Multiport Approach Research Articles

Full thoracoscopic segmentectomies for lung cancer: rational of a multiportal fissure-based approach

: Following the partial results of ongoing randomized trials, thoracoscopic anatomic sublobar resections (SLRs) may become the standard treatment of ground-glass opacities (GGO) and of some early- stage lung carcinomas. However, these procedures are challenging. The performance of closed-chest pulmonary segmentectomies, especially for complex ones, requires a meticulous dissection of bronchovascular elements. A thorough preparation facilitates the procedure. In this article, we review the different technical and technological aspects of the multiportal approach with fissure-first dissection. Prerequisites are (I) precise preoperative study of the anatomical variations, based on 3D reconstructions or 3D printing, (II) preoperative evaluation of safety margins, based on a virtual margin, (III) for small nodules, localization of the target using either preoperative or intraoperative marking, (IV) fissure-based approach to allow extensive dissection of bronchovascular elements, (V) intraoperative analysis of resection margins and intersegmental lymph nodes in order to extend resection in case on invaded margin or lymph node, (VI) accurate delineation and division of the intersegmental plane. Technical and technological helpful means are discussed in this article.

Uniportal thoracoscopic lateral and posterior basal segmentectomy using intersegmental tunneling: Comparison with multiportal approach

Thoracoscopic lateral and posterior basal (S9 + 10) segmentectomy (or S10 segmentectomy) is one of the most technically challenging anatomical segmentectomies. We have used "intersegmental tunneling" in the multiportal approach, and we now apply this with a little ingenuity in the uniportal approach. However, because of interference between instruments and the limited insertion angles in the uniportal approach, complex segmentectomies such as S9 + 10 or S10 become even more difficult. The perioperative outcomes were compared between uniportal and multiportal thoracoscopic lateral and posterior basal segmentecomy using intersegmental tunneling. There were no significant differences between the groups in patient characteristics and perioperative outcomes other than operation time, which was significantly shorter in the uniportal group than in the multiportal group (169 ± 21 vs 216 ± 34 min, P=.011). Thoracoscopic S9 + 10 (S10) segmentectomy can be safely performed through the uniportal approach without any difficulties using an intersegmental tunneling method and adding a little ingenuity.

MP50-14 SINGLE PORT VS MULTI PORT ROBOTIC RENAL SURGERY: ANALYSIS OF PERIOPERATIVE OUTCOMES FOR EXCISION OF HIGH AND LOW COMPLEXITY RENAL MASSES

You have accessJournal of UrologyCME1 May 2022MP50-14 SINGLE PORT VS MULTI PORT ROBOTIC RENAL SURGERY: ANALYSIS OF PERIOPERATIVE OUTCOMES FOR EXCISION OF HIGH AND LOW COMPLEXITY RENAL MASSES Grant Henning, Joel Vetter, Nicholas Pickersgill, Arjun Sivaraman, R. Sherburne Figenshau, and Eric Kim Grant HenningGrant Henning More articles by this author , Joel VetterJoel Vetter More articles by this author , Nicholas PickersgillNicholas Pickersgill More articles by this author , Arjun SivaramanArjun Sivaraman More articles by this author , R. Sherburne FigenshauR. Sherburne Figenshau More articles by this author , and Eric KimEric Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is limited data on the safety and feasibility of the da Vinci Single Port (SP)® robotic surgical system (Intuitive Surgical, Sunnyvale, CA) as a minimally invasive alternative to robotic platforms requiring multiple ports. We sought to compare perioperative outcomes between SP and multi-port (MP) robotic approaches for excision of high and low complexity renal masses. METHODS: Retrospective chart review was performed for all patients undergoing robotic partial or radical nephrectomy using the SP surgical system (N=23) at our institution between its adoption in November 2019 and November 2021. Patient demographics, preoperative imaging, operative approaches, and perioperative outcomes were recorded. Renal masses were categorized into high (7+) and low complexity groups (4-6) using the RENAL nephrometry scoring system (RNS). Patients were matched using an institutionally maintained MP database by patient BMI, renal mass size, renal mass complexity, and partial or radical nephrectomy in a 2:1 (MP:SP) ratio. Perioperative outcomes were compared. RESULTS: For high complexity tumors (N=12), SP renal surgery was associated with a significantly longer average operative time compared to MP surgery (248.4 ± 75.0 min vs 188.1 ± 61.0 min, p=0.02), and tended towards higher average estimated blood loss (410.0 ± 669.9 mL vs 171.2 ± 136.0 mL, p=0.62) and a higher positive surgical margin rate (25.0% vs 12.5%, p=0.38). For low complexity tumors (N=11), there was no significant difference in operative time (177.7 ± 53.9 min vs 161.4 ± 41.9 min, p=0.53), average estimated blood loss (69.6.0 ± 33.0 mL vs 142.0 ± 168.6 mL, p=0.62) or positive margins (9.1% vs 4.5%, p=1.00) between SP and MP approaches and all patients underwent successful partial nephrectomy using the SP system. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p=0.07) using best of fit linear modeling (Figure 1). CONCLUSIONS: SP nephron-sparing surgery is safe and feasible for low complexity renal masses. For excision of high complexity renal masses, the SP system is associated with a significantly longer operative time when compared to a MP approach. Careful selection should be performed when planning operative approach. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e870 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grant Henning More articles by this author Joel Vetter More articles by this author Nicholas Pickersgill More articles by this author Arjun Sivaraman More articles by this author R. Sherburne Figenshau More articles by this author Eric Kim More articles by this author Expand All Advertisement PDF DownloadLoading ...

