Robot-assisted Laparoscopic Prostatectomy Research Articles

Perioperative, Oncological, and Functional Outcomes Between Robot-Assisted Laparoscopic Prostatectomy and Open Radical Retropubic Prostatectomy: A Randomized Clinical Trial.

Limited high-quality studies have compared robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy. We sought to compare their postoperative outcomes in a randomized setting. In a single center, 354 men with newly diagnosed prostate cancer were assessed for eligibility; 342 were randomized (1:1). The primary outcome was 90-day complication rates. Functional outcomes and quality of life were assessed over 18 months, and oncological outcomes, biochemical recurrence-free survival, and additional treatment over 36 months. From 2014 to 18, 327 patients underwent surgery (retropubic radical prostatectomy = 156, RALP = 171). Complications occurred in 27 (17.3%) vs 19 (11.1%; P = .107). Patients undergoing RALP experienced lower median bleeding (250.0 vs 719.5 mL; P < .001) and shorter hospitalization time. Urinary EPIC (Expanded Prostate Cancer Index Composite) median scores were better for RALP over 18 months, with higher continence rate at 3 months (80.5% vs 64.7%; P = .002), 6 months (90.1% vs 81.6%; P = .036) and 18 months (95.4% vs 78.8%; P < .001). Sexual EPIC and Sexual Health Inventory for Men median scores were higher with RALP up to 12 months, while the potency rate was superior at 3 months (23.9% vs 5.3%; P = .001) and 6 months (30.6% vs 6.9%; P < .001). Quality of life over the 18 months and oncological outcomes over 36 months were not significantly different between arms. Complications at 90 days were similar. RALP showed superior sexual outcomes at 1 year, improved urinary outcomes at 18 months, and comparable oncological outcomes at 36 months.

The Association between Urine N-Glycome and Prognosis after Initial Therapy for Primary Prostate Cancer

Next to prostate-specific antigen, no biochemical biomarkers have been implemented to guide patient follow-up after primary therapy for localized prostate cancer (PCa). We evaluated the prognostic potential of urine N-glycome in terms of event-free survival (EFS) in patients undergoing primary therapy for PCa. The prognostic features of the urine N-glycosylation profile at diagnosis, assessed in 77 PCa patients, were determined in terms of EFS next to standard clinical parameters. The majority of patients were diagnosed with International Society of Urological Pathology grade ≤ 3 (82%) T1–2 tumors (79%) and without pelvic lymph node invasion (96%). The patients underwent active surveillance (14%), robot-assisted laparoscopic prostatectomy (48%), or external beam radiotherapy (37%). Decreased ratios of biantennary core-fucosylation were noted in patients who developed an event, which was linked to a shorter EFS in both the intention-to-treat cohort and all subcohort analyses. Combining the urine N-glycan biomarker with the D’Amico Risk Classification for PCa resulted in an improved nomogram for patient classification after primary therapy. The rate of urine N-glycan biantennary core-fucosylation, typically linked to more aggressive disease status, is lower in patients who eventually developed an event following primary therapy and subsequently in patients with a worse EFS. The combination of urine N-glycan biomarkers together with clinical parameters could, therefore, improve the post-therapy follow-up of patients with PCa.

A Comprehensive Review of the Current State of Robot-assisted Laparoscopic Salvage Prostatectomy.

Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP. We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings: Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively. Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP.

Peritoneal Vaginoplasty in Gender Diverse Patients

Abstract Purpose of Review To describe robotic-assisted peritoneal vaginoplasty in the genital gender affirming surgical setting and demonstrate existing surgical outcomes. Recent Findings Robotic peritoneal vaginoplasty is similar to a posterior approach to a robotic-assisted laparoscopic prostatectomy and can be done utilizing both multi-port and single port robotic platforms. Neovaginal canal depths and widths of 14 ± 0.7 cm by 3.6 ± 0.2 cm respectively can be obtained. Peritoneal flaps can also augment neovaginal depth by approximately 5 cm beyond the length of a skin graft or flap, proving advantageous in cases of genital hypoplasia or canal depth loss requiring revision. Patients typically report high sexual satisfaction following vaginoplasty. Summary The robotic peritoneal vaginoplasty as a genital gender affirming surgery offers additional neovaginal depth, with reported low complication rates, acceptable cosmesis, and satisfactory sexual function. Ongoing research in alternative grafts and revision remain to be studied.

