Combined Robotic Surgery for Double Renal Masses and Prostate Cancer: Myth or Reality?

With the widespread use of imaging modalities performed for the staging of prostate cancer, the incidental detection of synchronous tumors is increasing in frequency. Robotic surgery represents a technical evolution in the treatment of solid tumors of the urinary tract, and it can be a valid option in the case of multi-organ involvement. We reported a case of synchronous prostate cancer and bifocal renal carcinoma in a 66-year-old male. We performed the first case of a combined upper- and lower-tract robotic surgery for a double-left-partial nephrectomy associated with radical prostatectomy by the transperitoneal approach. A comprehensive literature review in this field has also been carried out. Total operative time was 265 min. Renal hypotension time was 25 min. Blood loss was 250 mL. The patient had an uneventful postoperative course. No recurrence occurred after 12 months. In the literature, 10 cases of robotic, radical, or partial nephrectomy and simultaneous radical prostatectomy have been described. Robotic surgery provides less invasiveness than open surgery with comparable oncological efficacy, overcoming the limitations of the traditional laparoscopy. During robotic combined surgery for synchronous tumors, the planning of the trocars’ positioning is crucial to obtain good surgical results, reducing the abdominal trauma, the convalescence, and the length of hospitalization with a consequent cost reduction. Rare complications can be related to prolonged pneumoperitoneum. Simultaneous robotic prostatectomy and partial nephrectomy appears to be a safe and feasible surgical option in patients with synchronous prostate cancer and renal cell carcinoma.

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A Review of the Robotic Radical Prostatectomy Outcomes

World Journal of Laparoscopic Surgery with DVD ◽

10.5005/jp-journals-10033-1184 ◽

2013 ◽

Vol 6 (2) ◽

pp. 69-73

Author(s):

Suhani Maharajh

Keyword(s):

Prostate Cancer ◽

Robotic Surgery ◽

Radical Prostatectomy ◽

Surgical Outcomes ◽

Survival Rates ◽

Intensity Modulated Radiotherapy ◽

Cancer Control ◽

Radical Retropubic Prostatectomy ◽

Range Of Movement ◽

Robotic Radical Prostatectomy

ABSTRACT Robotic radical prostatectomy was first performed in 2000. The superior range of movement as well as better ergonomics were clear advantages of this technology. This technology and its cost can however only be justified, if it has clear data confirming its equivalence or preferably superiority in management. Open radical retropubic prostatectomy has previously been the gold standard for oncological outcomes in organ confined prostate cancer. Follow-up data showed good 5-year cancer free survival and mortality and Walsh's technique contributed significantly to improvement of quality of life issues, such as sexual function. In spite of improved survival rates with other less invasive modalities, such as brachytherapy and intensity-modulated radiotherapy, the radical prostatectomy is still a popular treatment choice as there is long-term data to support evidence of durable cancer control. The recovery and cost of the open procedure has often been a disadvantage. Minimal access surgery was able to overcome these issues with good surgical outcomes. Robotic surgery may well be the next step in surgical and technological revolution and has the possibility of making minimally invasive surgery accessible to surgeons with less laparoscopic experience. This review will attempt to assess the outcomes of robotic surgery to determine if it is indeed a feasible option for the treatment of organ confined prostate cancer, by assessing the surgical outcomes. How to cite this article Maharajh S. A Review of the Robotic Radical Prostatectomy Outcomes. World J Laparosc Surg 2013;6(2):69-73.

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Disparities in Access to Hospitals with Robotic Surgery for Patients with Prostate Cancer Undergoing Radical Prostatectomy

The Journal of Urology ◽

10.1016/j.juro.2012.09.033 ◽

2013 ◽

Vol 189 (2) ◽

pp. 514-520 ◽

Cited By ~ 32

Author(s):

Simon P. Kim ◽

Stephen A. Boorjian ◽

Nilay D. Shah ◽

Christopher J. Weight ◽

Jon C. Tilburt ◽

...

