Da Vinci Robotic Radical Research Articles

V13-12 SINGLE PORT DA VINCI ROBOTIC RADICAL ADRENALECTOMY VIA MCBURNEY INCISION

You have accessJournal of UrologyCME1 May 2022V13-12 SINGLE PORT DA VINCI ROBOTIC RADICAL ADRENALECTOMY VIA MCBURNEY INCISION Jason Elyaguov, Mubashir Billah, Michael Stifelman, and Mutahar Ahmed Jason ElyaguovJason Elyaguov More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002646.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Incidental adrenal masses are often benign and biopsy is not recommended. However, malignant potential exists in 6% of lesions >4cm and as high as 25% in lesions over 6cm, as a result surgical resection is recommended for masses over 5cm. Robotic resection today is considered standard of care, and the single port approach is novel and minimally described. In this video, we aim to review da Vinci single port (SP) access for left adrenalectomy via a McBurney incision as well as describe robotic instrument and assistant port configuration via the specialized da Vinci SP globe and demonstrate surgical technique for efficient and safe adrenal gland excision. METHODS: 59 year old male initially presented with left flank pain and CT imaging showed large left renal cysts as well as an incidental heterogenous 4.8 cm x 3.9 cm left adrenal mass with mixed attenuation. Full metabolic workup was normal. Surveillance MRI showed the mass to be >5cm and therefore patient elected for surgical resection. He underwent an SP left adrenalectomy in the right lateral decubitus position via a McBurney incision employing the specialized multi-access SP globe port, allowing for optimal dissection. We highlight efficient and judicious use of bipolar cautery in ligating the adrenal vein and excising out the adrenal gland. RESULTS: The patient tolerated the procedure well with a total operative time of 78 minutes and minimal blood loss. No intra-abdominal drain was placed, while a Foley catheter was removed 12 hours post operatively. The patient was discharged within 24 hours with no residual symptoms or complications at 90-day follow-up. The small single incision healed very well. Final pathology favored adrenal adenoma with a 4.2cm tumor and positive-free margins. CONCLUSIONS: SP da Vinci robotic adrenalectomy with multi-access globe port is feasible and safe. The McBurney incision allows for efficient access to the renal hilum and avoids risk of midline hernia, while providing excellent cosmesis and minimal pain. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1034 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Elyaguov More articles by this author Mubashir Billah More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF DownloadLoading ...

Sustainable long-term results on postoperative sexual activity after radical prostatectomy when a clinical sexologist is included in the sexual rehabilitation process. A retrospective study on 7 years postoperative outcome.

IntroductionThe aim of this study was to perform a retrospective evaluation of long-term sustainability of a postoperative combined penile and sexual rehabilitation program involving a clinical sexologist (CS) for preoperative fully potent men undergoing daVinci robotic radical prostatectomy (dVRP) regardless of whether preservation of the neurovascular bundles was performed or not.Material and methodsThe study included 79 preoperatively potent and sexually active patients (aged 45–74 years, mean 61) that had undergone a dVRP due to localized prostate cancer and during the 1st postoperative year participated in a combined penile and sexual rehabilitation program involving a CS. The subjects were followed up with the same interview and questionnaires at approximately 1, 3 and 7 years postoperatively. The interview and questionnaires addressed erectile function (EF), erectile dysfunction (ED) treatment, frequency of penetrating sexual activity, patient’s perceptions of sexual life (LISAT-8).ResultsOne year postoperatively, 84% of patients were sexually active with penetrating sex, 15% with unassisted normal erections. 45% found their postoperative sexual life satisfactory (LISAT-8, question #6). Three years postoperatively, 76 patients were evaluable, 73% were sexually active with penetrating sex, 19% with unassisted normal erections. Furthermore, 56% of patients found their postoperative sexual life to be satisfactory. Seven years postoperatively, 74 patients were evaluable, 74% were sexually active with penetrating sex, 44% with unassisted normal erections. A total of 59% of patients found their postoperative sexual life to be satisfactory. The reasons for not having penetrating sex were diverse.ConclusionsInvolvement of a CS in a postoperative combined penile and sexual rehabilitation program appears to improve the possibility of an acceptable sexual life and function one year after surgery. These results appear to be sustainable in the long-term.