COMPARISON OF ROBOTIC RADICAL PROSTATECTOMY VS LAPAROSCOPIC RADICAL PROSTATECTOMY ON PROSTATE CANCER PATIENT: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Prostate cancer constitutes 3.8 of all cancer-related deaths in men. Radical prostatectomy stands as a standard surgical treatment for prostate cancer. Robot-assisted systems have emerged aiming to simplify the intricacies of complex laparoscopic procedures. Specifically, robot-assisted laparoscopic prostatectomy (RALP) has been proposed as a means to expedite the learning curve, potentially leading to quicker reductions in operative time compared to traditional laparoscopic techniques (LRP). This study aims to serve a comprehensive systematic review to compare laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP) on prostate cancer based on literatures of the last 10 years. Methods: The review adhered to PRISMA 2020 standards and analyzed full-text English literature from 2014 to 2024. It excluded editorials, review papers from the same journal, and submissions lacking a DOI. Literature sources included PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 655 articles were retrieved from online databases (PubMed, SagePub, SpringerLink and Google Scholar). After three rounds of screening, five articles directly relevant to the systematic review were selected for full-text reading and analysis. Conclusion: Robot-assisted radical prostatectomy (RARP) offers advantages such as quicker recovery and comparable safety to laparoscopic radical prostatectomy (LRP). Studies show better urinary continence and potency outcomes with RARP. While PSM rates vary between RARP and LRP, further research is needed to understand their impact on recurrence. Despite challenges like the lack of tactile sensation in RARP, it remains a popular choice for prostate cancer treatment.

Safety and complications of continuation of aspirin therapy in patients undergoing robot-assisted laparoscopic simple prostatectomy

To evaluate the safety and feasibility of continued perioperative aspirin at the time of robotic assisted simple prostatectomy (RASP). We performed a retrospective review of our IRB approved institutional database of patients who underwent RASP between 2013 and 2022. Comparative groups included patients taking aspirin in the perioperative period and those not taking aspirin pre-operatively. The primary outcome was any post-operative bleeding related complication using the modified Clavien–Dindo classification. Secondary outcomes included the identification of risk factors for increased blood loss in the entire study population, operative time, and blood transfusion requirement. 143 patients underwent RASP of which 55 (38.5%) patients continued perioperative aspirin therapy and 88 (61.5%) patients did not. Baseline demographics were similar between groups. Patients taking perioperative aspirin had a higher rate of hypertension (74.5% vs 58.0%, p = 0.04) and other cardiovascular disease (30.9% vs 11.4%, p = 0.007). Postoperative complications were similar between the groups (Clavien-Dindo ≥ 3; p = 0.43). Median blood loss (150 cc vs 150 cc, p = 0.38), percentage drop in hemoglobin (13.4 vs 13.2, p = 0.94) and blood transfusion rate (3.6 vs 1.1, p = 0.56) were also similar between groups. The median blood loss was 150 ml for the whole study population. On regression analysis, neither aspirin nor any other variable was associated with increased blood loss (> 150 ml). Aspirin can be safely continued perioperatively in patients undergoing RASP without any risk of bleeding related complications, blood loss, or increased transfusion rate.

Acute kidney injury after robot-assisted laparoscopic prostatectomy: A meta-analysis.

