scholarly journals Canada’s First Robotic Assisted Totally Intracorporeal Orthotopic Ileal Neobladder

2013 ◽  
Vol 7 (7-8) ◽  
pp. 537 ◽  
Author(s):  
Richard L. Haddad ◽  
Patrick Richard ◽  
Franck Bladou
Keyword(s):  
Operative Time ◽  
Technical Difficulty ◽  
Outcome Data ◽  
Ileal Neobladder ◽  
Total Operative Time ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Timely Completion ◽  
Muscle Invasive

Despite robotic-assisted radical cysto-prostatectomy being performed in several centres, the urinary diversion is most often performed extra-corporeal. A robotic intra-corporeal ileal neobladder is technically demanding and long-term functional outcome data is lacking. We performed a robotic intra-corporeal ileal neobladder in a 73-year-old man for muscle invasive non-metastatic bladder cancer. The total operative time was 6 hours 8 minutes. The estimated blood loss was 900 mL. There were no complications and he was discharged on day 12. The principles of open neobladder surgery were maintained, however key modifications were used to reduce technical difficulty and enable timely completion. We found that robotic intracorporeal ileal neobladder can be safely performed with an experienced robotic unit.

scholarly journals Three-port approach vs standard laparoscopic radical cystectomy with an ileal conduit: a single-centre retrospective study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhouting Tuo ◽  
Ying Zhang ◽  
Jinyou Wang ◽  
Huan Zhou ◽  
Youlu Lu ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Operative Time ◽  
Ileal Conduit ◽  
Oncological Outcome ◽  
Perioperative Outcomes ◽  
Post Surgery ◽  
Estimated Blood Loss ◽  
Muscle Invasive

Abstract Background This study aimed to evaluate the effect of the three-port approach and conventional five-port laparoscopic radical cystectomy (LRC) with an ileal conduit. Methods Eighty-four patients, who were diagnosed with high-risk non-muscle-invasive and muscle-invasive bladder carcinoma and underwent LRC with an ileal conduit between January 2018 and April 2020, were retrospectively evaluated. Thirty and fifty-four patients respectively underwent the three-port approach and five-port LRC. Clinical characteristics, pathological data, perioperative outcomes, and follow-up data were analysed. Results There were no differences in perioperatively surgical outcome, including pathology type, prostate adenocarcinoma incidence, tumour staging, and postoperative creatinine levels between the two groups. The operative time (271.3 ± 24.03 vs. 279.57 ± 48.47 min, P = 0.299), estimated blood loss (65 vs. 90 mL, P = 0.352), time to passage of flatus (8 vs. 10 days, P = 0.084), and duration of hospitalisation post-surgery (11 vs. 12 days, P = 0.922) were no clear difference between both groups. Compared with the five-port group, the three-port LRC group was related to lower inpatient costs (12 453 vs. 14 134 $, P = 0.021). Our follow-up results indicated that the rate of postoperative complications, 90-day mortality, and the oncological outcome did not show meaningful differences between these two groups. Conclusions Three-port LRC with an ileal conduit is technically safe and feasible for the treatment of bladder cancer. On comparing the three-port LRC with the five-port LRC, our technique does not increase the rate of short-term and long-term complications and tumour recurrence, but the treatment costs of the former were reduced.

scholarly journals Completely Intracorporeal Robotic-Assisted Laparoscopic Ileovesicostomy

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
MaryEllen T. Dolat ◽  
Greg Wade ◽  
B. Mayer Grob ◽  
Lance J. Hampton ◽  
Adam P. Klausner
Keyword(s):  
Perioperative Complications ◽  
Da Vinci Surgical System ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Long Term Follow Up ◽  
Spastic Paresis ◽  
Vinci Surgical System ◽  
Surgical System

We present a report of a completely intracorporeal robotic-assisted laparoscopic ileovesicostomy with long term follow-up. The patient was a 55-year-old man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction. The procedure was performed using a da Vinci Surgical system (Intuitive Surgical, Sunnyvale, CA) and took 330 minutes with an estimated blood loss of 100 mL. The patient recovered without perioperative complications. He continues to have low pressure drainage without urethral incontinence over two years postoperatively.

scholarly journals Attaining Proficiency in Robotic-Assisted Minimally Invasive Esophagectomy While Maximizing Safety during Procedure Development

