Extraperitoneal Radical Prostatectomy Research Articles

Laparoscopic extraperitoneal radical cystoprostatectomy: for whom and how?

Background. Laparoscopic radical cystectomy is an established reliable minimally invasive method for the treatment of muscle-invasive bladder cancer. However, in the elderly and patients with serious comorbidities, laparoscopic radical cystectomy is still associated with high risk of complications. There are only a few reports on the use of extraperitoneal access for laparoscopic radical cystectomy in the literature. At the same time, extensive experience has been accumulated in laparoscopic extraperitoneal radical prostatectomy and retroperitoneoscopic operations on the kidney showing significant advantages of extraperitoneal access. Aim. To present initial results of laparoscopic radical cystectomy through extraperitoneal access in medically ill patients.Materials and methods. Between 2017 and 2021, extraperitoneal laparoscopic radical cystectomy was performed at the Volgograd Regional Uronephrology Center in four male patients with tumors affecting the bladder, stages T2–T4. All patients had serious comorbidities. In 3 patients, grade G2–G3 muscle-invasive bladder cancer was histologically verified prior to cystectomy. Two of them had invasion in the posterior urethra. One patient was diagnosed with prostate adenocarcinoma (Gleason score 8 (5 + 3)) with invasion into the bladder wall, ureterohydronephrosis and stage IV chronic kidney disease. None of the patients received neoadjuvant therapy: in 2 cases surgeries were emergency due to recurrent hemorrhages, and 3 patients had significantly decreased kidney function.Results. All operations were performed completely laparoscopically through extraperitoneal access. In 1 case, urine diversion was performed transperitoneally into a colon conduit. Simultaneous retroperitoneoscopic ureterocutaneostomy was performed in two patients: on one side (in a patient with a single functioning kidney) and on both sides, respectively. In a patient with stage V chronic kidney disease and permanent dialysis, bilateral simultaneous retroperitoneal nephrectomies were performed.In 2 patients, salvage cystectomy was done for recurrent bleeding that couldn’t be managed by conservative methods. The maximum intraoperative blood loss did not exceed 500 mL. Bowel function in all patients was recovered within 24–36 hours after the intervention.Conclusion. Laparoscopic  extraperitoneal radical cystectomy is a reproducible minimally invasive surgical procedure for bladder cancer treatment that has advantages in terms of postoperative recovery in patients with severe comorbidities. The use of extraperitoneal access may be a rational alternative for salvage cystectomy in male patients. More observations are needed to determine the place of the method in the surgical treatment of muscle invasive bladder cancer.

Transperitoneal Versus Extraperitoneal Approach for Laparoscopic and Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis.

To conduct a comparative analysis of outcomes from 2 different surgical approaches, transperitoneal radical prostatectomy (TP-RP) and extraperitoneal radical prostatectomy (EP-RP) in minimally invasive surgery. A comprehensive search was conducted up to September 2022 using 5 online databases, namely PubMed, Cochrane, Scopus, EMBASE, and Science Direct. Studies were screened per the eligibility criteria, and outcomes included operative duration, estimated blood loss (EBL), hospital stay, operative complication, and positive surgical margin. Total of 13 studies compiled of 2387 patients were selected, with TP-RP and EP-RP performed on 1117 (46.79%) and 1270 (53.21%) patients, respectively. Six laparoscopy radical prostatectomy (LRP) studies and 7 robotassisted radical prostatectomy (RARP) studies with 1140 and 1247 patients, respectively, were also included. The EP-RP demonstrated a marked advantage in terms of operative complications (Risk Ratio [RR]=0.78, 95% CI=0.62, 0.98; P=.04), but no significant difference concluded for operative duration, EBL, hospital stay, and surgical margin. In the RARP group, there was a significant difference in operative duration for EP-RARP and TP-RARP (Mean difference [MD]=-17.27, 95% CI=-26.89, -7.65; P=.0004), hospital stay (MD=-0.54, 95% CI=-0.94, -0.14; P=.008), and operative complications (RR=0.7, 95% CI=0.49, 0.99; P=.04). There were no noteworthy variations identified in EBL and surgical margin. Furthermore, the LRP group did not show any significant differences. This study shows that regardless of the techniques used, EP-RP has a lower risk of operative complications than TP-RP, with no significant difference in other outcomes.

Single-port robot-assisted radical prostatectomy with the novel Shurui single-port robotic surgical system.