We investigated the rates of acute kidney injury (AKI) post robot-assisted laparoscopic prostatectomy (RALP). A comprehensive search was conducted to identify studies that reported the rates of AKI post-RALP. A random effects model was used, and the pooled rates of AKI were calculated. We identified 10 studies with 60,937 patients to be included. The mean age was 65.1years. The mean anaesthesia time was 234.3min (95% CI: 177.8-290.9). The mean operation time was 212.2min (95% CI: 188.7-235.6). The mean estimated blood loss was 314.1mL (95% CI: 153-475.3). The mean intraoperative IV fluids administered were 1985mL (95% CI: 1516.3-2453.7). The pooled rate of AKI post RALP was 7.2% (95% CI 19-23.9). The rates of AKI after RALP are significant. Further studies are needed to detect the risk factors for AKI and to determine the rates of chronic kidney disease post-RALP.

Abstract 299: FAP/αSMA association with tumor visibility and progression in prostate cancer

Abstract Introduction Prostate cancer (PCa) ranks as the second most frequently diagnosed cancer in the male population worldwide. The challenge in effectively managing PCa is the absence of well-established biological markers, which often leads to both over and under treatment. To address this issue, a deeper understanding of the molecular alterations within PCa is essential for more accurate patient stratification. In this research, we embark on a comprehensive examination of how the presence of fibroblast activation protein (FAP) and alpha smooth muscle actin (αSMA) in PCa tissue associates with the visibility of the disease in Magnetic Resonance Imaging (MRI) and their impact on cancer progression. The objective of this study is to analyze cell compartmental expression of FAP and aSMA using an AI based image analysis method. We also study the role of FAP and αSMA expression in predicting disease progression and mortality. Materials and Methods We applied FAP (ab207178, Abcam)/αSMA (M0851, DAKO) double chromogen immunohistochemical (IHC) staining to three independent cohorts of formalin-fixed paraffin-embedded (FFPE) prostate cancer tissue microarrays. All together, we analyzed 835 patients’ samples. First cohort consists of 387 patients with preoperative multiparametric MRI and robot-assisted laparoscopic prostatectomy (RALP) as primary treatment. Second cohort was case vs control cohort of Grade group 2-4 localized PCa at radical prostatectomy (RP) with 168 patients. Third cohort consists PCa patents from continuous, population-based collection of radical prostatectomies of 319 patients. Image analysis was performed with Aiforia Create, which is cloud-based deep-learning artificial intelligence software that provides platform for training and validating automated image analysis pipelines using convolutional neural networks. Analysis algorithm in this project was based on semantic, pixel-level area segmentation. Results FAP expression was higher and αSMA lower in MRI-visible tumors compared with MRI-invisible tumors. Stromal and epithelial FAP expression associate with tumor progression. We could also see statistically significant differences in FAP positivity between clinically significant (GS ≥7) and insignificant (GS ≤6) tumors. Hazard ratios imply that FAP and αSMA have significant impact on risk of biochemical recurrence in patients with MRI-visible tumors. Conclusions FAP is closely linked to tumor MRI visibility, cancer progression, and Gleason scores, marking it as a valuable biomarker in PCa assessment. High stromal αSMA is primarily associated with MRI visibility. Our automated AI-based image analysis method has demonstrated reliability, aligning with our previous findings. This advances the potential for more accurate and efficient prostate cancer diagnosis and prognosis, offering a potential benefit to future patient care. Citation Format: Jenni Säilä, Timo-Pekka Lehto, Annabrita Schoonenberg, Katja Välimäki, Andrew Erickson, Antti Rannikko, Olli Kallioniemi, Tuomas Mirtti, Teijo Pellinen. FAP/αSMA association with tumor visibility and progression in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 299.

Extraperitoneal robot assisted laparoscopic prostatectomy with Versius system: single centre experience.