2016 ◽  
Vol 11 (4) ◽  
pp. 268-273 ◽  
Author(s):  
Inderpal S. Sarkaria ◽  
Nabil P. Rizk ◽  
Rachel Grosser ◽  
Debra Goldman ◽  
David J. Finley ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Intraoperative Complications ◽  
Team Approach ◽  
Robotic Assisted ◽  
Invasive Esophagectomy ◽  
Estimated Blood Loss ◽  
Dedicated Team ◽  
Median Operative Time

Objective Robotic-assisted minimally invasive esophagectomy (RAMIE) is an emerging complex operation with limited reports detailing morbidity, mortality, and requirements for attaining proficiency. Our objective was to develop a standardized RAMIE technique, evaluate procedure safety, and assess outcomes using a dedicated operative team and 2-surgeon approach. Methods We conducted a study of sequential patients undergoing RAMIE from January 25, 2011, to May 5, 2014. Intermedian demographics and perioperative data were compared between sequential halves of the experience using the Wilcoxon rank sum test and the Fischer exact test. Median operative time was tracked over successive 15-patient cohorts. Results One hundred of 313 esophageal resections performed at our institution underwent RAMIE during the study period. A dedicated team including 2 attending surgeons and uniform anesthesia and OR staff was established. There were no significant differences in age, sex, histology, stage, induction therapy, or risk class between the 2 halves of the study. Estimated blood loss, conversions, operative times, and overall complications significantly decreased. The median resected lymph nodes increased but was not statistically significant. Median operative time decreased to approximately 370 minutes between the 30th and the 45th cases. There were no emergent intraoperative complications, and the anastomotic leak rate was 6% (6/100). The 30-day mortality was 0% (0/100), and the 90-day mortality was 1% (1/100). Conclusions Excellent perioperative and short-term patient outcomes with minimal mortality can be achieved using a standardized RAMIE procedure and a dedicated team approach. The structured process described may serve as a model to maximize patients’ safety during development and assessment of complex novel procedures.

scholarly journals Multicenter Experience with Nonischemic Multiport Laparoscopic and Laparoendoscopic Single-Site Partial Nephrectomy Utilizing Bipolar Radiofrequency Ablation Coagulator

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Wassim M. Bazzi ◽  
Mohamad E. Allaf ◽  
Jared Berkowitz ◽  
Hany N. Atalah ◽  
Sijo Parekattil ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Tumor Size ◽  
Operative Time ◽  
Single Site ◽  
Laparoendoscopic Single Site ◽  
Bipolar Radiofrequency ◽  
Estimated Blood Loss ◽  
Multicenter Retrospective Review ◽  
Term Data

Objective. To investigate feasibility of multiport and laparoendoscopic single-site (LESS) nonischemic laparoscopic partial nephrectomy (NI-LPN) utilizing bipolar radiofrequency coagulator. Methods. Multicenter retrospective review of 60 patients (46 multiport/14 LESS) undergoing NI-LPN between 4/2006 and 9/2009. Multiport and LESS NI-LPN utilized Habib 4X bipolar radiofrequency coagulator to form a hemostatic zone followed by nonischemic tumor excision and renorrhaphy. Demographics, tumor/perioperative characteristics, and outcomes were analyzed. Results. 59/60 (98.3%) successfully underwent NI-LPN. Mean tumor size was 2.35 cm. Mean operative time was 160.0 minutes. Mean estimated blood loss was 131.4 mL. Preoperative/postoperative creatinine (mg/dL) was 1.02/1.07 (). All had negative margins. 12 (20%) patients developed complications. 3 (5%) developed urine leaks. No differences between multiport and LESS-PN were noted as regards demographics, tumor size, outcomes, and complications. Conclusion. Initial experience demonstrates that nonischemic multiport and LESS-PN is safe and efficacious, with excellent short-term preservation of renal function. Long-term data are needed to confirm oncological efficacy.

scholarly journals Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek

2015 ◽  
Vol 7 (3) ◽  
pp. 369-375 ◽  
Author(s):  
Michael P. Smrtka ◽  
Ravindu P. Gunatilake ◽  
Benjamin Harris ◽  
Miao Yu ◽  
Lan Lan ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Operative Time ◽  
Resident Training ◽  
University Hospital ◽  
Skin Closure ◽  
Delivery Time ◽  
Total Operative Time ◽  
Duty Hours ◽  
Estimated Blood Loss ◽  
Time Required