Combined endoscopic endonasal and transorbital multiportal approach for complex skull base lesions involving multiple compartments.

This study defines the specific areas that connect the surgical corridors of the endoscopic endonasal (EEA) and transorbital approach (TOA) to identify adequate clinical applications and perspectives of this combined multiportal approach. Consecutive patients who underwent combined EEA and TOA procedures for various pathologies involving multiple compartments of the skull base were enrolled. A total of eight patients (2 chondrosarcomas, 2 meningiomas, 2 schwannomas, 1 glioma, and 1 traumatic optic neuropathy) were included between August 2016 and April 2021. The cavernous sinus (CS) was targeted as the connection area of the combined approach in four patients with tumors infiltrating the middle cranial fossa (MCF) and central skull base through the CS. For two patients with MCF tumors extending into the infratemporal fossa (ITF), the horizontal portion of the greater sphenoid wing and the foramen ovale were utilized as the connection area. In the remaining 2 patients, connection was achieved through the optic canal (OC). Gross total and near total resection was achieved in 5 patients with tumors, and circumferential removal of bone composing the OC was performed in one patient with traumatic compressive optic neuropathy. Postoperative complications included one cardiac arrest due to underlying cardiovascular disease and one case of oculomotor nerve palsy. The combined EEA and TOA procedure is a useful strategy for complex lesions involving multiple compartments of the skull base. Herein, we identified the specific areas connecting the two surgical approaches, allowing a common path for EEA and TOA procedures.

Thoracoscopic lymphadenectomy via multiportal approach: a narrative review

Thoracoscopic lymphadenectomy via multiportal approach: a narrative review

Comparison of Perioperative Outcomes Between Single-Port and Multi-Port Robotic Adrenalectomy.

Single-port (SP) robotic surgery has been utilized in several surgical procedures. We aim to describe our institution's approach and perioperative experience with SP robotic adrenalectomy and compare it to the traditional multi-port (MP) approach. We retrospectively reviewed all patients who underwent robotic adrenalectomy by a single surgeon between March 2019 and March 2020. Patient demographic, perioperative factors, and pathologic outcomes were recorded and analyzed using t-tests, chi-square, or Fisher's exact tests. Thirty-six patients underwent SP (n = 11) and MP (n = 25) robotic adrenalectomy. Age, body mass index, gender, operative time, major Clavien-Dindo complications, and margin status showed no differences. Patients undergoing SP adrenalectomy had a lower estimated blood loss (18.1 ± 13.0 vs 65.6 ± 95.0 cc, P = .02) and smaller lesion size (2.8 ± 1.3 vs 4.1 ± 1.8cm, P = .04) compared to those undergoing MP. SP adrenalectomy appears to be a feasible approach in select adrenal masses. Further studies are needed to establish its safety and cost effectiveness.

