1,721,064 research outputs found
Transperineal Approach for Intracorporeal Ileal Conduit Urinary Diversion Using a Purpose-built Single-port Robotic System: Step-by-step
No full textIntroduction: To describe a step-by-step technique for single-port transperineal intracorporeal ileal conduit urinary diversion using a purpose-built robotic platform. Technical considerations: In one male cadaver, the da Vinci SP1098 surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used to perform intracorporeal ileal conduit urinary diversion by a transperineal approach after radical cystoprostatectomy and bilateral pelvic lymph node dissection. The surgery was completed through a 2.5-cm perineal incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) and a dedicated 25-mm multichannel port accommodating a 12-mm × 10-mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments, and a 6-mm accessory laparoscopic instrument were placed. Moreover, at the planned level of the cutaneostomy, a 12-mm port to accommodate the Endo-GIA was placed. The primary outcomes were the technical feasibility, the operative time, and the record of eventual procedural complications. The intervention was successfully completed without any conversion or need for additional ports. The total operative time was 200 minutes. Operative time for urinary diversion was 90 minutes. Conclusion: We demonstrated the feasibility of single-port transperineal intracorporeal ileal conduit urinary diversion using the SP1098 purpose-built robotic platform. Limitations include the preclinical setting. The applicability in the clinical model is awaited to be tested after the platform will be commercially available
Robotic Urologic Surgical Interventions Performed with the Single Port Dedicated Platform: First Clinical Investigation
No full textWe report the first clinical investigation for surgical procedures performed using the da Vinci SP robotic surgical platform (Intuitive Surgical, Sunnyvale, CA, USA) during the first 10 days (September 28-October 12, 2018) after the system was installed at our institution. The aim of the study was to determine the feasibility and safety of major urologic procedures, measured as the rate of conversions and the incidence of perioperative complications. Secondary aims of the study consisted of key perioperative surgical outcomes, including operative time, blood loss, and length of stay. Pathology data were reported. Data collection was performed under institutional review board approval (IRB 13-780). A total of nine patients were treated (3 robot-assisted radical prostatectomies, 3 transperitoneal robot-assisted partial nephrectomies, 1 simple cystectomy with intracorporeal ileal conduit urinary diversion, 2 ureteral reimplantations). No intraoperative complications occurred. In six cases the surgeries were performed according to a pure single-site approach. The mean operative time was slightly longer than that reported for the corresponding multiarm robotic procedures in the literature, which can easily be explained by the expected learning curve. One minor and one major complication occurred. A learning curve exists when embarking with this surgery. Further investigations are awaited
Technique for Docking and Port Placement Using a Purpose-built Robotic System (SP1098) in Human Cadaver
No full textObjectives: To describe step-by-step the port placement and the robot docking of the new purpose-built robotic platform for R-LESS. The feasibility of different approaches to the pelvic fossa and the retroperitoneum was reported in cadaver models. Methods: This was a preclinical study on human cadavers to assess the feasibility of the da Vinci SP1098 surgical system for R-LESS pelvic fossa and retroperitoneal urological surgeries. We used the SP1098 to perform R-LESS prostatectomies and cystoprostatectomies with transperineal and transvesical approaches, and nephrectomies (radical or partial) with retroperitoneal approach. The primary outcome was to report the port placement and docking. The technical feasibility of the procedures was then demonstrated as measured by the need for adjunctive ports or the occurrence of intraoperative complications. Operative times were recorded. Results: A total of 14 procedures were performed on 12 human cadavers. Namely 4 prostatectomies and 2 cystoprostatectomies with transperineal approach, 3 transvesical prostatectomies, 1 retroperitoneal radical, and 4 retroperitoneal partial nephrectomies. Operative times were in line with those of standard multiport robotic surgery. Neither additional ports nor percutaneous instruments were required. No intraoperative complications occurred. Limitations include the preclinical model, the small sample size, and the lack of a control group. Conclusion: In this preclinical model, the port placement and robot docking using the SP1098 robotic platform is reproducible and feasible for pelvic fossa and retroperitoneal urological surgeries
Single-Port Robot-Assisted Radical Prostatectomy: First Clinical Experience Using The SP Surgical System