ABSTRACT Background  In 2003, the Accreditation Council for Graduate Medical Education limited resident duty hours to 80 hours per week. More than a decade later, the effect of the limits on resident clinical competence is not fully understood. Objective  We sought to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery. Methods  We reviewed unlabored primary cesarean deliveries at Duke University Hospital after 34 weeks gestation, between 2003 and 2011. Descriptive statistics and linear regression were used to compare total operative time with incision to delivery time as a function of years since institution of the 80-hour workweek. Resident training level, subject body mass index, estimated blood loss, and skin closure method were controlled for in the regression model. Results  We identified 444 deliveries that met study criteria. The mean (SD) total operative time in 2003–2004 was 43.3 (14.3) minutes and 59.6 (10.7) minutes in 2010–2011 (P < .001). Multivariable regression demonstrated an increase in total operative time of 1.9 min/y (P < .001) but no change in incision to delivery time (P = .05). The magnitude of increased operative time was seen among junior residents (2.0 min/y, P < .001) compared to that of senior residents (1.2 min/y, P = .06). Conclusions  Since introduction of the 2003 duty hour limits, there has been an increase of nearly 20 minutes in the time required for a routine cesarean delivery. It is unclear if the findings are due to a change in residency duty hours or to another aspect of residency training.

scholarly journals Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2181
Author(s):  
Marco V. Marino ◽  
Adrian Kah Heng Heng Chiow ◽  
Antonello Mirabella ◽  
Gianpaolo Vaccarella ◽  
Andrzej L. Komorowski
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Pancreatic Fistula ◽  
Operative Time ◽  
Risk Group ◽  
High Risk Group ◽  
Retrospective Case ◽  
Pancreatic Anastomosis ◽  
Robotic Assisted ◽  
Estimated Blood Loss

Background: Different techniques of pancreatic anastomosis have been described, with inconclusive results in terms of pancreatic fistula reduction. Studies comparing robotic pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are scarcely reported. Methods: The present study analyzes the outcomes of two case-matched groups of patients who underwent PG (n = 20) or PJ (n = 40) after pancreaticoduodenectomy. The primary aim was to compare the rate of post-operative pancreatic fistula. Results: Operative time (375 vs. 315 min, p = 0.34), estimated blood loss (270 vs. 295 mL, p = 0.44), and rate of clinically relevant post-operative pancreatic fistula (12.5% vs. 10%, p = 0.82) were similar between the two groups. PJ was associated with a higher rate of intra-abdominal collections (7.5% vs. 0%, p = 0.002), but lower post-pancreatectomy hemorrhage (2.5% vs. 10%, p = 0.003). PG was associated with a lower rate of post-operative pancreatic fistula (POPF) (33.3% vs. 50%, p = 0.003) in the high-risk group of patients. Conclusions: The outcomes of post-operative pancreatic fistula are comparable between the two reconstruction techniques. PG may have a lower incidence of POPF in patients with high-risk of pancreatic fistula.

scholarly journals Early Robotic-Assisted Laparoscopic Pyeloplasty for Infants Under 3 Months With Severe Ureteropelvic Junction Obstruction

2021 ◽  
Vol 9 ◽  
Author(s):  
Pin Li ◽  
Huixia Zhou ◽  
Hualin Cao ◽  
Tao Guo ◽  
Weiwei Zhu ◽  
...  
Keyword(s):  
Renal Function ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Solitary Kidney ◽  
Laparoscopic Pyeloplasty ◽  
Renal Hypoplasia ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Feasible Option ◽  
The Mean