Cirugía torácica por puerto único Experiencia inicial

Introduction: video assisted thoracic surgery is widely accepted today as a safe, feasible and effective procedure to treat almost all thoracic conditions. In 2010, uniportal complex procedures begin to appear in scientific publications around the world, evidencing major expansion. This surgical approach is at least comparable to the multiportal approach in terms of postoperative results or even in regards to pain, intercostal neuralgia and length of hospital stay. We performed a retrospective study of uniportal procedures between September 2018 and August 2020.Results: 40 patients underwent uniportal thoracic surgeries. 18 of these were subject to anatomic resections (45%), 19 to atypical resection (non-anatomic), one thymectomy and two pleural biopsies, 12 lobectomies (30%), 3 neumomectomies (7,5%) and 3 segmentomectomies (7,5%). In 6 patients the procedure was converted to an open surgery (15%) and one patient died for respiratory sepsis. As to the occurrence of complications, 8 complications were seen in anatomic resections (5 major complications) and 4 complications in non-anatomic resections (2 major complications). One patient reported pain that lasted over one week in the postoperative stage, another one referred paresthesia and two reported dyspnea. Length of stay in the hospital was 8 days in anatomic resections and 5.8 days of pleural drainage, whereas in non-anatomic resections it was 5.5 and 3.3 respectively.Conclusion: uniportal surgery is safe and feasible in a relatively small health center.

Management of parapharyngeal space tumors with transparotid–transcervical approach: analysis of prognostic factors related with disease-control and functional outcomes

Different therapeutic strategies have been developed to improve surgical and functional outcome of parapharyngeal space (PPS) neoplasms. The transparotid-transcervical approach (TTa) is a valid surgical option to manage most PPS tumors. Its short- and long-term disease control and cranial nerve (c.n.) function outcomes have not been discussed extensively. All patients who underwent TTa over a 10-year period at a tertiary academic center were retrospectively reviewed. Data about preoperative imaging, clinical presentation, tumor's size, location and histology, and postoperative oncological and functional results were registered and analyzed. Sixty patients matched the inclusion criteria. Most of the lesions were benign (71.7%), involved the prestyloid PPS (63.3%) and measured more than 30mm (75%). Fifty-two (86.7%) lesions were resected en-bloc. Clear margins were achieved in 91.7% of the cases, with positive margins solely associated with malignancy (p = 0.008). Post-operative c.n. function was satisfactory, with X c.n. function significantly associated with the retrostyloid location (p = .00) and neurogenic tumors (p = 0.02). Local disease-control was achieved in 96% of the cases after a median follow-up of 46 (± 19.7-82.0 IQR) months. The TTa was safe and effective, achieving a satisfactory local control rate. Nevertheless, malignancies maintain a higher rate of positive margin due to their infiltrative nature and the complex anatomy of the PPS. In such cases, multiportal approaches might be more effective. However, post-operative c.n. function remained satisfactory, irrespective of lesions' size and histopathologic behavior. A higher X c.n. deficit rate was observed in retrostyloid and neurogenic lesions.

V08-06 BILATERAL PYELOPLASTY WITH SINGLE PORT ROBOT - ONE INCISION, ONE POSITION

You have accessJournal of UrologyNOTES/LESS (V08)1 Sep 2021V08-06 BILATERAL PYELOPLASTY WITH SINGLE PORT ROBOT - ONE INCISION, ONE POSITION John Sheng, Chrystal Chang, Gregory Lovallo, Michael Stifelman, and Mutahar Ahmed John ShengJohn Sheng More articles by this author , Chrystal ChangChrystal Chang More articles by this author , Gregory LovalloGregory Lovallo 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.0000000000002041.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Da Vinci Single Port (SP) robotic system has made it feasible to perform robotic surgery through one incision. This technology advances minimally invasive surgery, allowing for multiple instruments through a single 25mm port. -In this video, we demonstrate the feasibility of performing bilateral retroperitoneal surgery through a single small Pfannenstiel incision. -We previously showed this surgery with an assistant port. Now we demonstrate the use of the remotely operated suction irrigation (ROSI) system in making this a true single port surgery. METHODS: A 26 year old female with bilateral symptomatic UPJ obstructions and multiple large left kidney stones presented for robotic assisted bilateral pyeloplasty and left pyelolithotomy. Whereas using a multiport approach may have necessitated more than 5 incisions to perform bilateral surgery, we demonstrate using one incision and re-docking the single port robot to perform bilateral pyeloplasty. We did not need to re-drape the patient in order to perform the second side. RESULTS: Our patient tolerated the procedure well with excellent cosmetic and functional outcomes. Foley catheter was removed 12 hours post op. Drain had minimal output and was removed 2 hours after foley removed. Patient was discharged within 18 hours of surgery without any narcotic use post operatively. Stents were removed 4 weeks later and the patient remains asymptomatic. A total of 24 single port pyeloplasties were performed by three surgeons at our institution over an 18 month period. Two, including the one described in this video, were bilateral. Average operative time was 128 minutes. Average estimated blood loss was 20cc. Average length of stay was 1.1 days. CONCLUSIONS: Using Single Port robot has the potential to: Have better cosmesis with only one incision. Have improved pain control. Be able to use lower incision on abdomen to perform kidney surgery by pointing instruments upward. Advance robotic surgery in an even more minimally invasive way. In this video, we are able to demonstrate bilateral retroperitoneal surgery without the use of an assistant port through a single small Pfannenstiel incision. Limitations: SP has a learning curve and is may not be able to translate multiport skills entirely to single port. Cannot use indocyanine green with single port system yet to be able to identify and preserve vascularity of ureter for reconstructive cases. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e602-e602 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Sheng More articles by this author Chrystal Chang More articles by this author Gregory Lovallo More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement Loading ...