Versius Surgical System (CMR Surgical, Cambridge, UK) is a novel tele-operated robotic surgical system designed to assist surgeons for minimally invasive surgery which is gaining momentum in the world of robotic surgery. We describe our single centre experience with Versius and report the advantages and challenges posed by this new robotic system in a series of 53 extraperitoneal robotic assisted laparoscopic prostatectomies (eRALP) for prostate cancer (PCa). Data of 53 eRALP performed with Versius in our centre were collected and analysed, Descriptive statistics were used to report our results. In 16 months we performed 53 eRALP: 18 (34%) with PLND, 33 (62%) nerve sparingcases. Mean setup time was 15 min, mean console time was 100 min and mean operative time was 130 min. We observed a substantial reduction of console time and set-up time after only 5 procedures. In the first 4 procedures, the dissection of the neurovascular bundle was performed laparoscopically, to switch back to robotic assisted approach afterwards. No major system failures were observed. No major intra-operative and post-operative complications occurred. Mean follow-up time was 9 months (range 3-15 months); no patients experienced biochemical recurrence or metastatic progression over this period, 8 (15%) patients had adjuvant radiotherapy based on unfavourable pathology report (positive surgical margins or positive limphnodes). This represents to our knowledge the largest extraperitoneal RALP case series with Versius, and it aims to provide solid clinical proof of the safety, effectiveness and versatility of this innovative system. In our experience, this platform represents a good option for every urologic surgeon who wants to start a robotic programme and it appears particularly suitable for urologists with a large laparoscopic expertise.

Epidemiology of and Risk Factors in Postoperative Complications from Robotically Assisted Laparoscopic Radical Prostatectomy in Contemporary National Surgical Quality Improvement Program Data.

Introduction: For localized clinically significant prostate cancer (csPCa), robotically assisted laparoscopic radical prostatectomy (RALP) is the gold standard surgical treatment. Despite low overall complication rate, continued quality assurance (QA) efforts to minimize complications of RALP are important, particularly given movement toward same-day discharge. In 2019, National Surgical Quality Improvement Program (NSQIP) began collecting RALP-specific data. In this study, we assessed pre- and perioperative factors associated with postoperative complications for RALP to further QA efforts. Materials and Methods: Surgical records of csPCa patients who underwent RALP were retrieved from the 2019 to 2021 NSQIP database, including new RALP-specific data. Multivariate logistic regression evaluated the association between risk factors and outcomes specific to RALP and pelvic lymph node dissection (PLND). Input variables included American Society of Anesthesiologists (ASA) class, age, operative time, and body mass index (BMI). Variables from the extended dataset with PLND information included number of nodes evaluated, perioperative antibiotics, postoperative venous thromboembolism (VTE) prophylaxis, history of prior pelvic surgery, and history of prior radiotherapy (RT). Outcomes of interest were any surgical complication, infection, pulmonary embolism, deep venous thrombosis, acute kidney injury, pneumonia, lymphocele, and urinary/anastomotic leak (UAL). Results: A total of 11,811 patients were included with 6.1% experiencing any complication. Prior RT, prior pelvic surgery, older age, higher BMI, lack of perioperative antibiotic therapy, longer operative time, PLND, and number of lymph nodes dissected were associated with higher risk of postoperative complications. Regarding procedure-specific complications, there were increased odds of UAL with prior RT, prior pelvic surgery, longer operative time, and higher BMI. Odds of developing lymphocele increased with prior pelvic surgery, performance of PLND, and increased number of nodes evaluated. Conclusion: In contemporary NSQIP data, RALP is associated with low complication rates; however, these rates have increased compared with historical studies. Attention to and counseling regarding risk factors for peri- and postoperative complications are important to set expectations and minimize risk of unplanned return to a health care setting after discharge.

Highly accurate and effective deep neural networks in pathological diagnosis of prostate cancer.