The aim of the present study was to explore the safety and efficacy of radical prostatectomy with a novel Shurui single-port robotic surgical system. A total of 11 patients with prostate cancer were enrolled in this study. Extraperitoneal radical prostatectomy was performed using the Shurui single-port robotic surgical system for all patients. Clinicopathologic data, perioperative data, and short-term surgical outcomes were prospectively collected and analyzed. Of the 11 patients, the median age was 65 years (range, 52-73), and the median body mass index was 22.6 kg/m2 (range, 20.2-26.7). The median operative time was 229 minutes (range, 194-317), and the median console time was 167 minutes (range, 141-265). The median blood loss was 40 mL (range, 10-120), and none of the patients required intraoperative transfusion. There was no conversion to open surgery during the operation, and no assistant ports were added. The surgeons reported a good task load rating with a NASA-TLX score of 25.1±3.3 points. The median postoperative hospital stay time was 7 days (range, 4-15). There were no severe intraoperative or postoperative complications (claviene grade≥3). Postoperative positive surgical margin occurred in 4 (36.4%) patients. No biochemical recurrence occurred within 1 month of surgery. The continence rate was 72.7% (8/11) at 1 month after surgery. The new Shurui single-port robotic surgical system is safe, effective, flexible, and stable for application in radical prostatectomy.

MP80-14 EXTRAPERITONEAL SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY IN OVER 700 PATIENTS: UPDATED MULTI-INSTITUTIONAL COHORT STUDY FROM THE SPARC COLLABORATION

You have accessJournal of UrologyCME1 Apr 2023MP80-14 EXTRAPERITONEAL SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY IN OVER 700 PATIENTS: UPDATED MULTI-INSTITUTIONAL COHORT STUDY FROM THE SPARC COLLABORATION Ethan Ferguson, Jennifer L. Nguyen, Roxana Ramos, Grace Chen, Kennedy Okhawere, Samantha Wilder, Ruth Sanchez De La Rosa, Jaya Chavali, Indu Saini, James Peabody, Ketan K. Badani, Craig Rogers, Jeffrey Nix, Jean Joseph, Michael Stifelman, Simone Crivellaro, Mutahar Ahmed, Moses Kim, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Jennifer L. NguyenJennifer L. Nguyen More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Grace ChenGrace Chen More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Jaya ChavaliJaya Chavali More articles by this author , Indu SainiIndu Saini More articles by this author , James PeabodyJames Peabody More articles by this author , Ketan K. BadaniKetan K. Badani More articles by this author , Craig RogersCraig Rogers More articles by this author , Jeffrey NixJeffrey Nix More articles by this author , Jean JosephJean Joseph More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Simone CrivellaroSimone Crivellaro More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , Moses KimMoses Kim More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An extraperitoneal approach to single-port (SP) robot-assisted radical prostatectomy has been demonstrated with proposed benefits in decreased morbidity, single incision, and same-day discharge. We sought to determine the perioperative and early postoperative outcomes in a large, multi-institutional setting. METHODS: SP extraperitoneal radical prostatectomy was performed in 712 patients between February 2019 and October 2022. All procedures were performed by experienced robotic surgeons from eight tertiary medical centers. Data from baseline demographics, perioperative and early postoperative outcomes were collected prospectively and analyzed retrospectively RESULTS: All reported procedures were completed without open conversion, blood transfusions, or intraoperative complications. The median follow-up time was 11.7 months for the entire cohort. The median age, BMI and preoperative PSA were 64 years, 27.9kg/m2, and 6.4 ng/mL, respectively. About 30% of the patients had at least one previous abdominal surgery. On pathology, high risk disease was noted in 12% and lymph node involvement on final pathology was present in 5.8%. Extraprostatic extension was noted in 38% and positive surgical margins were present in 30.2% of cases. Lymphadenectomy was performed in 85% of patients and the median lymph node yield was 5 nodes. There were no intraoperative complications and inadvertent peritoneal entry with insufflation was rare (0.6%) and managed conservatively. Postoperative complications occurred in 11.8%. The median length of stay and foley catheter duration were 8 hours and 7 days, respectively. Postoperative recovery of continence was 69% at 3 months and 88% at 6 months. Recovery of potency was 35.6% at 6 months. CONCLUSIONS: Single-port extraperitoneal robotic radical prostatectomy is safe and feasible for management of clinically localized prostate cancer. Analysis from a large multi-institutional cohort shows promising single incision and short hospital length of stay without compromise in early functional or oncologic outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1157 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Jennifer L. Nguyen More articles by this author Roxana Ramos More articles by this author Grace Chen More articles by this author Kennedy Okhawere More articles by this author Samantha Wilder More articles by this author Ruth Sanchez De La Rosa More articles by this author Jaya Chavali More articles by this author Indu Saini More articles by this author James Peabody More articles by this author Ketan K. Badani More articles by this author Craig Rogers More articles by this author Jeffrey Nix More articles by this author Jean Joseph More articles by this author Michael Stifelman More articles by this author Simone Crivellaro More articles by this author Mutahar Ahmed More articles by this author Moses Kim More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