Keyword(s):

Prostate Cancer ◽

Robotic Surgery ◽

Radical Prostatectomy

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Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

Journal of Clinical Oncology ◽

10.1200/jco.2011.36.8621 ◽

2012 ◽

Vol 30 (5) ◽

pp. 513-518 ◽

Cited By ~ 115

Author(s):

Michael J. Barry ◽

Patricia M. Gallagher ◽

Jonathan S. Skinner ◽

Floyd J. Fowler

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Adverse Effects ◽

Sexual Function ◽

Random Sample ◽

Open Surgery ◽

Mail Survey ◽

Population Based ◽

Robotic Prostatectomy ◽

Robotic Assisted

Purpose Robotic-assisted laparoscopic radical prostatectomy is eclipsing open radical prostatectomy among men with clinically localized prostate cancer. The objective of this study was to compare the risks of problems with continence and sexual function following these procedures among Medicare-age men. Patients and Methods A population-based random sample was drawn from the 20% Medicare claims files for August 1, 2008, through December 31, 2008. Participants had hospital and physician claims for radical prostatectomy and diagnostic codes for prostate cancer and reported undergoing either a robotic or open surgery. They received a mail survey that included self-ratings of problems with continence and sexual function a median of 14 months postoperatively. Results Completed surveys were obtained from 685 (86%) of 797 eligible participants, and 406 and 220 patients reported having had robotic or open surgery, respectively. Overall, 189 (31.1%; 95% CI, 27.5% to 34.8%) of 607 men reported having a moderate or big problem with continence, and 522 (88.0%; 95% CI, 85.4% to 90.6%) of 593 men reported having a moderate or big problem with sexual function. In logistic regression models predicting the log odds of a moderate or big problem with postoperative continence and adjusting for age and educational level, robotic prostatectomy was associated with a nonsignificant trend toward greater problems with continence (odds ratio [OR] 1.41; 95% CI, 0.97 to 2.05). Robotic prostatectomy was not associated with greater problems with sexual function (OR, 0.87; 95% CI, 0.51 to 1.49). Conclusion Risks of problems with continence and sexual function are high after both procedures. Medicare-age men should not expect fewer adverse effects following robotic prostatectomy.

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Application of Rapid Rehabilitation Nursing in Perioperative Period of Laparoscopic Radical Prostatectomy for Prostate Cancer Patients

Journal of Nanomaterials ◽

10.1155/2021/9934539 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Huimin Liu ◽

Ke Yang ◽

Fanghua Gong ◽

Yan Wu ◽

Sanhui Tang

Keyword(s):

Prostate Cancer ◽

Patient Satisfaction ◽

Radical Prostatectomy ◽

Perioperative Period ◽

Laparoscopic Radical Prostatectomy ◽

Control Group ◽

Stress Hormone ◽

Hospitalization Costs ◽

Experimental Group ◽

Length Of Hospitalization

The purpose of the study is to explore the application of rapid rehabilitation nursing strategy in the perioperative period of laparoscopic radical prostatectomy for patients with prostate cancer. A total of 120 patients with prostate cancer undergoing laparoscopic radical prostatectomy were randomly divided into two groups, with 60 cases per group. The control group was given routine nursing care, and the experimental group received rapid rehabilitation nursing strategies. The stress hormone (cortisol and norepinephrine) levels, patient satisfaction, length of hospitalization, hospitalization costs, and postoperative complication were compared between the two groups before and after nursing. The serum cortisol and norepinephrine levels in the control group before nursing were similar to those in the experimental group ( P > 0.05 ). The stress hormone levels in the experimental group were lower than those in the control group ( P < 0.05 ). It was found that the experimental group had reduced operation time, less intraoperative blood loss, shortened exhaust time, and hospitalization stay and was earlier to eat and to get out of bed than the control group ( P < 0.05 ). The time for the patients in the experimental group to pull out the drainage tube was significantly shorter than that of the control group ( P < 0.05 ), and the hospitalization costs were fewer than the control group ( P < 0.05 ). The rates of postoperative complications including nausea, vomiting, bleeding, and fever in the experimental group were significantly lower than those in the control group ( P < 0.05 ). In conclusion, the study suggests that rapid rehabilitation nursing strategies can reduce the stress hormone levels, shorten the length of hospitalization, reduce hospitalization costs, reduce postoperative complication rates, and improve patient satisfaction for prostate cancer patients undergoing laparoscopic radical prostatectomy, in support of clinical application.

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Combined Robotic-Assisted Retroperitoneoscopic Partial Nephrectomy and Extraperitoneal Prostatectomy. First Case Reported

Urologia Journal ◽

10.5301/ru.2011.8884 ◽

2011 ◽

Vol 79 (1) ◽

pp. 62-64 ◽

Cited By ~ 7

Author(s):

Andrea Guttilla ◽

Alessandro Crestani ◽

Fabio Zattoni ◽

Silvia Secco ◽

Fabrizio Dal Moro ◽

...

