted laparoscopic radical prostatectomy has overall lower perioperative morbidity and improved early oncologic outcomes compared to conventional laparoscopic or open approaches. Further studies comparing longer term oncologic and functional outcomes, as well as cost-benefit comparisons are needed before making recommendations for or against a specific type of surgery. [Table: see text]

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.

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 Analysis of predictors of adherent perinephric fat and its impact on perioperative outcomes in laparoscopic partial nephrectomy: a retrospective case–control study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lu Fang ◽  
Huan Li ◽  
Tao Zhang ◽  
Rui Liu ◽  
Taotao Zhang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Univariate Analysis ◽  
Warm Ischemia ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Estimated Blood Loss ◽  
Perinephric Fat

Abstract Background Adherent perinephric fat (APF), characterized by inflammatory fat surrounding the kidney, can limit the isolation of renal tumors and increase the operative difficulty in laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the predictors of APF and its impact on perioperative outcomes during LPN. Methods A total of 215 consecutive patients undergoing LPN for renal cell carcinoma (RCC) from January 2017 to June 2019 at our institute were included. We divided these patients into two groups according to the presence of APF. Radiographic data were retrospectively collected from preoperative cross-sectional imaging. The perioperative clinical parameters were compared between the two groups. Univariate and multivariate analyses were performed to evaluate the predictive factors of APF. Results APF was identified in 41 patients (19.1%) at the time of LPN. Univariate analysis demonstrated that APF was significantly correlated with the male gender (P = 0.001), higher body mass index (P = 0.002), lower preoperative estimated glomerular filtration rate (P = 0.004), greater posterior perinephric fat thickness (P< 0.001), greater perinephric stranding (P< 0.001), and higher Mayo Adhesive Probability (MAP) score (P< 0.001). The MAP score (P< 0.001) was the only variable that remained an independent predictor for APF in multivariate analysis. We found that patients with APF had longer operative times (P< 0.001), warm ischemia times (P = 0.001), and greater estimated blood loss (P = 0.003) than those without APF. However, there were no significant differences in surgical approach, transfusion rate, length of postoperative stay, complication rate, or surgical margin between the two groups. Conclusions Several specific clinical and radiographic factors including the MAP score can predict APF. The presence of APF is associated with an increased operative time, warm ischemia time, and greater estimated blood loss but has no impact on other perioperative outcomes in LPN.

scholarly journals Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thanasit Prakobpon ◽  
Apirak Santi-ngamkun ◽  
Manint Usawachintachit ◽  
Supoj Ratchanon ◽  
Dutsadee Sowanthip ◽  
...  
Keyword(s):  
Tumor Size ◽  
Adrenal Tumor ◽  
Intraoperative Complications ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Transfusion Rate ◽  
Intraoperative Complication ◽  
Estimated Blood Loss ◽  
Group 2 ◽  
Laparoscopic Transperitoneal

Abstract Background The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors. Methods We retrospectively reviewed all clinical data of patients who underwent unilateral transperitoneal LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n = 408) and patient in group 2 had tumor size ≥ 6 cm (n = 48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups. Results Patients in group 2 were significant older (p = 0.04), thinner (p = 0.001) and had lower incident of hypertension (p = 0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of postoperative stays ( 4 vs 5.5 days) than in group 2 (all p < 0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] = 9.67 (95% CI 4.22–22.17), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR = 5.67 (95% CI 2.48–12.97), p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. Conclusions Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications, and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expert surgeon in adrenal surgery is the key factor for successful laparoscopic surgery in a large adrenal tumor. Trial registration: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.

Effects of change in surgical approach in T3 renal cell carcinoma (RCC) with intracaval thrombus on complications and survival.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 471-471 ◽  
Author(s):  
Marleen Suzanne Vallinga ◽  
Anna Maria Leliveld ◽  
Paul M.J.G. Peeters ◽  
Igle J. De Jong
Keyword(s):  
Hospital Stay ◽  
Surgical Approach ◽  
Vena Cava ◽  
Perioperative Outcomes ◽  
High Morbidity ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Disease Specific Survival ◽  
Level 3 ◽  
Disease Specific