MP10-06 SINGLE- VERSUS MULTI-PORT ROBOTIC PARTIAL NEPHRECTOMY: A COMPARATIVE ANALYSIS OF PERIOPERATIVE OUTCOMES AND ANALGESIC REQUIREMENTS

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP10)1 Sep 2021MP10-06 SINGLE- VERSUS MULTI-PORT ROBOTIC PARTIAL NEPHRECTOMY: A COMPARATIVE ANALYSIS OF PERIOPERATIVE OUTCOMES AND ANALGESIC REQUIREMENTS Zachary Glaser, Zachary Burns, Andrew Fang, Ava Saidian, Christina Magi-Galluzzi, Jeffrey Nix, and Soroush Rais-Bahrami Zachary GlaserZachary Glaser More articles by this author , Zachary BurnsZachary Burns More articles by this author , Andrew FangAndrew Fang More articles by this author , Ava SaidianAva Saidian More articles by this author , Christina Magi-GalluzziChristina Magi-Galluzzi More articles by this author , Jeffrey NixJeffrey Nix More articles by this author , and Soroush Rais-BahramiSoroush Rais-Bahrami More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001983.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The da Vinci single-port (SP) robotic platorm permits true single-incision surgery through a 2.5 cm multi-channel trocar. While several series have demonstrated safety and oncologic efficacy for radical prostatectomy, evidence supporting the safe use of the SP platform for partial nephrectomy is scarce. The purpose of this study was to evaluate safety and postoperative opioid analgesic requirements for patients undergoing robotic assisted (RAL) SP vs multi-port (MP) partial nephrectomy (PNx) in a time-matched cohort. METHODS: All patients with clinically-localized renal masses who underwent RAL PNx from January 2019 to March 2020 were evaluated. Patients were stratified according to SP vs MP approach. Renal mass complexity was compared using R.E.N.A.L. nephrometry scores on preoperative cross-sectional imaging. Trans- vs. retroperitoneal approach, operative time, use of a separate assistant port for SP cases and estimated blood loss (EBL) were among the intraoperative data tracked. Postoperative analgesia was administered in accordance with department-wide opioid stewardship protocol and outpatient opioid use was tracked using the Alabama Prescription Drug Monitoring Program. RESULTS: A total of 78 patients underwent RAL PNx with 26 patients in the SP cohort. The majority of renal masses had low-complexity (53, 67.9%) R.E.N.A.L. nephrometry scores, without a significant difference between the two cohorts (p=0.19). A retroperitoneal approach was performed in 16 (20.5%) patients overall, though more commonly via the SP robotic approach (13 vs 3, p<0.001). Mean operative time for SP cases was 183.9 min vs 208.6 min in the MP cohort (p=0.12). A separate assistant port was utilized during 16 (61.5%) SP cases.Rate of conversion to radical nephrectomy was 3.8% vs 9.6% for SP vs MP cases, respectively, (p=0.37). Significant EBL defined as greater than 500cc did no significantly differ in the two cohorts (p=0.11). The majority of patients were discharged on postoperative day one (67.9%) irrespective of operative approach (p=0.60). There were no differences in inpatient milligram morphine equivalents administered (MME, p=0.08) or outpatient postoperative MME prescribed (p=0.21) between the two cohorts. CONCLUSIONS: In this retrospective single-institution study, SP robotic approach offers similar short-term perioperative outcomes to MP platforms for minimally-invasive, nephron-sparing surgery. Using the SP system was not associated with a reduction in postoperative opioid analgesic requirements. Source of Funding: Not applicable © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e170-e170 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Glaser More articles by this author Zachary Burns More articles by this author Andrew Fang More articles by this author Ava Saidian More articles by this author Christina Magi-Galluzzi More articles by this author Jeffrey Nix More articles by this author Soroush Rais-Bahrami More articles by this author Expand All Advertisement Loading ...