258 Sustainable longterm results in sexual function and activity after prostate cancer surgery, using a postoperative rehabilitation program with involvement of a clinical sexologist. A seven year follow-up

To evaluate long term sustainability of a postoperative combined penile and sexual rehabilitation program involving a clinical sexologist(CS) for preoperative fully potent men undergoing daVinci Robotic Radical Prostatectomy (dVRP) regardless of preservation of the neurovascular bundles or not. 79 preoperatively potent and sexually active patients (ages 45-74 years mean 61) that had a dVRP due localized Prostate cancer and during the 1st postoperative year participated in a combined penile and sexual rehabilitation program involving a CS with the aim to improve the postoperative outcome on erectile function, sexual activity and satisfaction, regardless of nerve sparing procedure or not. The subjects were followed-up at approximately 3 and 7 years postoperatively with the same combined telephone interview and questionnaires as at the end of the rehabilitation program 1 year postoperatively. The interview and questionnaires addressed Erectile Function(EF), Erectile Dysfunction(ED) treatment, frequency of penetrating sexual activity, patient’s perceptions of sexual life postoperatively as compared preoperatively LiSAT 8 question # 6 sexual life, marital status, reasons for not being sexually active postoperatively.

Clinical efficacy of single-port Da Vinci robotic surgical system in the radical resection of rectal cancer

Objective To explore the clinical efficacy of single-port Da Vinci robotic surgical system in the radical resection of rectal cancer. Methods The retrospective descriptive study was conducted. The clinical data of one patient with rectal cancer who was admitted to the Southwest Hospital of the Third Military Medical University in June 2017 was collected. The patient underwent the first case of radical resection of rectal cancer with the single-port Da Vinci robotic surgical system, and intraoperatively received laparoscopy-assisted digestive tract reconstruction. Observation indicators: (1) intra- and post-operative situations; (2) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect patients′ survival up to July 2017. Results (1) Intra- and post-operative situations: the patient underwent successful single-port Da Vinci robotic radical resection of rectal cancer. The operation time and volume of intraoperative blood loss were 145 minutes and 20 mL, without blood transfusion. The using time of nonsteroidal analgesic drug, time for out-of-bed activity, time to anal exsufflation, time of fluid diet intake and time of pelvic drainage tube removal were 1 day, 24 hours, 48 hours, 72 hours and 4 days after operation, respectively. No postoperative complication was detected. Results of postoperative pathological examination: moderate-differentiated rectal adenocarcinoma invaded serosal layer, with negative circumferential margin, negative distal margin of rectum and mesenteric lymph node metastasis (1 of 16 harvested lymph nodes was positive). Pathologic staging was T4aN1M0 (stage Ⅲb). The patient was discharged from hospital at postoperative day 6. (2) Follow-up and survival: the patient was followed up for 1 month, with a good survival. Conclusion Single-port Da Vinci robotic surgical system in the radical resection of rectal cancer is safe and feasible, with good short-term outcomes. Key words: Rectal neoplasms; Radical section; Da Vinci robotic surgical system; Single site

Change of carcinomacmbryonic-antigen and dopa decarboxylase in the peritoneal irrigation fluid from patients undergoing Da Vinic robotic, laparoscopic or open radical gastrectomy for gastric cancer