471 Background: In patients with T3 RCC with venous tumor thrombus reaching the inferior vena cava, without metastatic disease, a nephrectomy with cavotomy is performed. Before 2000, surgical approach of level 3-4 caval tumorthrombus included sternotomy and cardiopulmonary bypass with circulatory arrest, with high morbidity and mortality rates. After the routine use of liver mobilization around 2000, sternotomy became less necessary. We compared perioperative characteristics, complications and survival pre- and post-2000. Methods: We retrospectively studied 91 patients, operated between 1984 and 2016 in a referral hospital. Patients with a T3 RCC and caval thrombus underwent a radical nephrectomy with thrombectomy. Data on patient and tumor characteristics, operation approach, complications (Clavien-Dindo classification), hospital stay, progression and survival were collected and analyzed using Mann-Whitney U, Chi-Square, and Log-Rank tests. Results: 91 patients (56 male) with a mean age of 65 years were included. 33% had a level 3 or 4 cava thrombus. Surgical management before 2000 included sternotomy with circulation arrest in 32% and liver mobilization in 10%. After 2000, the number of sternotomies lowered to 8% while liver mobilization increased to 74%. See table 1 for perioperative outcomes and complications. Disease specific survival was significant longer in patients operated after 2000 (estimated mean 70 vs. 94 months, p = 0.03). Only N stage influenced progression free survival, patients N+ showed worse survival (p < 0.01). Conclusions: The change in surgical approach including liver mobilization significantly decreased complication rates, blood loss, transfusion rate, hospital stay and increased disease specific survival. [Table: see text]

scholarly journals New Surgical Technique for Robotic Myomectomy: Continuous Locking Suture on Myoma (LSOM) Technique

2021 ◽  
Vol 10 (4) ◽  
pp. 654
Author(s):  
Sa Ra Lee ◽  
Eun Sil Lee ◽  
Hye Rim Eum ◽  
Young-Jae Lee ◽  
Shin-Wha Lee ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Operating Time ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Cesarean Sections ◽  
Postoperative Fever ◽  
Estimated Blood Loss ◽  
Robotic Myomectomy ◽  
The Cost ◽  
New Surgical Technique

Robot-assisted laparoscopic myomectomy (RALM) has broadened the indications even in complex myomas. However, the high cost of RALM remains the main disadvantage. Therefore, a surgical technique that can reduce the cost of RALM and still has the advantages of robotic surgery is required. We propose a “locking suture on myoma (LSOM)” technique and compared the operative and perioperative outcomes of patients who underwent RALM with or without the LSOM technique. We included 337 patients who underwent RALM with (n = 160) or without (n = 177) the LSOM technique between March 2019 and August 2020. The LSOM group had low parity and gravidity, with a low rate of Cesarean sections. Myoma type was not different between the groups; however, patients in the LSOM group had larger, heavier, and higher number of myomas, although fewer patients had multiple myomas and were discharged earlier. Total operating time, estimated blood loss, pre- and postoperative hemoglobin levels, transfusion rate, and postoperative fever were not different between the two groups. In conclusion, the LSOM technique may be a viable surgical option for myomas, as it can reduce the cost of RALM by obviating the need for robotic Tenaculum forceps.

scholarly journals Robotic radical prostatectomy in the 21 st century: evolution of experience

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Jesus Moreno Sierra
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Keywords Prostate Cancer ◽  
Novel Technologies ◽  
Open Radical Prostatectomy

The advent of novel technologies and surgical techniques has revolutionized urological surgery in recent years. Robot-assisted radical prostatectomy (RARP) has become the most widely used surgical approach for radical prostatectomy (RP) in the treatment of localized prostate cancer. However, the current available evidence on the benefit of RARP compared to open radical prostatectomy (ORP) is still under debate. Moreover, recent studies have proposed technical modifications of RARP to improve functional outcomes and postoperative quality of life of prostate cancer patients. The aim of this review was to summarize the current evidence on oncological, functional and perioperative outcomes of RARP, considering the results of our series of 408 RARP performed between October 2006 and February 2015 at Clínico San Carlos Hospital, and to provide a framework on the latest and most relevant updates on RARP surgical technique modifications. Keywords Prostate cancer; robot-assisted radical prostatectomy; oncological outcomes; functional outcomes; robotic surgical techniques.

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