V08-01 SINGLE PORT ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL CREATION OF NEOBLADDER: DESCRIPTION OF TECHNIQUE AND PERIOPERATIVE OUTCOMES

You have accessJournal of UrologyNOTES/LESS (V08)1 Sep 2021V08-01 SINGLE PORT ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL CREATION OF NEOBLADDER: DESCRIPTION OF TECHNIQUE AND PERIOPERATIVE OUTCOMES Mubashir Billah, Rohan Sawhney, Nikhil Gopal, Michael Stifelman, David Ali, Salma Ahsanuddin, Gregory Lovallo, and Mutahar Ahmed Mubashir BillahMubashir Billah More articles by this author , Rohan SawhneyRohan Sawhney More articles by this author , Nikhil GopalNikhil Gopal More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , David AliDavid Ali More articles by this author , Salma AhsanuddinSalma Ahsanuddin More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002041.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The FDA approved the use of the DaVinci single port robotic system in 2018. The literature reports its use with radical cystectomy with an intracorporeal ileal conduit. However, there has been no publication of single port radical cystectomy with intracorporeal creation of neobladder to our knowledge. This study describes the technique in both male and female patients and illustrates preliminary outcomes. A learning curve was involved but the overall transition from multiport to single port was smooth. METHODS: This is an IRB approved prospective cohort study on robotic radical cystectomy. We identified five patients who underwent a single-port radical cystectomy with intracorporeal neobladder creation. We performed surgery by duplicating the institutional steps of the multiport approach. RESULTS: Single-port radical cystectomies with intracorporeal neobladder were successfully performed in all five patients. The mean operative time was 311 minutes, with an average blood loss of 120 ccs. The average length of hospital stay was five days. There were no intraoperative or immediate postoperative complications. CONCLUSIONS: This study demonstrates the feasibility of single-port radical cystectomy with intracorporeal neobladder creation in both sexes. More extensive, multi-institutional studies comparing single-port and multiport radical cystectomy are needed to determine this approach's benefits. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e601-e601 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mubashir Billah More articles by this author Rohan Sawhney More articles by this author Nikhil Gopal More articles by this author Michael Stifelman More articles by this author David Ali More articles by this author Salma Ahsanuddin More articles by this author Gregory Lovallo More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement Loading ...

Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements.

Evidence supporting the safe use of the single-port (SP) robot for partial nephrectomy is scarce. The purpose of this study was to compare perioperative outcomes for patients undergoing robotic assisted SP vs multi-port (MP) partial nephrectomy (PN) in a time-matched cohort. All patients with clinically localized renal masses who underwent robotic PN from January 2019 to March 2020 were evaluated. Patients were stratified according to SP vs MP approach. Postoperative analgesia was administered in accordance with department-wide opioid stewardship protocol and outpatient opioid use was tracked. Total of 78 patients underwent robotic PN with 26 patients in the SP cohort. The majority of renal masses had low-complexity (53, 67.9%) R.E.N.A.L. nephrometry scores, without a significant difference between the two cohorts (p = 0.19). A retroperitoneal approach was performed in 16 (20.5%) patients overall, though more commonly via the SP robotic approach (13 vs 3, p < 0.001). Mean operative time for SP cases was 183.9±63.5min vs 208.6±65.0min in the MP cohort (p = 0.12). Rate of conversion to radical nephrectomy was 3.8% vs 9.6% for SP vs MP cases, respectively, (p = 0.37). The majority of patients were discharged on postoperative day one (67.9%) irrespective of operative approach (p = 0.60). There were no differences in inpatient milligram morphine equivalents administered (MME, p = 0.08) or outpatient postoperative MME prescribed (p = 0.21) between the two cohorts. In this retrospective single-institution study, SP robotic approach offers similar short-term perioperative outcomes to MP platforms for minimally invasive, nephron-sparing surgery. Using the SP system was not associated with a reduction in postoperative opioid analgesic requirements.

Combined endoscopic endonasal and transorbital approach to skull base tumors: a systematic literature review.