Keyword(s):

Radical Prostatectomy ◽

Partial Nephrectomy ◽

Clear Cell ◽

Left Kidney ◽

Robot Assisted ◽

Cell Renal Cell Carcinoma ◽

Robotic Assisted ◽

First Case ◽

History Of ◽

Robotic Assisted Partial Nephrectomy

A 54-year-old man with a history of prostate cancer and clear cell renal cell carcinoma of the left kidney underwent concomitant robot-assisted laparoscopic partial nephrectomy and radical prostatectomy. We report, to our knowledge, the first case of a concomitant retroperitoneal robotic-assisted partial nephrectomy and extraperitoneal radical prostatectomy.

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Feasibility of nephron sparing surgery in giant oncocytoma

Canadian Urological Association Journal ◽

10.5489/cuaj.1552 ◽

2014 ◽

Vol 8 (1-2) ◽

pp. 96

Author(s):

Albert El Hajj ◽

Ruban Thanigasalam ◽

Isabelle Boulay ◽

Vincent Molinié ◽

Bernard Escudier ◽

...

Keyword(s):

Partial Nephrectomy ◽

Radical Nephrectomy ◽

Young Patients ◽

Normal Functioning ◽

Renal Masses ◽

First Case ◽

Nephron Sparing ◽

Benign Tumours ◽

Functioning Kidney

Oncocytomas represent 3 to 7% of renal masses and behave as benign tumours. Nephron-sparing procedures are preferred for biopsy confirmed lesions; however, giant oncocytomas have been generally treated by radical nephrectomy. We report the first case of partial nephrectomy in a 45-year-old man who presented with a 20-cm oncocytoma. At the 1 year follow-up, he had a normal functioning kidney. Despite the difficulty of this procedure, partial nephrectomy for very large benign tumours can be considered in appropriately selected young patients.

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Future Directions of Robotic Surgery: A Case Study of the Cornell Athermal Robotic Technique of Prostatectomy

The Scientific World JOURNAL ◽

10.1100/tsw.2006.395 ◽

2006 ◽

Vol 6 ◽

pp. 2553-2559 ◽

Cited By ~ 1

Author(s):

Robert A. Leung ◽

Tara S. Kim ◽

Ashutosh K. Tewari

Keyword(s):

Prostate Cancer ◽

Robotic Surgery ◽

Radical Prostatectomy ◽

Localized Prostate Cancer ◽

Preoperative Imaging ◽

Future Directions ◽

Robotic Radical Prostatectomy ◽

Surgical Instrumentation

Robotic radical prostatectomy (RRP) has become an effective modality in the treatment of localized prostate cancer. We detail the experience at our institution and provide a perspective for future considerations of RRP with respect to improved preoperative imaging and surgical instrumentation.

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Symphysis Pubis Osteomyelitis: An Uncommon Complication after Robotic Assisted Radical Prostatectomy—Case Description with Literature Review

Case Reports in Urology ◽

10.1155/2018/5648970 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Jad A. Degheili ◽

Mazen M. Mansour ◽

Rami W. Nasr

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Voiding Dysfunction ◽

Robotic Prostatectomy ◽

Symphysis Pubis ◽

Solid Cancer ◽

Urological Procedures ◽

Robotic Assisted Radical Prostatectomy ◽

Pubis Symphysis ◽

Robotic Surgeries

Prostate cancer is the most common solid cancer among American men. Although there are various modalities for treatment, including radical prostatectomy among many others, the former is, nevertheless, not without any accompanied complications. Other than the well-known surgical complications such as erectile dysfunction, urinary incontinence, and voiding dysfunction, osteomyelitis of the symphysis pubis is not a well-understood complication, with various hypotheses explaining its pathogenesis. Although osteomyelitis of the pubis symphysis has been reported after endoscopic urological procedures such as transurethral resection of the prostate, it has rarely been reported after robotic surgeries. We hereby report, to the best of our knowledge, the first osteomyelitis of the pubis symphysis, after robotic prostatectomy, in a patient with prostate cancer and no previous radiation therapy.

