Robot-assisted Partial Cystectomy Research Articles

“Robot-Assisted Partial Cystectomy for Deep Infiltrating Endometriosis of the Bladder With the Hugo RAS System”

ObjectiveInvolvement of the lower urinary tract is found in 0.2 to 2.5% of all deep infiltrating endometriosis (DIE) [1,2]. The bladder is the most affected organ with a prevalence of up to 80% of cases [3]. Patients with bladder endometriosis are often symptomatic (dysuria, hyperactive bladder, recurrent urinary tract infections, and hematuria). Surgery is the gold standard treatment for this condition when medical therapy fails [1,2]. Several studies have shown the feasibility, effectiveness, and safety of the laparoscopic approach [4] but data about robotic-assisted approach are missing in literature. Currently, novel platforms are entering the market and the Hugo™RAS (Medtronic, Minneapolis, USA) is a new system (HRS) consisting of an open console with 3D-HD screen and a multimodular bedside units. Even if some series are already available for radical cystectomies for oncologic purposes [5], a full description of DIE surgery performed with HRS is still lacking. Aim of this video-article is to show our technique and surgical setup to carry out a complex case of anterior compartment DIE. DesignA step-by-step explanation of surgical technique with narrated video footage. SettingTertiary Level Academic Hospital “IRCCS Azienda Ospedaliero—Universitaria di Bologna” Bologna, Italy. InterventionA 36-year-old nulliparous woman affected by DE was referred to our center due to severe dyspareunia, dysuria with hematuria and postvoiding pain not responsive to oral progestins. The preoperative work up consisted of a gynecological examination, pelvic ultrasound and MRI that showed the presence of an endometriotic nodule of the bladder base. All possible therapeutic strategies and related complications have been discussed with the patient before the signature of the informed consent. To carry out the procedure a “straight” port placement in a “compact” docking configuration [6] was installed. After developing the paravesical spaces bilaterally, the bladder nodule was approached in a latero-medial direction then a partial cystectomy with macroscopical free margins was performed. A double layer horizontal running suture with barbed thread was used to repair the bladder wall. ConclusionTo the best of our knowledge, this is the first case of bladder endometriotic nodule excision performed with HRS. We explained our technique and robotic set-up to successfully manage a compelx case of DIE of the bladder.

RF19 | PSUN367 Urinary bladder Paragangliomas – A Case series

Abstract Introduction Paragangliomas (PGL) are rare neuroendocrine tumours and account for approximately 10% of all chromaffin tumours. They may occur in the retroperitoneum, mediastinum, skull and the urinary bladder. Paragangliomas of the urinary bladder are rare entities accounting for 10% of all paragangliomas and 0.06% of all bladder tumours. Approximately 10% of urinary bladder paragangliomas are malignant. Bladder paragangliomas can be either functional or non-functional. Main symptoms of functional PGLs are due to catecholamine excess with palpitations, paroxysmal hypertension during micturition, sweating and headaches. Functional bladder PGL are diagnosed on biochemical analysis. Non-functional bladder PGLs present with haematuria and are often misdiagnosed as bladder cancer as they may cystoscopically and histologically resemble a urothelial neoplasm. Clinical cases: We present a case series of 4 surgically treated patients with urinary bladder paragangliomas who presented to Cambridge University Hospital over the last 3 years. All patients were female with an age range between 21 and 44 years. All four patients had SDHB deficient tumours, and all four patients were diagnosed with a pathogenic variant in the SDHB gene. Three patients had no family history of SDHx associated neoplasia whereas one had a paternal aunt who died from a metastatic pheochromocytoma. Three patients had presented with palpitations and hypertensive episodes, one of whom experienced symptoms while micturating. Biochemical analysis revealed elevated plasma normetadrenaline levels in all patients. On presentations, one patient had a synchronous paratracheal paraganglioma while two patients had lymph node metastasis. All patients were surgically treated with two patients undergoing fertility preserving cystectomy and bladder substitution, one undergoing partial cystectomy, radical hysterectomy and ureteric implantation and one managed with robot-assisted partial cystectomy. None of the patients have evidence of biochemical or radiological tumour recurrence on follow-up with a mean follow-up time of 23 months (range 12 to 40 months). Conclusion and points for discussion The diagnosis of urinary bladder PGL is challenging. Biochemical assessment to assess catecholamine production and imaging studies like CT, MRI and NM Ga68 DOTATATE PET CT are helpful modalities in diagnosis. Patients presenting with extra adrenal paragangliomas including bladder paragangliomas require genetic testing because of the strong hereditary predisposition, with mutations in the SDHx genes being most common with this clinical phenotype. The surgical approach should be tailored to the individual patient, agreed by a multi-disciplinary team and the risk of malignancy should be weighed against the potential morbidity associated with a curative oncological surgery. As urinary bladder PGLs have malignant potential and are frequently hereditary (as demonstrated in this series), lifelong follow-up is required to screen for synchronous tumours and tumour recurrence. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:42 p.m. - 12:47 p.m.