In the last decades, there has been a marked evolution in skull base surgery techniques and more recently a combination of different corridors has been proposed and used in order to improve angles of attack, shorten working distances, and ameliorate visualization of skull base lesions. Recently, the endoscopic endonasal and transorbital routes have been combined as multiportal approach to reach and treat complex skull base neoplasms. The aim of this paper is to examine data extracted from the recent literature about the feasibility and effectiveness of combined endonasal and transorbital endoscopic multiportal surgery. A PubMed comprehensive search of literature published until October 2020 was conducted. Nine studies, regarding 24 patients, were included. The majority of tumors were meningiomas (62.5%), mostly located at the spheno-orbital region (93.3%). GTR was accomplished in 10 patients (41.7%), NTR in two patients (8.3%). Endonasal transpterygoid approach (N.=8) and superior eyelid access (N.=17) were the most used routes used. No case of CSF fistula was observed, and the most common complication was a transient periorbital edema. The average hospitalization time (days) was five days. A combined endoscopic endonasal and transorbital multiportal approach grants an adequate corridor to access several skull base tumors, such as those extending towards the paramedian aspects, providing good outcomes in terms of extent of tumor resection with acceptable rates of complications. These preliminary results might encourage the use of multiportal approaches in selected complex skull base neoplasms.

The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach.

BackgroundIn some institutions, a recently introduced uniportal approach has replaced the multiportal approach for thoracoscopic major pulmonary resection. This study investigated the effect of this change on the surgical learning curve by examining the perioperative results of a single surgeon.MethodsBetween April 2012 and August 2020, 376 patients with primary lung cancer underwent thoracoscopic lobectomy with ND2a-1/2 lymphadenectomy in the authors’ hospital. Surgery was performed by one of the authors in 189 of these patients, who were thus enrolled in this retrospective study. The surgeries were classified chronologically into five phases and the operative time, rate of intraoperative massive bleeding, and rate of postoperative prolonged air leak (PAL) were then compared. The learning curve (i.e., operative time) was assessed by Spearman’s rank correlation test. The perioperative results achieved with the uniportal and multiportal approaches were also compared before and after the patients were matched for their characteristics based on the propensity score.ResultsThe five phases differed significantly with respect to the operative time and rate of postoperative PAL (P<0.0001, P=0.0061). The correlation between operative time and number of consecutive cases was also significant (r=−0.579, P<0.0001). Superior results in terms of operative time (P<0.0001), duration of postoperative drainage (P<0.0001), and rate of postoperative PAL (P=0.0034) were obtained using a uniportal rather than multiportal approach.ConclusionsThe transition from a multiportal to a uniportal approach did not cause a decline in the learning curve of thoracoscopic lobectomy with ND2a-1/2 lymphadenectomy.

Patient surgical satisfaction after da Vinci® single-port and multi-port robotic-assisted radical prostatectomy: propensity score-matched analysis.

The da Vinci® single-port (SP) and multiport (Xi) approaches to robotic-assisted radical prostatectomy (RARP) are described by different authors in the literature, primarily comparing short-term outcomes of both modalities. To our knowledge, this is the first article comparing the surgical perspective and satisfaction of patients who underwent RARP with the SP and Xi platforms. To determine the patient surgical perspective and satisfaction in terms of pain control, return to normal activity, and overall results of surgery for two groups who underwent SP and Xi radical prostatectomy. The data from 71 consecutive patients who underwent SP RARP in a single center from June 2019 to April 2020 was compared to 875 patients who underwent Xi RARP in the same period. A single surgeon performed all procedures with a transperitoneal technique. After a propensity score match, two groups of 71 patients (SP and Xi) were selected and compared in the study. Patients were contacted by phone by two interviewers and a questionnaire was administered in English or Spanish. Patients were instructed not to disclose the type of robotic surgery they underwent, as interviewers were blinded to that information. A validated Surgical Satisfaction Questionnaire (SSQ-8) was used, along with an additional question from our institution asking about the satisfaction with the number of incision sites (GRI-1). Data were analyzed as continuous and discrete variables to compare the differences between the Xi and SP cohorts. A response rate of 85.9% (n = 61) in the Xi group and 73.2% (n = 52) in the SP group was captured. Overall satisfaction with surgical results was 80% and 88% in the Xi and SP cohorts, respectively. No statistical difference in responses was found between the Xi and SP cohorts for SSQ-8. However, GRI-1 demonstrated a statistically significant difference (P < 0.001) in terms of number of scars that favors the SP approach. Limitations of this study are the small sample size and recall bias. We found no statistical difference between the groups regarding the answers for SSQ-8 questionnaire; both groups were very satisfied. When assessing the number of incision sites with the GRI-1 question, patients who underwent MP had lower satisfaction rates compared to SP. These patients perceived the number of scars and their appearance as reason for lower satisfaction. We believe that future studies should consider patient’s postoperative perspective when adopting new platforms in order to combine adequate treatment with patient expectations. We performed a study assessing the postoperative satisfaction and perspectives of two groups of patients who underwent radical prostatectomy with two different robots (SP and Xi). There was no difference in patient satisfaction with the results of either the da Vinci® SP or Xi RARP except for the patients’ perception on their number of scars, which favored the SP group.