UPGRADING OF LAPAROSCOPIC INTERVENTION OF THE PROSTATE GLAND TUMORS

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.
 The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).
 Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.
 Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).
 Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

THE VALUE OF METHODS FOR DIAGNOSING ALVEOLAR RHABDOMYOSARCOMA: A CLINICAL CASE

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.
 The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).
 Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.
 Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).
 Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

THE VALUE OF METHODS FOR DIAGNOSING ALVEOLAR RHABDOMYOSARCOMA: A CLINICAL CASE

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.
 The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).
 Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.
 Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).
 Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

UPGRADING OF LAPAROSCOPIC INTERVENTION OF THE PROSTATE GLAND TUMORS

Relevance: Laparoscopic surgery supplies many benefits due to lower postoperative sequelae. Laparoscopic radical prostatectomy has become a first-line treatment for patients with localized prostate cancer worldwide.
 The study aimed to compare outcomes after traditional laparoscopic extraperitoneal radical prostatectomy with modified laparoscopic extraperitoneal radical prostatectomy (MLERPE).
 Methods: All information about patient treatment for this historical cohort study was obtained from the “Electronic In-patient Registry” of the Republic of Kazakhstan. The study included case records of 94 patients who underwent laparoscopic extraperitoneal radical prostatectomy from 2017 to 2021. Of them, 45 underwent a modified laparoscopic prostatectomy, and 49 – a traditional laparoscopic prostatectomy. Data are presented as the means ± standard deviation or as frequencies and percentages. Pearson’s Chi-square was used for qualitative data. T-test and Mann-Whitney U test were used to compare the means of the two groups. The statistical significance level was 0.05.
 Results: We revealed significant differences between the laboratory parameters of both groups after surgery. The mean difference in hemoglobin level between the two groups was 14.04, the mean difference in erythrocyte level was 0.69, the mean difference in leukocyte level was 1.26, and the mean difference in ESR level was 2.01. All differences were statistically significant (p=0.000). We found a statistical difference in the duration of operation and hospital stay between the two groups (p=0.000).
 Conclusion: The modified laparoscopic technique avoids adverse worse outcomes such as bleeding, pneumoperitoneum, and decreasing oxygen saturation. This technique is also beneficial in the early postoperative period for excluding peritonitis, and the late postoperative period avoids adhesive processes.

A comprehensive comparison between mpMRI of the prostate, MR-US fusion biopsy and whole mount histopathology.

To compare multiparametric magnetic resonance imaging (mpMRI) findings, US-MR fusion prostate biopsy results and whole-mount thin-section histopathology after radical prostatectomy. Overall 259 patients,who had undergone mpMRI with lesions reported as PI-RADS 3-5, underwent a MR-US fusion biopsy between 2018 and 2020.Overall 186 biopsies yielded prostate cancer and 104 patients subsequently underwent endoscopic extraperitoneal radical prostatectomy. Histopathology of biopsies was compared to the final histopathology in whole mount thin sections after radical prostatectomy by means of descriptive statistics, and further, the lesions from mpMRT were compared to whole mount histology. Prostate cancer was diagnosed in 186 (71.8%) of 259 patients (median age 69.2 y, range 42-82 y, median PSA 7.8ng/ml, range 2.1-31.3ng/ml). Of those, 95 (51,1%) underwent radical endoscopic prostatectomy, and 80 (43%) chose radiotherapy or active surveillance. In 52/95 (54,7%) with RPE additional lesions were found in the final histological whole mount sections not described at mpMRI. 22/95 (23,2%) of RPE patients had ≥ 1 additional Gleason score ≥ 7 lesions, 23 /259 (8,4%) of biopsies, respectively. The Gleason score after surgery was upgraded in 37/95 (38,9%) and downgraded in 18/95 (18,9%) patients. If we compare all 259 performed biopsies with the final histological whole mount sections which showed additional lesions with Gleason ≥ 7 (23,2%), it can be assumed that up to 10% ofclinical significant carcinomas are missed during primary assessment via mpMRI. The majority of additional findings after RP were intermediate/high risk tumors. Upgrades from low-risk to intermediate or high-risk occurred.