No full textObjectives: To describe the first clinical experience with the novel purpose-built single-port robotic platform after Food Drug Administration approval. Methods: Two male patients diagnosed with prostate cancer amenable of radical prostatectomy underwent single-port robot-assisted radical prostatectomy with bilateral pelvic lymph-nodes dissection performed by using the da Vinci SP Surgical System (Intuitive Surgical, Sunnyvale, CA). The surgeries were completed through a 2.5-cm periumbilical incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA) and the dedicated 25-mm multichannel port accommodating a 12 × 10 mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments and a 6-mm accessory laparoscopic instrument were placed. One port for the assistant was placed at the level of the para-rectal line, at the planned final site for the drainage. The primary aim was to report, for the first time in the United States after Food Drug Administration approval of the system, the technical feasibility in the living human. The secondary aim was to report the perioperative outcomes. Results: The surgeries were successfully completed without conversion. In both cases, the total operative time was 140 minutes. Blood loss was negligible. No complications were recorded. Patients were discharged within 24 hours postoperation. Conclusions: Herein, we documented the first clinical application of the SP surgical platform for single-port transumbilical robot-assisted radical prostatectomy in the United States. This approach will be further investigated regarding the surgical morbidity and the outcomes
“At-risk” kidney: How surgical factors influence renal functional preservation after partial nephrectomy
No full textObjectives: To investigate the influence of surgical modifiable factors on chronic kidney disease upstaging in a contemporary cohort of patients with normal and "at-risk" kidneys undergoing partial nephrectomy. Methods: We reviewed 778 consecutive patients with (n = 634)/without (n = 144) chronic kidney disease or risk factors for chronic kidney disease in our institutional partial nephrectomy database. Chronic kidney disease upstaging was assessed using glomerular filtration rate measurements preoperatively and at 3-12 months postoperatively. Using a multivariate logistic regression, baseline clinicodemographic factors, and the operative measurements of excisional volume loss and warm and cold ischemia time on rates of chronic kidney disease upstaging were determined. Marginal effects were used to analyze the impact of ischemia time and generate interaction curves. Results: Chronic kidney disease/risk factors for chronic kidney disease had equivalent rates of chronic kidney disease upstaging as the healthy kidney cohort (31.5% vs 38.2%, P = 0.15). Of the entire cohort, 2.8% were upstaged to stage IV-V chronic kidney disease. Multivariate analysis found a significant association between chronic kidney disease upstaging and excisional volume loss in both cohorts (no chronic kidney disease/risk factors for chronic kidney disease: odds ratio 1.63, P = 0.04; chronic kidney disease/risk factors for chronic kidney disease: odds ratio 1.42, P = 0.001). Only in the chronic kidney disease/risk factors for chronic kidney disease cohort, there was an association between ischemia type/duration and chronic kidney disease upstaging (odds ratio 1.04, P = 0.04). Warm ischemia began to predict an increased risk of chronic kidney disease upstaging at 17.6 min, which became statistically significant at 49 min. Conclusions: Chronic kidney disease upstaging is common after partial nephrectomy. Although volume loss unequivocally affects rates of upstaging irrespective of baseline renal function, warm ischemia time disproportionately influences "at-risk" kidneys. Therefore, strong consideration should be given to minimizing volume loss and using cold ischemia when extended clamp times are anticipated in "at-risk" kidneys
Single-port Robotic Intracorporeal Ileal Conduit Urinary Diversion During Radical Cystectomy Using the SP Surgical System: Step-by-step Technique
No full textObjective: To describe the step-by-step technique for robotic intracorporeal ileal conduit urinary diversion (ICUD) following radical cystectomy performed by using the novel da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA). Methods: Four consecutive patients (2 males and 2 females) were initially counseled for robotic cystectomy with ICUD performed by using the da Vinci SP surgical system. Surgeries were performed by duplicating the steps of the institutional approach for intracorporeal ICUD performed with the multiarms robotic platform. Perioperative outcomes were analyzed. Data were collected under institutional review board approval (IRB 13-780). Results: Single-port robot-assisted radical cystectomy with ICUD was successfully completed in 3 patients (2 males and 1 female). Mean robotic operative time for ICUD was 75 minutes (range 67-90). There was no conversion to standard multiarms robotic approach. One patient needed to be converted to extracorporeal urinary diversion due to severe adhesions of small bowels. No additional ports were placed. Neither transfusions nor intraoperative complications occurred. All patients were discharged on postoperative day 5. One patient reported self-limited nausea and vomiting after discharge (Clavien grade I). Conclusion: In our preliminary experience, ICUD after robot-assisted radical cystectomy is feasible using the da Vinci SP surgical system. Further comparative studies with open and multiarms robotic approaches are warranted
The evolution and resurgence of perineal prostatectomy in the robotic surgical era