Uniportal video-assisted thoracic surgery for major lung resection is associated with less immunochemokine disturbances than multiportal approach

Multiportal video-assisted thoracic surgery (VATS) for major lung resection causes less immunochemokine production compared to thoracotomy. Whether uniportal VATS is similarly associated with lower early postoperative circulating levels of immunochemokines compared to multiportal VATS have not been studied. Selected patients who received uniportal or multiportal VATS major lung resection were recruited. Blood samples were collected preoperatively and on postoperative days 1 and 3 for enzyme linked immunosorbent assay of serum levels of Tissue Inhibitor of Metalloproteinase (TIMP)-1, Insulin Growth Factor Binding Protein (IGFBP)-3, and Matrix Metalloproteinase (MMP)-9. A linear mixed-effects models were used to analyze the effects of uniportal VATS on the postoperative circulating chemokine levels. From March 2014 to April 2017, 68 consecutive patients consented for the prospective study and received major lung resection by either uniportal VATS (N = 29) or multiportal VATS (N = 39) were identified. Uniportal VATS major lung resection was associated with lower post-operative levels of TIMP-1 and MMP-9 compared to multiportal VATS after controlling for the effects of the corresponding baseline level and the time of follow-up measurement. No difference was observed for the level of IGFBP-3. Less immunochemokine disturbances was observed after uniportal VATS major lung resection compared to multiportal VATS.

Initial Experience with Single-Port Robot-Assisted Radical Cystectomy: Comparison of Perioperative Outcomes Between Single-Port and Conventional Multiport Approaches.

Background: The surgical techniques and devices used to perform radical cystectomy have evolved significantly with the advent of laparoscopic and robotic methods. The da Vinci® Single-Port (SP) platform (Intuitive Surgical, Inc., Sunnyvale, CA) is an innovation that allows a surgeon to perform robot-assisted radical cystectomy (RARC) through a single incision. To determine if this new tool is comparable to its multiport (MP) predecessors, we reviewed a single-surgeon experience of SP RARC. Materials and Methods: We identified patients at our institution who underwent RARC between August 2017 and June 2020 by one surgeon at our institution (n = 64). Using propensity scoring analysis, patients whose procedure were performed with the SP platform (n = 12) were matched 1:2 to patients whose procedure was performed with the MP platform (n = 24). Univariable analysis was performed to identify differences in any perioperative outcome, including operative time, estimated blood loss (EBL), lymph node yield, 90-day complication/readmission rates, and positive surgical margin (PSM) rates. Results: Patients who had an SP RARC on average had a lower lymph node yield than those who had an MP RARC (11.9 vs 17.1, p = 0.0347). All other perioperative outcomes, including operative time, EBL, 90-day complication rates, 90-day readmission rates, and PSM rates, were not significantly different between the SP and MP RARC groups. Conclusions: Based on their perioperative outcomes, the SP platform is a feasible alternative to the MP platform when performing RARC. The SP's perioperative outcomes should continue to be evaluated as more SP RARCs are performed.

Uniportal Video-Assisted Thoracoscopic Lung Resection: A Single-Surgeon Experience and Comparison with Multiportal Technique in the Veteran Population.