To established an AI system to make the pathological diagnosis of prostate cancer. Prostate histopathological whole mount (WM) sections from patients underwent robot-assisted laparoscopic prostatectomy were prepared. All the prostate WM pathological sections were converted to digital image data and marked with different colors on the basis of the ISUP Gleason grade group. The image was then fed into a segmentation algorithm. We chose modified U-Net as our fundamental network architecture. 172 patients were involved in this study. 896 pieces of prostate WM pathological sections from 160 patients, in which 826 pieces of WM sections from 148 patients were assigned to the training set randomly. After image segmentation there were totally 2,138,895 patches, of which 1,646,535 patches were valid for training. The other WM section was arranged for testing. Based on the whole image testing, AI and pathologists presented the same answers among 21 of 22 pieces of sections. To evaluate the diagnostic results at the pixel level, we anticipated correct cancer or non-cancer diagnose from this AI system. The area under the ROC curve as 96.8%. The value of pixel accuracy of three methods (binary analysis, clinically oriented analysis and analysis for different ISUP Gleason grade) were 96.93%, 95.43% and 93.88%, respectively. The value of frequency weighted IoU were 94.32%, 92.13% and 90.21%, respectively. This AI system is able to assist pathologists to make a final diagnosis, indicating the great potential and a wide-range of applications of AI in the medical field.

(196) Reconstruction of Complex Midline Septal Corporal Defect in a Distal Crossover Penile Implant Cylinder: A Step-by-step Demonstration of Surgical Technique

Abstract Introduction Inflatable penile prosthesis (IPP) placement is a common and effective treatment for erectile dysfunction. Around 20,000 procedures are performed annually. Complications can arise after the procedure, with non-infectious complications occurring in approximately 4% of cases. One rare non-infectious complication is complete cylinder crossover, which can happen due to variable windows in the corporal septum. Objective This case report presents a complex distal septal defect caused by distal cylinder crossover and its repair using Tutoplast graft. Methods The patient, a 59-year-old African American male, had a history of prostate cancer and underwent robotic-assisted laparoscopic prostatectomy in 2018. He received an IPP in September 2020. In 2022, the patient experienced painful leftward penile curvature during erections and incomplete deflation of the penile prosthesis. A physical examination revealed crossover of the right prosthesis cylinder to the left. After a thorough discussion of the risks and benefits, the patient opted for surgical revision and reconstruction of the penile prosthesis. The procedure involved a right corporotomy, septal corporal reconstruction using a 5 × 2 cm Tutoplast graft, and redirection of the uninfected, functioning cylinder into the neocorporal space. Results The surgery was successfully completed without any complications, and the IPP functioned well at the end of the procedure. During the 6-week clinic follow-up, the patient reported proper cycling of the device, excellent erectile function, the ability to orgasm, and minimal pain. Conclusions In conclusion, our case demonstrates that Tutoplast graft, along with appropriate seating and redirection of the displaced cylinder without replacing the functional hardware, is a viable surgical approach for IPP revision, even in complex cases involving septal defects. Disclosure No.

Incisional hernias following robotic-assisted laparoscopic prostatectomy: does the extraction site matter?

The incidence of incisional hernia (IH) following robotic-assisted laparoscopic prostatectomy (RALP) varies widely within the literature (0.4-9.7%). Whilst small hernias may go unnoticed, the potential exists for bowel strangulation and subsequent emergency surgery. We suggest that the extraction site may influence the rate of IH. A retrospective chart review of a single surgeon RALP series was undertaken. One hundred charts were sampled, of which 69 had sufficient data to be analysed. Prior to July 2017, specimen extraction had been via the supra-umbilical port site. After this time, specimens were extracted via a Pfannenstiel incision. Of the 69 patients, 24 underwent RALP prior to July 2017. Three patients developed IH at the supra-umbilical port extended for extraction site in the pre-2017 group and three patients developed IH at the supra-umbilical port (not extraction) site in the post-2017 group. The rate of IH was almost double in the pre-July 2017 group (12.5% vs. 6.7%). No patient developed an incisional hernia at the Pfannenstiel site in the post-2017 group. In our series, no patient developed a hernia at the Pfannenstiel site. This is in keeping with the reported < 1% IH rate following Pfannenstiel specimen extraction. Given that incisional hernias are a known complication of robotic surgery, thought should be given to changing the site of specimen extraction site to lower the rate of incisional hernias and the morbidity associated with such.