Comparison of Perioperative, Functional, and Oncological Outcomes of Transperitoneal and Extraperitoneal Laparoscopic Radical Prostatectomy.

This study aimed to compare the oncological, functional, and perioperative outcomes of localized and locally advanced prostate cancer treated with intraperitoneal or extraperitoneal laparoscopic radical prostatectomy (LRP). From April, 2008, through December, 2020, 266 patients underwent laparoscopic radical prostatectomy, 168 cases with an extraperitoneal approach (E-LRP) and 98 cases using a transperitoneal approach (T-LRP). The clinical, perioperative, functional, and oncological outcomes were collected and compared between these groups. At the 3-, 12- and 24-monthfollow-ups, the functional outcomes tested were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC). The oncological outcomes of biochemical recurrence, biochemical recurrence-free survival, and positive surgical margin status were evaluated. Univariable and multivariable Cox regression analyses were used to identify factors predictive for biochemical recurrence. All statistical analyses used the R program. The patient characteristics were similar between the E-LRP and T-LRP groups except for higher prostatic-specific antigen (PSA) in the T-LRP group. The T-LRP had lower overall operative time (222.5 min vs. 290 min, p 0.001), decreased blood loss (400 ml vs. 800 ml, p < 0.001), and shorter hospital stays (4 days vs. 7 days, p < 0.001) compared to the E-LRP. Early sexual intercourse with penetration at 3 months was higher in the T-LRP group (36.7% vs. 15.5%, p 0.001). Urinary continence (no pads) was not different between the T-LRP and E-LRP groups at 3 and 24 months after surgery but higher in the E-LRP group at 12 months (1% vs. 3%; p=0.419, 85.1 vs. 83.7%; p=0.889, 47.4% vs. 34.6%; p=0.028, respectively). The EPIC questionnaire was used to assess functional outcomes at 3, 12, and 24 months after surgery and found that urinary function was significantly higher in the T-LRP group at 3 and 12 months (p < 0.001) but did not show a difference at 24 months (p=0.734), and sexual function scores were higher in the T-LRP group at 12 and 24 months (p=0.001). The positive surgical margin rate was higher in the E-LRP (38.7% vs. 21.4%; p=0.006). The BCR rate was not different between the groups (36.3% in the E-LRP group and 27.6% in the E-LRP group; p=0.184). Transperitoneal laparoscopic radical prostatectomy (T-LRP) was found to be superior to extraperitoneal radical prostatectomy (E-LRP) in perioperative outcomes such as decreased operative time, decreased blood loss, shorter hospital stay, lower positive surgical margin, and improved early sexual intercourse and sexual function. The urinary functional outcome was better in the T-LRP group at 3 and 12 months. These findings support the use of transperitoneal laparoscopic radical prostatectomy, as our study patients exhibited significant benefits from this procedure.

Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched Study

To compare the perioperative and early postoperative outcomes between single-port (SP) extraperitoneal radical prostatectomy (EPRP) and SP transperitoneal radical prostatectomy (TPRP), in a multi-institutional setting. We identified all patients who underwent SP robot-assisted radical prostatectomy at 6 different institutes. Data of 650 patients were collected and divided into 2 groups based on the surgical approach: SP EPRP or SP TPRP. A Propensity-score matched-pair analysis for body mass index (BMI), prostate size, and National Comprehensive Cancer Network risk was performed with a 1:1 ratio. Analysis of perioperative and postoperative outcomes was performed using Wilcoxon signed-rank test and chi-square and Fisher's exact tests. After matching, 238 patients were included in each arm. The median follow-up period was 7 and 6 months for EPRP and TPRP groups, respectively. The total operative time was longer in the EPRP group (206 vs 155 minutes, P < .001). The EPRP group had a shorter length of hospitalization and same-day discharge rate compared to the TPRP approach (P < .001). There was no difference in the overall intraoperative or postoperative complications rate between the 2 groups, nor positive surgical margin rates. The SP extraperitoneal approach is associated with a shorter hospital stay and higher rate of same-day discharge, with no difference in the surgical margin, or complication rates.

Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis.

To compare our initial perioperative and postoperative outcomes of the single-port (SP) transvesical radical prostatectomy (TVRP) approach with the single-port extraperitoneal radical prostatectomy (ERP) approach. Initial consecutive seventy-eight patients underwent SP TVRP between December 2020 and October 2021. Patients with extensive previous abdominal surgeries, or low- to intermediate-risk prostate cancer were selected. Data of consecutive 169 patients treated with SP ERP between February 2019 and November 2020, were used for comparison. Optimal matched-paired analysis of PSA value, biopsy Gleason score, and prostate volume was performed. Preoperative, perioperative, and early functional outcomes were included in the analysis. The median follow-up was 7months and 9months for TVRP and ERP groups respectively. The median total operative time was longer in the TVRP compared to the ERP group (p = .002). There were no differences in intraoperative complications or surgical margin status. TVRP group had less rate of grade 3a Clavien-Dindo complications (p = .026). The Foley catheter duration was 3 (3, 4) days in the TVRP group compared to 7 (7, 8) days in the ERP group (p < .001). There was a consistently improved continence rate in the TVRP group at 6weeks (72% TVRP, 48% ERP, p = .004), 3months (97% TVRP, 81% ERP, p = .008), and 6months postoperatively (100% TVRP, 93% ERP, p = .047). There was no difference in biochemical recurrence at 6months of follow-up. In our initial series, TVRP allows for a faster continence recovery, without other functional or oncological compromises.

MP32-13 TRANSPERITONEAL RADICAL PROSTATECTOMY USING THE SENHANCE ROBOTIC SYSTEM: INITIAL CASE SERIES, LEARNING CURVE AND COST ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP32-13 TRANSPERITONEAL RADICAL PROSTATECTOMY USING THE SENHANCE ROBOTIC SYSTEM: INITIAL CASE SERIES, LEARNING CURVE AND COST ANALYSIS Yen-Chun Lin, Lun-Hsiang Yuan, Shi-Wei Huang, Yu-Wen Huang, and Chao-Yuan Huang Yen-Chun LinYen-Chun Lin More articles by this author , Lun-Hsiang YuanLun-Hsiang Yuan More articles by this author , Shi-Wei HuangShi-Wei Huang More articles by this author , Yu-Wen HuangYu-Wen Huang More articles by this author , and Chao-Yuan HuangChao-Yuan Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002581.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Senhance robotic surgical system (TransEnterix Inc, Morrisville, NC, USA) is a novel laparoscopy-based robotic system, equipped with eye tracking system, haptic feedback system, and reusasble instruments. Currently, only two studies reported their experiences on extra-peritoneal radical prostatectomy. To assess the feasibility, learning curve and cost analysis of the transperitoneal Senhance robotic radical prostatectomy. METHODS: From Aug 2019 to July 2021, the Senhance robotic radical prostatectomies were performed in 44 biopsy confirmed prostate cancer patients.Perioperative data were collected. Complications were graded with Clavien-Dindo classification. Learning curve was analyzed with CUSUM (cumulative summation) method classified by surgeon’s laparoscopic experiences. Total cost for the each operation was also recorded. RESULTS: The median patient age was 67 [64-71.5] years with a mean body mass index of 25.35 [23.3-27.9] kg/m2. The median ASA score was 2±0.35. Median operative time was 246 (107-340) minutes. The median blood loss was 162.5 [50-287.5]ml. Foleys were removed at a median of 7 (3-17) days after surgery. There were 10 cases (22.7%) with Clavien-Dindo grade I/II complications and no case with grade III or IV complications. Among 44 patients, 17( (38.6%) had positive margins, of those 6 cases (13.6%) in pT2 and 11 (25.0%) cases in pT3. Total cost for each Senhance robotic radical prostatectomy was NT$61000-110000 (about US $2200-3970), compared with NT$180000-250000 (abouot US 6400-8900) in da Vinci robotic radical prostatectomy in Taiwan. CONCLUSIONS: The Senhance robotic system is technically feasible and economically affordable. The learning curve depends on surgeons laparoscopic experiences. It may serve as an alternative tool for robotic radical prostatectomy. Source of Funding: nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e536 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yen-Chun Lin More articles by this author Lun-Hsiang Yuan More articles by this author Shi-Wei Huang More articles by this author Yu-Wen Huang More articles by this author Chao-Yuan Huang More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP57-10 SINGLE-PORT EXTRAPERITONEAL ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL COHORT STUDY