Background: Uniportal video-assisted thoracoscopic surgery (VATS) has been shown to offer improved postoperative outcomes compared with multiportal technique. Shorter operative time has rarely been described. Our objective was to compare operative time and clinical outcomes between uniportal and multiportal VATS approaches for lung resection. Methods: This is a retrospective review of patients that underwent video-assisted thoracoscopic lung resection at United States Veterans Affairs centers between 2008 and 2018 using the Veteran Affairs Surgical Quality Improvement Program. Cases were assigned to uniportal (single surgeon) or multiportal cohorts. Multivariable analysis of clinical outcomes was performed, adjusting for preoperative confounding covariates. Temporal trend in operative time in uniportal cohort was analyzed in the context of cumulative operative volume using Spearman's rank correlation coefficient, rho (ρ). Results: In total, 8,212 cases were selected from 2008 to 2018 at Veterans Affairs centers: 176 (2.1%) uniportal and 8036 (97.9%) multiportal cases. Uniportal cohort was significantly associated with shorter operative time (1.7 hours versus 3.1 hours, P < .001), higher adjusted odds of surgical site infection (adjusted odds ratio = 2.76; P = .005), and longer length of stay (6 days versus 5 days; P = .04). Uniportal cohort operative time decreased over time (ρ = -0.474), with most significant change corresponding with increased cumulative operative volume from 25 to 44 cases. Conclusions: Uniportal technique offered shorter operative duration in veterans compared with multiportal approach, validating its technical advantages. Operative time decreased as cumulative operative volume increased, demonstrating a learning curve. Future studies should prospectively investigate any association between operative time and clinical outcomes after thoracoscopic lung resection.

Combined Simultaneous Multiportal Approach via Minimally Invasive Transciliary and Endoscopic Endonasal Approaches for Tumors Invading Both the Skull Base and the Sinonasal Area

A combined transcranial and transfacial approach has long been the gold standard for surgical management of large tumors with sinonasal and skull base involvement. The extended endoscopic endonasal approach for such pathologies has its advantages, but it has flaws as well, such as anatomic limitations and more ponderous skull base reconstruction and thus higher risk of postoperative complications. Our primary technique for surgical treatment of these pathologies has been a combination of transfacial and minimally invasive transciliary supraorbital keyhole approaches. With the aim to further minimize invasiveness, potential complications, and unsatisfactory aesthetic outcomes during surgical treatment of large tumors invading both the sinonasal area and the skull base, we abandoned the transfacial approach and simultaneously combined the transciliary supraorbital keyhole approach with the endoscopic endonasal approach. The well-known microscope-assisted minimally invasive approach via a transciliary supraorbital keyhole craniotomy was combined with the endoscopic endonasal approach. Six patients with different histologic types of tumors affecting the sinonasal area and the skull base were operated on. The mean operative time was 3 hours, there were no unexpected intraoperative or postoperative complications, and total tumor removal was achieved in each patient. None of the patients experienced complications associated with the surgery during follow-up. Our combined simultaneous multiportal approach enables total tumor eradication with reduced operative time and is associated with minimal intraoperative and postoperative complications, low mortality rate, and excellent cosmetic results.

Uniportal versus multiportal thoracoscopic sleeve lobectomy for the surgical treatment of centrally located lung cancer: a single institution experience.

BackgroundUniportal thoracoscopic sleeve lobectomy is rarely reported owing to its high degree of difficulty. We conducted a comparative study on the safety and efficacy of uniportal versus multiportal thoracoscopic sleeve lobectomy for the treatment of centrally located lung cancer.MethodsFrom January 2016 to December 2018, 30 thoracoscopic sleeve lobectomies (12 by the uniportal approach and 20 by the multiportal approach) for centrally located lung cancer at our institution were retrospectively analyzed.ResultsThe uniportal approach resulted in a significantly shorter chest drainage duration (5.3±1.9 vs. 7.1±2.8 days, P=0.028) and a smaller chest drainage volume (796.7±582.9 vs. 1,667.8±1,154.9 mL, P=0.004) than the multiportal approach. The two groups showed no significant differences in the dissection of lymph nodes, operation time, estimated blood loss, conversion rate, length of postoperative hospital stay and the proportion of patients with postoperative complications. The short-term overall survival (OS) and disease-free survival (DFS) between uniportal and multiportal groups were similar (3-year OS, 100.0% vs. 82.5%, P=0.222; 3-year DFS, 75.8% vs. 84.4%, P=0.641). For the eight cases of the uniportal approach conducted by the same surgeon, the cumulative sum (CUSUM) curve showed its inflection at patient number 4 and divided the series into phase I (learning phase) and phase II (experienced phase). A significant reduction in estimated blood loss (42.5±8.7 vs. 177.5±121.2 mL, P=0.037), chest drainage volume (280.0±155.8 vs. 972.5±464.5 mL, P=0.043) and chest drainage duration (3.8±1.0 vs. 6.8±2.2 days, P=0.027) was also noted in the phase II patients compared with the phase I patients.ConclusionsUniportal thoracoscopic sleeve lobectomy is technically feasible and safe for the treatment of centrally located lung cancer and may achieve superior surgical outcomes compared with the multiportal approach.