Application of lean nursing in patient care of Da Vinci robot-assisted laparoscopic prostatectomy

ObjectiveIn order to meet the needs of patients in modern medicine for lean nursing mode, the author proposes a method of lean nursing combining Da Vinci robot-assisted surgery and laparoscopic-assisted surgery, using the data analysis system, the authors retrospectively analyzed the differences in the basic conditions, medical safety, short-term efficacy, hospitalization time, and hospitalization costs of the patients in the Da Vinci robot group and the laparoscopy group. ResultsThe results showed that: Compared with the general nursing group, the lean nursing group combined with DaVinci robot technology had a significantly higher nursing compliance score (96.14 points vs. 82.23 points, P<0.05); The nursing job satisfaction score was significantly improved (47.26 points vs. 41.19 points, P<0.05). The postoperative hospital stay was significantly shortened (4.46 d vs 6.02 d, P<0.05); Karnofsky physical condition score at 1 week after operation (88.62 points vs 83.47 points, P<0.05) and EORTC QLQ-C30 quality of life evaluation system overall health standardization score at 1 week after operation (73.79 points and 68.02 points, P<0.05) were also significant improve. Conclusion: Lean nursing combined with the DaVinci robot has a great effect and help in the operation and after operation of the surgical patient, and the patient also has a high evaluation of the author's method.

Optimizing Nerve Sparing in Robotic-Assisted Radical Prostatectomy: A Comparative Investigation of Traditional and Modified Endopelvic Fascia Preservation Techniques.

Prostate cancer (PCa) is the second most common cancer and the sixth leading cause of cancer-related mortality in men. In 2000, Abbou performed the first robot-assisted radical prostatectomy, and radical prostatectomy has developed rapidly. Robot-assisted radical prostatectomy (RARP) is a valuable therapeutic option for the management of localized Pca. To present the functional outcome of robot-assisted laparoscopic radical prostatectomy using traditional and modified endopelvic fascia preservation methods in a single center in Vietnam. We prospectively analyzed a series of 65 patients diagnosed with prostate cancer from 2020 to 2023. All of those were operated by DaVinci Si system robot-assisted laparoscopic prostatectomy. Twenties patients were applied with a modified nerve-sparing technique, intrafascial dissection, and lateral prostatic fascia preservation, leaving the lateral tissue, including the neurovascular bundle, untouched and covered. We used the traditional approach, intrafascial nerve-sparing with open endopelvic fascia and lateral prostatic fascia in 45 cases. Patients were followed up to 12 months to assess the continence and erectile function by using IIEF-5 and EPIC questionnaires. The study sample included 65 cases; the mean patient age was 64.21 ± 6.68, erection rate after surgery at six months in bilateral NS was 36.58% (15/41) in the traditional group, and 68.42% (13/19) in the modified group (p=0.028). The patient did not recover erectile ability in the group of elderly patients (>65 years old) and unilateral nerve-sparing group. The continence rate six months after surgery was 86.66 % in the conventional group and 85% in the modified group, with no significant difference between the two groups. In the potency group, the IIEF-5 score was 13 ± 4.9, and the EPIC-26 score was 62.20 ± 10.04. Erectile ability in the modified group was better than the traditional group at six months after surgery. Our results showed better potency recovery in the modified group. These results should be tested in future research with randomized studies.

Correlation of Radiological and Pathological Staging in Early Prostate Cancer Treated with Robot-assisted Laparoscopic Prostatectomy

Correlation of Radiological and Pathological Staging in Early Prostate Cancer Treated with Robot-assisted Laparoscopic Prostatectomy

Novel online comprehensive pelvic floor therapy program following prostatectomy.

