Comparative analysis of operative time, length of stay in ICU and estimated blood loss in robot-assisted and laparoscopic surgery

Objective: To report and compare the peri-operative outcomes of patients undergoing open (ORC) and robotic-assisted radical cystectomy (RARC) for bladder cancer performed with a radiofrequency seal and cut device (Caiman®). Materials and Methods: Data of patients undergoing ORC or RARC between January 2015 and March 2016 at 6 Italian institutions were prospectively recorded and analyzed. Thirty-and 90-day complications were stratified according to the Martin's criteria and graded according to the Clavien-Dindo classification. Data on operative time, blood loss, transfusion rate, complications, and length of stay were evaluated and compared between the ORC and RARC groups. Results: Thirty-three (66%) and 17 (34%) patients were treated with ORC and RARC, respectively. The median age was 72 (64-78) years. Overall operative time was longer in RARC compared to ORC (389 ± 80.1 vs. 242 ± 62.2 min, p < 0.001), while the estimated blood loss during cystectomy was higher after ORC (370 ± 126.8 vs. 243.3 ± 201.6 ml, p = 0.03). The transfusion rate was significantly higher in the ORC compared to RARC (24.2 vs. 5.9%, p = 0.04). Eight (19%) and 7 (16.7%) patients experienced 30- and 90-day post-operative complications, with no significant difference between ORC and RARC. Length of stay was significantly shorter in RARC group (median 7 vs. 14 days, p < 0.001). Conclusion: Open and robot-assisted procedures were safely performed by using a new advanced bipolar seal and cut technology (Caiman®). RARC demonstrated to be superior to ORC in terms of bleeding, transfusion rates and length of hospital stay, despite longer operative time.

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

BMC Urology ◽

10.1186/s12894-020-00637-y ◽

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.

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Feasibility of robot-assisted radical prostatectomy in elderly patients: Comparative analysis of the peri-surgical/oncological outcomes with younger patients.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.134 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 134-134

Author(s):

Takehiro Iwata ◽

Takashi Saika ◽

Kohei Edamura

Keyword(s):

Comparative Analysis ◽

Radical Prostatectomy ◽

Blood Loss ◽

Elderly Patients ◽

Robot Assisted ◽

Younger Patients ◽

Open Conversion ◽

Oncological Outcomes ◽

Elder Patients ◽

Estimated Blood Loss

134 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical/oncological outcomes for younger and elderly patients underwent RARP. Methods: We reviewed and compared our initial 340 consecutive patients who underwent RARP from 9/2012 to 8/2015 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 70 and over 70 years. Results: In our cohort, 202 men were age less than 70 and 138 men were ≥70. Preoperative parameters (age, PSA, Gleason score) were similar in both younger and elder groups. Operative time (median: 167 vs. 171 minutes) and estimated blood loss were similar in both groups. One of elder patients (0.7%) needed transfusion. Peri/post-operative complications in both groups appeared to be minimal with no cases of intra-operative open conversion. One of younger patients needed a surgical settlement for port site herniation. Surgical positive margin rates in organ-confined (pT2) disease were also similar (5.6%, younger vs. 9.0%,elder). Continence at 3 months was 82% in elder patients as opposed to 87% in younger patients. Median follow-up period in in elder patients and younger patients were 15.2 and 15.3 months, respectively. Biochemical recurrence free survival rates in elder patients and younger patients were 89.9% and 93.6%, respectively (p=0.1026). Conclusions: In our study, RARP in elderly patients was relatively safe and yielded good oncologic results. RARP is feasible even in elderly patients.

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Genitofemoral Nerve Protection During the Lateral Retroperitoneal Transpsoas Approach

Operative Neurosurgery ◽

10.1227/01.neu.0000431473.49042.95 ◽

2013 ◽

Vol 73 (2) ◽

pp. ons192-ons197 ◽

Cited By ~ 6

Author(s):