Robot-Assisted Partial Cystectomy versus Open Partial Cystectomy for Patients with Urachal Cancer

Introduction: Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial cystectomy (RAPC) is an alternative approach, of which its safety and efficacy for UrC remains to be determined. In the present study, we analyze these outcomes after RAPC, compared with OPC. Methods: We retrospectively evaluated 55 cN0M0 UrC patients who underwent RAPC (n = 8) or OPC (n = 47) between 1994 and 2020. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier methods. Positive surgical margins (PSM), port-site recurrences (PSR) versus wound recurrences were compared. Complications were recorded using the Clavien-Dindo classification. Results: Median follow-up was 40 months (IQR 21–95). Two-year OS and RFS for RAPC were 73% (95% confidence intervals (CI); 56–89 months) and 60% (95% CI; 42–78 months), respectively, versus 90% (95% CI; 85–95 months) and 66% (95% CI; 59–73 months) for OPC. PSM rate was 13% in both groups. PSR occurred in 2/8 (25%) patients after RAPC. No wound recurrences occurred after OPC. Postoperative complications occurred in 2/8 (25%) patients after RAPC, versus 5/47 (11%) after OPC (p = 0.27). Conclusion: Both RAPC and OPC seem feasible surgical modalities to treat localized UrC with comparable survival. The PSR rate of 25% after RAPC should prompt us to be cautious to recommend RAPC as no such recurrences were seen using OPC.

A0629 - Robot-assisted partial cystectomy versus open partial cystectomy for patients with urachal cancer

A0629 - Robot-assisted partial cystectomy versus open partial cystectomy for patients with urachal cancer

A rare case of eosinophilic cystitis involving the inside and outside of the urinary bladder associated with an infected urachal cyst

BackgroundEosinophilic cystitis is a rare inflammatory disease of the bladder characterized by eosinophilic infiltration of the bladder wall. Most Eosinophilic cystitis cases present with mucosal lesions of the urinary bladder. We present a very rare case of large mass-forming eosinophilic cystitis, involving the inside and outside of the bladder associated with an infected urachal cyst.Case presentationA 59-year-old man presented with gross hematuria, fever, dysuria, and suprapubic pain. Computed tomography showed a heterogeneously enhancing mass that measured 7.6 cm × 4 cm located on the anterosuperior portion of the bladder with an internal fluid collection. Cystoscopy revealed a raspberry-like mass lesion on the bladder dome. Transurethral resection of the bladder was initially performed. The mass lesion protruding from inside the bladder was removed, and pus-like fluid was drained. The pathologic diagnosis was eosinophilic cystitis. Follow-up computed tomography showed a remnant mass outside the bladder and urachal cyst. To eliminate the remnant lesion, robot-assisted partial cystectomy was performed. The patient showed no evidence of recurrent disease on follow-up cystoscopy and computed tomography for up to 2 years.ConclusionsClinicians should consider the possibility of eosinophilic cystitis in patients who present with hematuria, fever, and suprapubic pain and have both intravesical and extravesical masses.

VE08 - Cystoscopy guided robot-assisted partial cystectomy for the treatment of an inflammatory myofibroblastic tumour

VE08 - Cystoscopy guided robot-assisted partial cystectomy for the treatment of an inflammatory myofibroblastic tumour

Robot-assisted partial cystectomy: perioperative outcomes and early oncological efficacy.

To report on patients undergoing robot-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomical and pathological variables, as well as the overall oncological efficacy of this approach. We retrospectively reviewed all patients who underwent RAPC by a single surgeon between 2005 and 2015. We identified 29 patients who underwent surgery for definitive management of a primary bladder tumour. Clinicopathological data and perioperative variables were recorded. Continuous variables were compared using the Student's t-test. Prediction of perioperative outcomes for those undergoing RAPC for intra-diverticular neoplasms was done using univariate logistic regression. Survival was estimated using the Kaplan-Meier method. The median (interquartile range) patient age was 75 (65-81) years, 18 patients (62.1%) had an American Society of Anesthesiologists classification of ≥3, and 10 patients (34.5%) had a history of prior abdominal surgery. The median estimated blood loss (EBL) was 50 mL and the median length of stay (LOS) was 1 day. Two patients (6.9%) had a perioperative complication and five (17.9%) a post-discharge complication at ≤90 days, all of which were minor. The positive surgical margin rate was 3.6% and in those with muscle-invasive disease a median of 12 lymph nodes were removed. Neither the size of diverticulum nor the need for ureteric re-implantation was predictive of LOS, EBL, or complication (P > 0.05). We did not encounter any wound, port site, or unusual recurrence patterns to suggest the technical factors of a robotic approach influenced oncological outcomes. The 5-year overall and recurrence-free survival rates were 79% and 68%, respectively. RAPC confers the ability to achieve favourable outcomes with low morbidity and reduced hospital stays. Oncological efficacy compares favourably with the published literature. For experienced surgeons, this may represent the optimal surgical approach for organ-preserving bladder surgery.

Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique

PurposeTo describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis.Materials and MethodsA total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires.ResultsThe mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction.ConclusionsThe 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy.

Robot-assisted partial cystectomy for bladder endometriosis

Robot-assisted partial cystectomy for bladder endometriosis

Robot-Assisted Partial Cystectomy for Treatment of Bladder Paraganglioma

Abstract Introduction: Bladder paragangliomas (BP) (also commonly called bladder pheochromocytomas) account for 0.06% of bladder tumors, but may occur more frequently with familial syndromes, inclu...

V1890 ROBOT-ASSISTED PARTIAL CYSTECTOMY FOR BLADDER CANCER OF A BLADDER DIVERTICULUM

You have accessJournal of UrologyOncology, Bladder Oncology1 Apr 2012V1890 ROBOT-ASSISTED PARTIAL CYSTECTOMY FOR BLADDER CANCER OF A BLADDER DIVERTICULUM Wooju Jeong, Quoc-Dien Trinh, Khurshid R. Ghani, Jesse D. Sammon, Jay Jhaveri, Shyam Sukumar, Ali Dabaja, Emil Kheterpal, Fred Muhletaler, Mani Menon, and Piyush K. Agarwal Wooju JeongWooju Jeong Detroit, MI More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh Detroit, MI More articles by this author , Khurshid R. GhaniKhurshid R. Ghani Detroit, MI More articles by this author , Jesse D. SammonJesse D. Sammon Detroit, MI More articles by this author , Jay JhaveriJay Jhaveri Detroit, MI More articles by this author , Shyam SukumarShyam Sukumar Detroit, MI More articles by this author , Ali DabajaAli Dabaja Detroit, MI More articles by this author , Emil KheterpalEmil Kheterpal Detroit, MI More articles by this author , Fred MuhletalerFred Muhletaler Detroit, MI More articles by this author , Mani MenonMani Menon Detroit, MI More articles by this author , and Piyush K. AgarwalPiyush K. Agarwal Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2045AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of bladder diverticula is 1.7%, while the incidence of urothelial carcinoma within these diverticula ranges from 0.8 to 13%. In this video, we report our technique of robot-assisted partial cystectomy for urothelial cancer located within a bladder diverticulum. METHODS Our patient was a 64 year-old male who presented with a history of prostate cancer on active surveillance. He underwent a cystoscopy for increasing post-void residual, which revealed an incidental bladder tumor within a diverticulum. This tumor turned out to be a high-grade pTa lesion. A transperitoneal robot-assisted laparoscopic approach was used to mobilize the bladder. The bladder lesion was marked with a hook cautery circumferentially. Simultaneous cystoscopic monitoring was performed to ensure a margin of resection of 2 cm around the lesion. Bladder reconstruction and bilateral pelvic lymph node dissection were subsequently completed. RESULTS Our console time was 5 hours with an estimated blood loss of 50 mL. No JP drain was placed. There were no intra or post-operative complications. Diet was resumed on postoperative day 1 and the patient was discharged on postoperative day 1. Pathological examination revealed an urothelial carcinoma pTaN0Mx with low grade and negative surgical margins. He is doing well with no sign of recurrence at three months of follow-up. CONCLUSIONS Robot-assisted laparoscopic partial cystectomy is technically feasible and represents an alternative to open and conventional laparoscopic approaches. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e762-e763 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wooju Jeong Detroit, MI More articles by this author Quoc-Dien Trinh Detroit, MI More articles by this author Khurshid R. Ghani Detroit, MI More articles by this author Jesse D. Sammon Detroit, MI More articles by this author Jay Jhaveri Detroit, MI More articles by this author Shyam Sukumar Detroit, MI More articles by this author Ali Dabaja Detroit, MI More articles by this author Emil Kheterpal Detroit, MI More articles by this author Fred Muhletaler Detroit, MI More articles by this author Mani Menon Detroit, MI More articles by this author Piyush K. Agarwal Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...