You have accessJournal of UrologyCME1 May 2022MP57-10 SINGLE-PORT EXTRAPERITONEAL ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL COHORT STUDY Mahmoud Abou Zeinab, Ethan Ferguson, Aaron Kaviani, Alp T. Beksac, Luca Morgantini, Susan Talamini, Jean Joseph, Moses Kim, Simone Crivellaro, Jeffrey Nix, and Jihad Kaouk Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Aaron KavianiAaron Kaviani More articles by this author , Alp T. BeksacAlp T. Beksac More articles by this author , Luca MorgantiniLuca Morgantini More articles by this author , Susan TalaminiSusan Talamini More articles by this author , Jean JosephJean Joseph More articles by this author , Moses KimMoses Kim More articles by this author , Simone CrivellaroSimone Crivellaro More articles by this author , Jeffrey NixJeffrey Nix More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted radical prostatectomy through the extraperitoneal approach has increased in popularity after the introduction of the single-port (SP) da Vinci platform. We sought to evaluate the perioperative and postoperative outcomes in a multi-institutional setting. METHODS: From February 2019 to October 2021, data of 412 patients who underwent SP extraperitoneal radical prostatectomy (ERP) in five different institutions were prospectively collected. All procedures were performed by surgeons with extensive robotic and SP experience. Baseline demographics, intraoperative, functional, and short oncological outcomes were evaluated. RESULTS: The median follow-up was time was 8 months. The median cohort age, BMI, and preoperative PSA were 64 years, 29 kg/m2, and 6.6 ng/mL respectively. 23.8% of the cohort were at high-risk prostate cancer according to the NCCN classification. Almost 30% of the patients had at least one previous abdominal surgery. The median operative time and estimated blood loss were 205 minutes and 150 cc, respectively. A nerve-sparing approach was performed in more than 90% of the patients and 3 cases had peritoneal breach. On pathology, the positive surgical margins were 26.8% and the median lymph node yield was 6 nodes. Most of the patients were discharged a few hours after the surgery with a median pain score of 2. In the postoperative phase, 50% and 90% of the patients were continent within 3 and 6 months, respectively. 40% of the patients restored their sexual function by 6 months. CONCLUSIONS: The Single-port extraperitoneal robotic-assisted radical prostatectomy is a minimally invasive approach in the management of localized prostate cancer. It is a suitable approach for patients with previous abdominal surgeries. This approach offers patients with promising outcomes in terms of single incision, minimal pain and same-day discharge without compromising the functional or oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e984 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahmoud Abou Zeinab More articles by this author Ethan Ferguson More articles by this author Aaron Kaviani More articles by this author Alp T. Beksac More articles by this author Luca Morgantini More articles by this author Susan Talamini More articles by this author Jean Joseph More articles by this author Moses Kim More articles by this author Simone Crivellaro More articles by this author Jeffrey Nix More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF DownloadLoading ...

Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method.

Single-port (SP) was recently implemented as an alternative robotic system for extraperitoneal radical prostatectomy (EPP). The primary aim of this study is to characterize the learning curve (LC) for the SP-EPP for an experienced multi-port (MP) robotic surgeon. All consecutive SP-EPP cases (N=150) performed by a single surgeon from initial experience in a high-volume tertiary care center were prospectively included. The cumulative sum Method (CUSUM) was used retrospectively to create the LCs for SP-EPP surgery based on several outcomes used to gauge the surgeon's performance relative to those previously obtained with the current gold standard (MP-Robot Assisted Radical Prostatectomy (MP-RALP);N=80). The evaluation of a surgical transition from MP to SP prostatectomy analyzed with the Statistical Process Control and the CUSUM method revealed a smooth and safe LC divided into four phases of 30-40 cases and a decrease of surgical time, blood loss and postoperative complication rate after the first learning phase.

V08-10 SP EXTRAPERITONEAL RADICAL PROSTATECTOMY: TECHNIQUE AND LESSONS ON THE BRINK OF 200 CASES

INTRODUCTION AND OBJECTIVE:Enthusiasm for the robotic extraperitoneal radical prostatectomy (RERP) has been renewed with the introduction of the Da Vinci Single Port (SP) robotic platform. Our earl...