Gabriel C. Tender ◽

Daniel Serban

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Femoral Nerve ◽

Psoas Muscle ◽

Lateral Approach ◽

Direct Visualization ◽

Genitofemoral Nerve ◽

Estimated Blood Loss

Abstract BACKGROUND: The minimally invasive lateral retroperitoneal approach for lumbar fusions is a novel technique with good results, but also with significant sensory and motor complications. OBJECTIVE: To present the early results of a modified surgical technique, in which the psoas muscle is dissected under direct visualization. METHODS: Thirteen consecutive patients with L4-5 or L3-4 pathology were prospectively followed after being treated using a minimally invasive lateral approach with direct exposure of the psoas muscle before dissection. There were 7 woman and 6 men with a mean age of 52.3 years. Perioperative parameters like operative time, estimated blood loss, and length of stay, were noted. Pain, paresthesia, and motor weakness, as well as any other complications, were evaluated at 2 weeks and 3 months postoperatively. RESULTS: The mean operative time, estimated blood loss, and length of stay were 163 minutes, 126 mL, and 3 days, respectively. One patient exhibited anterior thigh pain and paresthesia at 2 weeks, both of which resolved by 3 months. Two patients experienced superficial wound infections that healed with antibiotics. The genitofemoral nerve was identified and protected in 7 patients; in 4 patients, it had a more posterior anatomic location than expected. The femoral nerve was not exposed or detected in the operative field by neuromonitoring, nor were there any symptoms related to a femoral nerve injury in any patient. CONCLUSION: Dissection of the psoas muscle under direct visualization during the minimally invasive lateral approach may provide increased safety to the genitofemoral and femoral nerves.

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Robotic and Laparoscopic Approaches for Adrenal Surgery in Obese Patients

The American Surgeon ◽

10.1177/0003134820951498 ◽

2020 ◽

pp. 000313482095149

Author(s):

Hosam Shalaby ◽

Mohamed Abdelgawad ◽

Mahmoud Omar, MD ◽

Ghassan Zora, MD ◽

Saad Alawwad ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Laparoscopic Approach ◽

Obese Patients ◽

Adrenal Surgery ◽

Robotic Approach ◽

Robot Assisted ◽

Operative Outcomes ◽

Estimated Blood Loss

Objective Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the robotic and laparoscopic adrenalectomy, particularly in obese patients. Materials and Methods A retrospective analysis was performed on all consecutive patients undergoing adrenalectomy for benign disease by a single surgeon using either a laparoscopic or robotic approach. Adrenal surgeries for adrenal cancer were excluded. Demographics, operative time, length of hospital stays, estimated blood loss (EBL), and intraoperative and postoperative complications were evaluated. Patients were divided into 2 groups; obese and nonobese. A sub-analysis was performed comparing robotic and laparoscopic approaches in obese and nonobese patients. Results Out of 120, 55 (45.83%) were obese (body mass index ≥ 30 kg/m2). 14 (25.45%) of the obese patients underwent a laparoscopic approach, and 41 (74.55%) underwent a robotic approach. Operative times were longer in the obese vs. nonobese groups (173.30 ± 72.90 minutes and 148.20 ± 61.68 minutes, P = .04) and were associated with less EBL (53.77 ± 82.48 vs. 101.30 ± 122, P = .01). The robotic approach required a longer operative time when compared to the laparoscopic approach (187 ± 72.42 minutes vs. 126.60 ± 54.55 minutes, P = .0102) in the obese but was associated with less blood loss (29.02 ± 51.05 mL vs. 138.30 ± 112.20 mL, P < .01) and shorter hospital stay (1.73 ± 1.23 days vs. 3.17 ± 1.27 days, P < .001). Conclusion Robot-assisted adrenal surgery is safe in obese patients and appears to be longer; however, it provides improvements in postoperative outcomes, including EBL and shorter hospital stay.

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4K ultra HD technology reduces operative time and intraoperative blood loss in colorectal laparoscopic surgery

F1000Research ◽

10.12688/f1000research.21297.1 ◽

2020 ◽

Vol 9 ◽

pp. 106

Author(s):

Giulio M. Mari ◽

Jacopo Crippa ◽

Pietro Achilli ◽

Angelo Miranda ◽

Letizia Santurro ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Comparative Analysis ◽