Although pelvic floor muscle training (PFMT) is widely shown to improve post-prostatectomy incontinence (PPI), numerous barriers impede access to formal PFMT and include the limited availability of specialized therapists and financial or scheduling barriers. To address these barriers, we developed a novel online program delivering comprehensive long-term PFMT, pelvic floor education (PFE), and dietary/behavioral modification education. This study is a prospective interim analysis of online PFMT/PFE (oPFMT/PFE), with focus on feasibility, satisfaction, and continence outcomes. Patients anticipating robotic-assisted laparoscopic prostatectomy (RALP) were recruited (6/2021-9/2022) for oPFMT/PFE. oPFMT/PFE comprises a 12-month program of 3 phases, including multiple exercises with varied contraction types and duration, and comprehensive dietary and behavioral technique education. Incontinence and quality of life (QOL) outcomes are assessed at 3 weeks, 3, 6, and 12 months following RALP using validated International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Incontinence Impact Questionnaire (IIQ-7) questionnaires and additional items assessing satisfaction, improvement, and daily pad use. Primary study outcomes included ICIQ-MLUTS stress urinary incontinence (SUI) domain score (SDS) and SUI cure [ICIQ SUI domain score (SDS) =0]. Interim 6-month analysis was performed using mixed effects linear regression and mixed effects Poisson regression. Analysis included 21 men (64±6 years). At 6-month follow-up, men undergoing oPFMT/PFE showed significant improvement in SDS compared to the 3-week time point [mean ± standard error (SE) =1.05±0.24 vs. 0.45±0.17, P=0.011], but still experienced higher scores than at baseline (P=0.017). Six-month patient-reported improvement averaged 7.42±0.74 (10-point Likert scale). All (100%) of 19 respondents (2 missing data) found the program easy to use, educational, and would recommend it to others, with 89% expressing satisfaction with the program. During patient interview at 6-month follow-up, no men reported inability to access the program online or any adverse events. Finally, IIQ-7 score improved significantly from the 3-week timepoint (4.47±1.10) at both time points (3-month 1.14±0.44, P<0.001 and 6-month 1.10±0.37, P<0.001), and neither 3- nor 6-month scores differed from baseline (P=0.808 and P=0.444, respectively). Our novel oPFMT/PFE yields significant improvements to validated urinary incontinence (UI) and QOL measures, providing a valuable and accessible treatment option for PPI.

Effect of the Duration of Restrictive Fluid Therapy on Acute Kidney Injury in Robot-Assisted Laparoscopic Prostatectomy.

In robot-assisted laparoscopic prostatectomy (RALP), restrictive fluid therapy (RFT) is often utilized until the vesicourethral anastomosis (console period) is completed. RFT can cause acute kidney injury (AKI). Thus, RFT prolongation in surgeries that utilize the Trendelenburg position and pneumoperitoneum may increase the risk of postoperative AKI. We aimed to evaluate the effect of RFT duration on postoperative AKI. Forty-four patients who underwent RALP were included in this prospective observational study. Patients were divided into two groups according to the RFT duration (Group I, RFT duration ≤ 3 h, and Group II, RFT duration >3 h). AKI was diagnosed and staged according to the Kidney Disease Improving Global Outcomes criteria (KDIGO) using patients' serum creatinine levels after the first 24 h postoperatively. Hemodynamic parameters were monitored using the pressure recording analytical method. The AKI incidence was significantly higher in Group II than in Group I (45.5% vs. 9.1%; p = 0.016). In both groups, all patients who developed AKI were KDIGO stage 1 and all recovered on the second postoperative day. At the end of the console period, the heart rate and arterial elastance were significantly higher, whereas the stroke volume index was significantly lower in Group II than in Group I (p = 0.041, p = 0.016, and p < 0.001, respectively). Although the amounts of fluid administered before and after the anastomosis were similar between the groups, the total amount of fluid administered was significantly different (p < 0.001). There was a significant negative correlation between RFT duration and the total amount of fluid administered (r2 = 0.43, p < 0.001). RFT duration of >3 h, total fluid administration of ≤3.3 mL/kg/h, and stroke volume index (SVI) at the end of the console period of ≤32 mL/m2 increased the risk of AKI by 12.0 times (1.7-85.2) (p = 0.013). RFT prolongation in RALP may increase the risk of developing AKI.