Objective: To present our primary experience of robotic-assisted laparoscopic pyeloplasty (RALP) for severe ureteropelvis junction obstruction (UPJO) infants under 3 months.Methods: We performed a retrospective study of 9 infants under 3 months who underwent RALP for severe UPJO between April 2017 and March 2019 in our center. The severe UPJO was defined as infants with severe hydronephrosis (Society of Fetal Urology grades III or IV, anteroposterior diameter >3 cm or split renal function <40% or T 1/2 >20 min) involving bilateral, solitary kidney, or contralateral renal hypoplasia UPJO at the same time. All clinical, perioperative, and postoperative information was collected.Results: There were four bilateral UPJO cases, two solitary kidney UPJO cases and three unilateral UPJO with contralateral renal hypoplasia cases included. One single surgeon performed RALP on all of the infants. The mean age of the infants was 1.62 ± 0.54 months. The mean operative time was 109.55 ± 10.47 min. The mean estimated blood loss was 19.29 ± 3.19 ml, and the mean length of hospital stay was 5.57 ± 0.73 days. According to the ultrasonography results, all patients had a significant recovery of renal function at 12 months after the operation.Conclusions: To maximize the protection of renal function, early RALP is a safe and feasible option for the treatment of severe UPJO in infants under 3 months.

scholarly journals Comparison of Trifecta Outcome Among Open, Laparoscopic, and Robotic-Assisted Partial Nephrectomy in Patients With Small Renal Masses: 10-Year Experience in Ramathibodi Hospital

2021 ◽  
Author(s):  
Chaichant Soisrithong ◽  
Wit Viseshsindh ◽  
Wisoot Kongchareonsombat ◽  
Charoen Leenanupunth ◽  
Wachira Kochakarn ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Intraoperative Complication ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Number Of Patients ◽  
Robotic Assisted Partial Nephrectomy

Abstract Purpose: To compare the trifecta outcome and perioperative and postoperative outcomes among open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic-assisted partial nephrectomy (RAPN) in patients with small renal masses in Ramathibodi Hospital.Methods: We retrospectively reviewed 141 patients who underwent partial nephrectomy from January 2009 to December 2018. The baseline characteristics and preoperative outcomes were compared among the three surgical approaches. Results: Among the 141 patients, 42 (29.79%), 29 (20.57%), and 70 (49.64%) patients underwent OPN, LPN, and RAPN, respectively. Among 116 patients with available data, 71 achieved the trifecta outcome [18 (56.25%), 14 (56.00%), and 39 (73.58%) in the OPN, LPN, and RAPN group, respectively; p=0.276]. The rate of conversion to OPN was higher in the LPN than RAPN group. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. The estimated blood loss was significantly lower in the LPN group than OPN and RAPN groups (p=0.041). The operative time was shorter in the OPN group than LPN and RAPN groups (p<0.001). Multivariate analysis showed that the intraoperative complication rate was a predictive factor for trifecta outcome achievement.Conclusion: OPN had the shortest operative time. LPN had the highest rate of conversion to OPN and lowest estimated blood loss. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. However, achievement of the trifecta outcome was not significantly different among the three groups. The predictive factor for trifecta outcome achievement was the intraoperative complication rate.

Robotic-assisted radical cystectomy with complete intracorporal diversion: Initial experience in a tertiary teaching hospital

2021 ◽  
pp. 205141582110391
Author(s):  
Yilu He ◽  
Ramesh Shanmugasundaram ◽  
Bishoy Hana ◽  
Steve P McCombie ◽  
Varun Bhoopathy ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Teaching Hospital ◽  
Median Number ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
Neo Adjuvant Chemotherapy ◽  
Muscle Invasive

Objective: The aim of this study was to report the outcomes from robotic-assisted radical cystectomy (RARC) at an Australian public teaching hospital since the introduction of this technique in 2012. Methods: A retrospective analysis was conducted on perioperative and pathological outcomes from a consecutive series of 43 patients who underwent RARC for bladder cancer between 2012 and 2020 at Nepean Public Hospital. Results: Median operative time was 352 minutes for 32 (74.4%) patients undergoing construction of an ileal conduit, 499 minutes for nine (20.9%) patients undergoing construction of a neo-bladder and 239 minutes for two (4.7%) patients undergoing percutaneous urostomy. Median estimated blood loss was 500 mL, and median length of stay was 12 days. Complications within 60 days of any grade occurred in 63.4% of patients, and major complications (Clavien–Dindo ⩾Grade III) occurred in 20.9% of patients. The median number of lymph nodes removed was 17. Positive surgical margins occurred in 11.6% of patients overall, all in patients with T3 and above disease. Neo-adjuvant chemotherapy was utilised in 34.9% of patients overall and in 71.4% of patients with muscle-invasive urothelial cancer. Conclusion: The perioperative and pathological outcomes from RARC at our institution are comparable to the international literature. Level of evidence Level 4.

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