Blood Loss ◽

Operative Time ◽

High Volume ◽

Intraoperative Blood Loss ◽

Surgical Performance ◽

Operative Outcomes ◽

Time Frames

Background: HD systems are routinely used in laparoscopic surgery, 4K ultra HD monitors are mainly available within specialized, high-volume laparoscopic centers. The higher resolution of 4K ultra HD video could upgrade the surgical performance improving intraoperative and post-operative outcomes. Methods: We performed a retrospective comparative analysis of intraoperative parameters and post-operative outcomes in a cohort of patients operated on for elective laparoscopic procedures for colo-rectal cancer during two different time frames: 2017 procedures performed using the Visera Elite full HD technology (® Olympus America, Medical) and the 2018 procedures performed the Visera 4K Ultra HD System (® Olympus America, Medical). Results: There was a statistically significant reduction in operative time in patients operated on with the 4K ultra HD technology compared to HD technology (p < 0.05). Intraoperative blood loss was significantly reduced in patients operated in 2018 (p < 0.05). There were no statistically significant differences in complication rate and postoperative outcomes between the two groups.

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Perioperative results following lumbar discectomy: comparison of minimally invasive discectomy and standard microdiscectomy

Neurosurgical FOCUS ◽

10.3171/foc/2008/25/8/e20 ◽

2008 ◽

Vol 25 (2) ◽

pp. E20 ◽

Cited By ~ 60

Author(s):

John W. German ◽

Mathew A. Adamo ◽

Regis G. Hoppenot ◽

Jessin H. Blossom ◽

Henry A. Nagle

Keyword(s):

Cerebrospinal Fluid ◽

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Cerebrospinal Fluid Leak ◽

Lumbar Discectomy ◽

Estimated Blood Loss ◽

Fluid Leak ◽

First Time

Object Minimally invasive lumbar discectomy is a refinement of the standard open microsurgical discectomy technique. Proponents of the minimally invasive technique suggest that it improves patient outcome, shortens hospital stay, and decreases hospital costs. Despite these claims there is little support in the literature to justify the adoption of minimally invasive discectomy over standard open microsurgical discectomy. In the present study, the authors address some of these issues by comparing the short-term outcomes in patients who underwent first time, single-level lumbar discectomy at L3–4, L4–5, or L5–S1 using either a minimally invasive percutaneous, muscle splitting approach or a standard, open, muscle-stripping microsurgical approach. Methods A retrospective chart review of 172 patients who had undergone a first-time, single-level lumbar discectomy at either L3–4, L4–5, or L5–S1 was performed. Perioperative results were assessed by comparing the following parameters between patients who had undergone minimally invasive discectomy and those who received standard open microsurgical discectomy: length of stay, operative time, estimated blood loss, rate of cerebrospinal fluid leak, post-anesthesia care unit narcotic use, need for a physical therapy consultation, and need for admission to the hospital. Results Forty-nine patients underwent minimally invasive discectomy, and 123 patients underwent open microsurgical discectomy. At baseline the groups did differ significantly with respect to age, but did not differ with respect to height, weight, sex, body mass index, level of radiculopathy, side of radiculopathy, insurance status, or type of preoperative analgesic use. No statistically significant differences were identified in operative time, rate of cerebrospinal fluid leak, or need for a physical therapy consultation. Statistically significant differences were identified in length of stay, estimated blood loss, postanesthesia care unit narcotic use, and need for admission to the hospital. Conclusions In this retrospective study, patients who underwent minimally invasive discectomy were found to have similiar perioperative results as those who underwent open microsurgical discectomy. The differences, although statistically significant, are of modest clinical significance.

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The role of bedside assistant during robot assisted radical prostatectomy: Is more experience better? Analysis on perioperative and clinical outcomes

Urologia Journal ◽

10.1177/0391560320951085 ◽

2020 ◽

pp. 039156032095108

Author(s):

Mario Salvatore Mangano ◽

Claudio Lamon ◽

Francesco Beniamin ◽

Alberto De Gobbi ◽

Matteo Ciaccia ◽

...