Impact of multiparametric magnetic resonance imaging targeted biopsy on functional outcomes in patients following robot-assisted laparoscopic radical prostatectomy.

Multiparametric magnetic resonance imaging guided prostate biopsy (mpMRI PBx) leads to a higher rate of successful nerve-sparing in robot-assisted laparoscopic prostatectomy (ns-RALP) for prostate cancer (PCa). This study aimed to evaluate the impact of mpMRI PBx compared to standard ultrasound-guided PBx on functional outcomes focusing on erectile function in patients following ns-RALP. All RALPs performed between 01/2016 and 06/2021 were retrospectively stratified according to (attempted) ns vs. non ns RALPs and were then categorized based on the PBx technique (mpMRI PBx vs. standard PBx). We compared RALP outcomes such as pathological tumor stage, rates of secondary nerve resection (SNR) and positive surgical margin status (PSM). Furthermore, we explored the association between PBx-technique and patient-reported outcomes assessed 12 months after RALP using the prospectively collected 26-item Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. Chi-square tests and logistic regression analysis were conducted. A total of 849 RALPs included 517 (61%) procedures with (attempted) ns. Among these, 37.5% were diagnosed via preoperative mpMRI PBx. Patients with a preoperative standard PBx had a 57% higher association of PSM (p = 0.030) compared to patients with mpMRI PBx and a 24% higher risk of erectile dysfunction (ED) 12 months post RALP (p = 0.025). When ns was attempted, we observed a significantly higher rate of SNR in patients who underwent a standard PBx compared to those who received a mpMRI PBx (50.8% vs. 26.7%, p < 0.001) prior RALP. In comparison, upgrading occurred more often in the standard PBx group (50% vs. 40% mpMRI PBx, p = 0.008). The combination of mpMRI PBx for PCa diagnosis followed by ns-RALP resulted in significantly fewer cases of SNR, better oncological outcomes and reduced incidence of ED 1 year after surgery. This included fewer PSM and a lower rate of postoperative tumor upgrading.

The Effectiveness of a Criteria-Led Discharge Initiative on the Length of Stay of Patients Who Underwent a Robotic-Assisted Laparoscopic Prostatectomy

ObjectivesTo determine the impact of a criteria-led discharge initiative (CLD) on the hospital length of stay of patients undergoing a robotic-assisted laparoscopic prostatectomy (RALP).MethodsThis is a cohort study of prospectively collected data completed at a major tertiary hospital from December 2017 to August 2020. The CLD initiative consists of 4 criteria: clinical haemodynamic stability (heart rate &lt; 100 beats/minute, systolic blood pressure &gt; 100mmHg), a drain output of less than 50 mL, flatulence or bowel movement, and the ability to tolerate an oral diet. The primary outcome was hospital length of stay for patients before and after the introduction of CLD.ResultsOne hundred men undergoing RALP before the implementation of the CLD initiative were compared to 118 men undergoing RALP following the implementation of CLD. The patients had similar baseline demographic features. There was a significant difference found in hospital LOS with the pre-CLD group LOS (mean = 1.8 days, SE = 0.12) being longer than the LOS in the post-CLD group (mean = 1.4 days, SE = 0.09, P = 0.015). There were no significant between-group differences in the proportion of patients discharged on the first postoperative day and the 30-day readmission rate.ConclusionWithin our study population, we have demonstrated that the introduction of CLD was associated with reduced hospital LOS with no increase in adverse events. These findings support the need for the development of CLD in other conditions.