Objective To explore the change of carcinomacmbryonic-antigen (CEA) and dopa decarboxylase (DDC) in the peritoneal irrigation fluid from patients undergoing Da Vinic robotic,laparoscopic and open radical gastrectomy for gastric cancer.Methods The clinical data of 126 patients undergoing radical gastrectomy for gastric cancer at the Southwest Hospital from January 2013 to March 2014 were retrospectively analyzed.There were 42 patients in the Da Vinic robotic radical gastrectomy group (RRG group),42 in the laparoscopic radical gastrectomy group (LRG group) and 42 in the open radical gastrectomy group (ORG group).The preoperative and postoperative peritoneal irrigation fluids were collected,respectively.Concentrations of CEA and DDC in the peritoneal irrigation fluids were detected by the enzyme-linked immunosorbent assay (ELISA).The quantitative data were analyzed using the t test and the chi-squared test,the multiple comparison were analyzed using the least significance difference (LSD) and the count data were analyzed using the chi-square test and nonparametric test.Results The preoperative and postoperative concentrations of CEA in the RRG group,LRG group and ORG group were (242 ± 189)xg/L,(221 ± 174)μg/L,(257 ± 135) μg/L and (1 262 ± 785) μg/L,(1 172 ± 699) iμg/L,(2 996 ± 1 947) μg/L,respectively.The preoperative and postoperative concentration of DDC in the RRG group,LRG group and ORG group were (8 ±5)μg/L,(7 ±4)μg/L,(8 ±6)μg/L and (87 ±55) μg/L,(81 ±52) pg/L,(146 ± 135)μg/L,respectively.No significant differences were observed for the preoperative concentrations of CEA and DDC in the 3 groups (F =0.491,0.161,P ＞ 0.05),and the postoperative concentration of CEA and DDC in the 3 groups were significantly different (F =27.214,6.865,P ＜ 0.05).The postoperative concentration of CEA and DDC in the ORG group were significantly higher than those in the RRG group and LRG group (P ＜ 0.05),while no significant differences in the postoperative concentration of CEA and DDC were observed between the LRG group and RRG group (P ＞ 0.05).The preoperative and postoperative concentrations of CEA and DDC were significantly increased in all the 3 groups,with a significant difference when compared with the preoperative concentrations of CEA and DDC (t =-11.053,-11.700,-9.780,-10.261,-9.955,-6.969,P ＜0.05).Conclusion The postoperative concentration of CEA and DDC in the peritoneal irrigation fluid after Da Vinic robotic radical gastrectomy is significant decreased when compared with the open radical gastrectomy,while no significant difference is observed between the Da Vinci robotic radical gastrectomy and the laparoscopic radical gastrectomy,which is helpful for preventing CEA-and DDC-mediated abdominal metastasis of gastric cancer. Key words: Gastric neoplasms; Da Vinic robotic surgery system; Laparoscopy; Carcino-embryonic antigen ; Dopa decarboxylase

Anatomic Guide for Port Placement for DaVinci Robotic Radical Prostatectomy

Anatomic Guide for Port Placement for DaVinci Robotic Radical Prostatectomy

Anatomic guide for port placement for daVinci robotic radical prostatectomy.

At present, robotic arm port placement for daVinci trade mark robot-assisted laparoscopic radical prostatectomy is based on the umbilicus. However, the robotic arm has a maximum manufactured required working distance of 25 cm. Accordingly, normal variability of patient height, weight, and umbilical location can leave the working arms too short to reach the membranous urethra. We present data to support port placement using the pubis, rather than the umbilicus, as the landmark. If we assume the 25-cm working distance of the robot arm (Z) equals the hypotenuse of a triangle and the Y axis is the sum of the distance from the membranous urethra to the skin (Y1) plus the displacement of the skin secondary to CO(2) insufflation (Y2), then the horizontal distance X is from the robot port site to the pubis. To ascertain Y1, we randomly selected the CT scans of 25 men and measured the depth from the skin over the pubis to the membranous urethra. To determine Y2, we measured the change in height from the table of the port site after CO(2) insufflation in 11 robotic laparoscopic prostatectomies. The average distance of Y1 was 11 cm; Y2 was 6 cm. Using the formula (Z(2) - (Y1 + Y2)(2))(1/2), the maximum distance X from the port site to the pubis, for an average man, should not exceed 18 cm. The optimal landmark for calculating the placement of ports for the daVinci robotic arm placement should be the pubis and not the umbilicus. Tall men (>72 inches) are at risk for exceeding functional robot arm length, and in these men, port sites should not be more than 18 cm from the pubis.