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The importance of surgical access in the treatment of patients with prostate cancer and abnormal prostate anatomy

Siberian Journal of Oncology ◽

10.21294/1814-4861-2021-20-6-32-40 ◽

2022 ◽

Vol 20 (6) ◽

pp. 32-40

Author(s):

A. V. Zyryanov ◽

A. S. Surikov ◽

A. A. Keln ◽

A. V. Ponomarev ◽

V. G. Sobenin

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Blood Loss ◽

Comparison Group ◽

Prostate Volume ◽

Robotic Prostatectomy ◽

Study Group ◽

Open Prostatectomy ◽

Large Prostate ◽

Blood Loss Volume

Background. The increased volume of the prostate in patients with confirmed prostate cancer (pc) is observed in 10 % of cases. The limitations of external beam radiotherapy and brachytherapy associated with large prostate volume and obstructive symptoms define radical prostatectomy (Rp) as the only possible treatment for prostate cancer in these patients. The purpose of the study was to determine the importance of the surgical approach in radical prostatectomy in patients with abnormal anatomy of the prostate. Material and methods. The study group consisted of patients with a prostate volume of more than 80 cm3 (n=40) who underwent a robot prostatectomy. The comparison group was represented by patients also selected by the prostate volume ≥ 80 cm3, who underwent classical open prostatectomy (n=44). The groups were comparable in age and psa level. The average prostate volume in the study group was 112.2 ± 26 cm 3(80–195 cm 3). The average prostate volume in the comparison group was 109.8 ± 18.7 cm3 (80–158 cm 3) (р>0.05). Both groups had favorable morphological characteristics. Results. The average surgery time difference was 65 minutes in favor of the open prostatectomy (p<0.05). The average blood loss volume in the study group was 282.5 ± 227.5 ml (50–1000 ml). The average blood loss volume in the group with open prostatectomy was 505.7 ± 382.3 ml (50–2000 ml). Positive surgical margin in the robotic prostatectomy was not detected, at 6.9 % in the group with open prostatectomy (p<0.05). According to the criterion of urinary continence, the best results were obtained in the group of robotic prostatectomy (p<0.05). Overall and relapse-free 5-year survival did not show a statistically significant difference. Conclusion. The use of robotic prostatectomy in a group of patients with a large prostate volume (≥ 80 cm3) allows us to achieve better functional and oncological outcomes.

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Long-term patient outcomes from the first year of a robotic surgery program using multi-surgeon implementation

Canadian Urological Association Journal ◽

10.5489/cuaj.4528 ◽

2017 ◽

Vol 12 (2) ◽

pp. 38-43

Author(s):

Joshua Montroy ◽

Ehab Elzayat ◽

Chris Morash ◽

Brian Blew ◽

Luke T. Lavallée ◽

...

Keyword(s):

Robotic Surgery ◽

Radical Prostatectomy ◽

Treatment Failure ◽

Specific Antigen ◽

Positive Margin ◽

Robotic Prostatectomy ◽

First Year ◽

Historical Cohort ◽

Estimated Blood Loss

Introduction: There is concern that surgical quality initially declines during the learning phase of robotic surgery. At our institution, we used a multi-surgeon programmatic approach to the introduction of robotic surgery. The purpose of this study was to evaluate outcomes of patients treated during the first year of our program.Methods: This is a historical cohort of all radical prostatectomy patients during a one-year period. Baseline, perioperative, and long-term followup data were prospectively and retrospectively collected. Treatment failure was a composite of any postoperative radiation, androgen-deprivation, or prostate-specific antigen (PSA)≥0.2. Results: During the study period, 225 radical prostatectomy procedures were performed (104 robotic and 121 open). Baseline characteristics were similar between groups (p>0.05). All patients were continent and 74% were potent prior to surgery. Mean estimated blood loss (280 cc vs. 760 cc; p<0.001) and blood transfusion (0% vs. 8.3%; p=0.002) was lower in the robotic cohort. Non-transfusion complications were similar between groups (13% vs. 12%; p=0.7). Mean hospital stay was shorter in the robotic cohort (1.4 vs. 2.5 days). There was no difference in overall positive margin rate (38% vs. 43%; p=0.4) or treatment failure at a median followup of 3.5 years (p=0.4). Robotically treated patients were more often continent (89% vs. 77%; p=0.02) and potent (48% vs. 32%; p=0.02).Conclusions: Using an inclusive multi-surgeon approach, robotic prostatectomy was introduced safely at a Canadian academic institution.

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