Keyword(s):

Radical Prostatectomy ◽

Blood Loss ◽

Clinical Outcomes ◽

Operative Time ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Robot Assisted ◽

Estimated Blood Loss ◽

Bedside Assistant ◽

The Impact

Objectives: To analyze the impact of the bedside assistant’s experience during RARP. It is believed that the outcome of robotic surgery during Robot Assisted Radical Prostatectomy (RARP) for prostate cancer depends not only on the console surgeon’s experience. Materials and Methods: All consecutive RARPs from January 2017 to March 2018 were sourced from a prospectively maintained database. All cases were performed by the same surgeon. He was supported by three bedside assistants: one with bedside and console experience, one only with relevant bedside experience, one basically inexperienced. The patient’s parameters analyzed: age, Body Mass Index (BMI), previous abdominal surgery, prostate volume (by TRUS), pre-operative PSA, bioptic grading. Surgical outcomes analyzed included skin-to-skin operative time and estimated blood loss; clinical outcomes included length of hospital stay and time to catheter removal; the oncological outcome was represented by positive surgical margin rate. Results: A total of 116 RARPs were identified: 38 RARPs were performed with the console experienced bedside assistant, 38 with the experienced one, 40 with the novice one. The variables were similar between the three groups. As far as outcomes are concerned, there were no statistically significant differences between the three bedside assistants in terms of operative time, estimated blood loss, length of stay, days of catheterization, positive surgical margin rate.

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Feasibility of robot-assisted radical prostatectomy in elderly patients: Comparative analysis of the perisurgical/oncological outcomes with younger patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.111 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 111-111

Author(s):

Noriyoshi Miura ◽

Osuke Arai ◽

Ryuta Watanabe ◽

Yuichiro Sawada ◽

Seiji Asai ◽

...

Keyword(s):

Comparative Analysis ◽

Radical Prostatectomy ◽

Blood Loss ◽

Elderly Patients ◽

Urinary Continence ◽

Robot Assisted ◽

Younger Patients ◽

Oncological Outcomes ◽

Elder Patients ◽

Estimated Blood Loss

111 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 631 consecutive patients who underwent RARP from 9/2012 to 6/2016 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 555 men were age less than 75 and 76 men were ≥75. Preoperative parameters (age, PSA, Gleason score) were similar in both younger and high elder groups. Operative time (median: 180 vs. 180 minutes) and estimated blood loss were similar in both groups. One of elder patients (1.4%) needed transfusion. Peri/post-operative complications over grade 3 were 0.9% in younger group and 1.4% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates in organ-confined (pT2) disease were also similar (13.4%, younger vs. 17.9%, elder). Continence at 3 months was 73% in elder patients as opposed to 77% in younger patients. Biochemical recurrences in short follow-up period (median 11.1 vs. 11.0 months) were observed 7.9% in elder patients as opposed 8.3% in younger patients. Conclusions: In our study, although urinary continence recovery in high elderly patients might show a short delay, RARP in high elderly patients was relatively safe and yielded good oncologic results. RARP is feasible even in elderly patients.

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Feasibility of robot-assisted radical prostatectomy in high elderly patients: Comparative analysis of the perisurgical/oncological outcomes with younger patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.120 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 120-120 ◽

Cited By ~ 1

Author(s):

Noriyoshi Miura ◽

Terutaka Noda ◽

Kenichi Nishimura ◽

Tetsuya Fukumoto ◽

Yutaka Yanagihara ◽

...

Keyword(s):

Comparative Analysis ◽

Radical Prostatectomy ◽

Blood Loss ◽

Elderly Patients ◽

Robot Assisted ◽

Younger Patients ◽

Open Conversion ◽

Oncological Outcomes ◽

Elder Patients ◽

Estimated Blood Loss

120 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 553 consecutive patients who underwent RARP in 3 institutes from 6/2013 to 2/2018 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 477 men were age less than 75 and 76 men were ≥75. Preoperative parameters (PSA, T factor) were similar in both younger and high elder groups. But Gleason score was higher in elder group than younger group ( p=0.009). Operative time (median: 232 vs. 212 minutes) and estimated blood loss (median 100 ml vs 100 ml) were similar in both groups. Two of elder patients (3.8%) needed transfusion. Peri/post-operative all grade complications were 1.4%/6.5% in younger group and 3.8%/9.6% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates were also similar (29.5%, younger vs. 23.7%, elder). Both younger patients (93.6%) and elder patients (90.3%) recovered their continence at 12 months. After a median follow-up of 33.0 months, the 3-year PSA-free survival rates were 86.0% for elder patients and 88.9% for younger patients (p>0.05). Conclusions: In our study, RARP in high elderly patients was relatively safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes. RARP is feasible even in elderly patients.

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