No full textPurpose: To review the recent advances in terms of surgical technique and new robotic platforms applied to radical perineal prostatectomy (RPP). Methods: A literature review was performed focusing on original articles on perineal prostatectomy searching via Medline/Pubmed and Embase. The entire spectrum was covered such as development of surgical technique including pelvic lymphadenectomy, adoption of novel surgical platforms, learning curve and future directions. Results: Surgical removal of the prostate plays a significant role on the treatment of localized prostate cancer (PCa). RPP was the first surgical approach described for radical prostatectomy. This technique declined in popularity secondary to the development of the retropubic approach. Recently, the appearance of novel robotic technology has generated renewed interest in the perineal approach. Conclusion: There has been a recent resurgence on the interest of radical perineal prostatectomy for the treatment of localized PCa driven by the advent of new robotic surgical technologies into the field. Future studies are needed to better determine the learning curve of the perineal approach and its current role in the treatment of prostate cancer
Robot-assisted surgery for benign distal ureteral strictures: step-by-step technique using the SP ® surgical system
Full text linkObjectives: To describe the step-by-step techniques for robot-assisted ureteric reimplantation performed using the Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA, USA), including different case scenarios with an educational purpose. Materials and methods: Three consecutive patients diagnosed with distal benign ureteric strictures were counselled for ureteric reimplantation and consented to undergo surgery performed using the da Vinci SP surgical system. Demographics and peri-operative outcomes were collected after institutional review board approval (IRB 13-780). Patients provided informed consent having received an explanation for the adoption of the novel platform. The first patient was a woman referred to our institution for a left distal ureteric stricture after total hysterectomy for uterine fibroids with ureteric injury. The second patient was a man with BPH and recurrent UTIs, who was diagnosed with a 1.5-cm bladder stone and a large bladder diverticulum compressing the left distal ureter. The third patient was a man diagnosed with bilateral uretero-enteric anastomoses stricture status after radical cystectomy with orthotopic ileal neobladder urinary diversion for bladder cancer. Results: The procedures were successfully completed. An extra port through a separate skin incision for the bedside assistant was placed for the first two procedures. In such cases, this additional port was used electively from the start of the procedure and did not represent a change in the treatment plan. Moreover, the port wound was used to accommodate the drainage. The bilateral ureteric reimplantation, however, was completed according to a pure single-site approach (no extra ports were placed out of the GelSeal cap). The mean operating times were 165, 150 and 180 min, respectively. Blood loss was 50 mL in all cases. No intra-operative complications occurred. Patients were discharged on postoperative days 1, 1 and 2, respectively, with normal serum creatinine levels. Neither transfusions nor major complications occurred. Conclusion: Robot-assisted reconstructive surgery for benign distal ureteric strictures is feasible and safe using the da Vinci SP surgical system
Robot-assisted repair for ureteroileal anastomosis stricture after cystectomy: technical points
Full text linkAIM: Uretero-ileal anastomosis strictures (UAS) occur in 3 to 11% of patients who undergo ileal conduit urinary diversion after cystectomy. We aimed to demonstrate our surgical technique for robotic repair of UAS after cystectomy, focusing on the technical points. MATERIALS AND METHODS: We present the case of a 75 year-old male with right hydronephrosis status post cystectomy with ileal conduit urinary diversion. Da Vinci Si® surgical system (Intuitive Surgical, Sunnyvale, CA) was docked and access into the abdominal cavity was gained. Uretero-ileal anastomosis was identified followed by ureteral stent visualization guiding the dissection. Stent was cut and further ureteral dissection was performed to maximize the length. Ureter was spatulated and specimen was sent for frozen section. Ileal conduit was incised at the site of the planned ureteral reimplantation. A new ureteral stent was inserted and the uretero-ileal anastomosis was performed. Thereafter, the previous site of the right ureteral anastomosis was closed. RESULTS: Operative time was 120 minutes. Blood loss was 60mL. No perioperative complications occurred. Patient was discharged on postoperative day 1. Technical points for outcomes optimization during UAS robotic repair: 1) Preoperative placement of a ureteral stent is required for guidance and urinary diversion, 2) Port placement should be tailored according to the previous surgical site, 3) Maximal ureteral dissection facilitates reimplantation, 4) Frozen section from the stricture is mandatory to rule out malignancy. CONCLUSIONS: In our experience, UAS repair is feasible and reproducible using a minimally invasive robotic approach. Comparative studies with open surgical approach are warranted
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