Functional and Perioperative Outcomes of Extraperitoneal Laparoscopic Radical Prostatectomy versus Transperitoneal in University-Based Hospital

Functional and Perioperative Outcomes of Extraperitoneal Laparoscopic Radical Prostatectomy versus Transperitoneal in University-Based Hospital

The application and outcomes of C. R.P.C. four-step radical prostatectomy under extraperitoneal laparoscopy

Objective To summarize the preliminary experience of extraperitoneal laparoscopic radical prostatectomy (C.R.P.C. four-step) for localized prostate cancer and the outcomes based on early follow-up. Methods A total of 102 prostate cancer patients were screened by prostate specific antigen (PSA) and diagnosed by prostate magnetic resonance imaging and prostatic puncture biopsy with cT1c-cT3b, with average age of (67±5) years old, average preoperative total PSA value of (45.32±18.33) ng/ml, and average prostate volume was (42±12)cm3. All these patients underwent extraperitoneal laparoscopic radical prostatectomy by the four-step technique, abbreviating as C. R.P.C.[C: control DVC (dorsal deep venous complex). R: recognize three anatomical layers (prostate and bladder junction, seminal vesicle, and Denonvilliers’fascia surface). P: preserve urethral sphincter and bladder neck. C: continuous anastomosis between urethra and bladder neck (4 key needles at 3, 5, 7 and 9 o’clock)]. The operative time, estimated blood loss, length of hospital stay and postoperative complications were recorded, and the postoperative PSA was followed up. Results All the 102 cases were successfully treated by laparoscopic radical prostatectomy. The operative time was from 55 to 156 min (mean 92 min), and the estimated blood loss was from 55 to 185 ml (mean 105 ml). There was no case converted of open surgery, only one case received blood transfusion for postoperative hemorrhage (0.98%), and positive surgical margin was found in 15 case (14.70%) by pathological examination. Postoperative urinary extravasation within one week occurred in 2 (1.96%) cases, and resolved after tensioning the catheter and prolonging the indwelling time. During the follow-up period of 12 to 45 months, 2 cases were incontinent (grade Ⅰ-Ⅱ), and the other cases(98.04%) had no incontinence or dysuria . However, 11 cases(10.78%) developed to biochemical recurrence within 6 months after the operation. Conclusions The C. R.P.C. four-step technique of lparoscopic radical prostatectomy is easily to be grasped and performed by the greenhand urologists, and was efficient and safe. Key words: Prostatic neoplasms; Radical prostatectomy; Extraperitoneal laparoscopy; Prostate cancer; Four-step method; Curative effect

Extraperitoneal radical prostatectomy with the Senhance Surgical System robotic platform

Extraperitoneal radical prostatectomy with the Senhance Surgical System robotic platform

Extended pelvic lymph node dissection during extraperitoneal laparoscopic or robotic assisted radical prostatectomy

Objective: Extraperitoneal access in endoscopic (laparoscopicic or robotic assisted) radical prostatectomy is a standard approach in the management of prostatic cancer with well-established advantages over transperitoneal access. Still, traditionally, extraperitoneal endoscopic radical prostatectomy (EERP) has been associated with an inability to offer an extended pelvic lymph node dissection (PLND). The former is due to the fact that in the extraperitoneal space, peritoneal folding covers the majority of common iliac vessels and as a result in extraperitoneal PLND, lymph nodes (LNs) located above the bifurcation of common iliac vessels cannot be dissected. We herein present a simple and easy technique to offer an extended PLND during EERP. Methods: After a conventional extraperitoneal PLND, a peritoneal fenestration cranially to extrernal iliac vessels is performed bilaterally exposing the common iliac vessels. Results: Upon peritoneal fenestration, PLND can be continued in a standard fashion as in transperitoneal approach until the uppermost limit of the extended PLND template which is the ureteral crossing over common iliac vessels. Following LN dissection, both peritoneal fenestrations are left open at both sides, as this approach has been found to decrease the incidence of postoperative lymphocele formation. Conclusions: Peritoneal fenestration over common iliac vessels during extraperitoneal PLND is an easy approach that allows surgeon to reach the uppermost limit of extended PLND template. The latter peritoneal dissection is not time consuming and is expected to decrease the morbidity of the operation reducing the incidence of postoperative lymphocele formation.