Robot-assisted Urologic Surgery Research Articles

Simulation and Training in Robot-Assisted Urological Surgery: From Model to Patient.

(1) Background: Simulation-based training has revolutionized surgical education, providing a solution to the changing demands of surgical training and performance. The increasing demand for standardized training in robotic surgery has accelerated the adoption of simulation-based training as a necessary component of modern surgical education. This study examines the existing literature on training approaches employed in robot-assisted urological surgery; (2) Methods: The authors conducted a standardized search of online databases. Upon collecting the articles, the authors assessed their relevance and content before proceeding with the drafting of the text; (3) Results: The use of simulators is supported by convincing evidence that shows an advantage in the acquisition of robotic skills. Urological societies have created detailed training programs for robotic surgery that guide beginners through the entire process of skill acquisition; (4) Conclusions: The future landscape for robotic urology training is likely to involve organized, obligatory, and centralized training, which may be overseen by urologic associations.

Robot-assisted surgery in urology

Background: In the field of urological surgery, robotic surgery continues to develop and increase. This paper is an overview of the present and future of robotic urological surgery.Current Concepts: Robot-assisted surgery has revolutionized minimally invasive surgery and advanced the technical limitations of laparoscopy. Urologists have always been eager to adopt new technological advances to benefit their patients, and they have also been pioneers in the field of robotic surgery.Discussion and Conclusion: Following the first approval by the Food and Drug Administration in 2000, the da Vinci System (Intuitive Surgical, USA) remained the leading robotic surgical system for over 20 years. In 2000, the first robot-assisted laparoscopic radical prostatectomy was performed in urology. Subsequently, applications of the da Vinci System in urology have grown exponentially, including the kidney, urinary bladder, and reconstructive and functional urological surgeries. To date, urology is driving robotic innovation. The first specialist-engineered system for single-site surgery, the da Vinci SP, was initially approved for use in urological surgery. Due to the advantages of robotic surgery, such as excellent visibility and operability, the demand for robotic surgery in the urology department is continuously increasing. Recently, in addition to the da Vinci System, other robot platforms are being developed and commercialized in many countries. In South Korea, robots such as Revo-I (Meere Company Inc., Korea) and Zamenix (Roen Surgical, Korea) are being released and commercialized. Urologists continue to lead the development of domestic robots and robotic surgery.

РОБОТ-АССИСТИРОВАННАЯ ХИРУРГИЯ В ДЕТСКОЙ УРОЛОГИИ - ПЕРВЫЙ ОПЫТ

Robot-assisted surgery in pediatric urology is developing most intensively among other surgical disciplines in the direction from simple to complex reconstructive interventions. The purpose of the Article is to summarize the current state of the problem of robotic surgery in pediatric urology and evaluate its future possibilities. The scientific study was carried out at the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia) in Dec. 2022-May 2023. 19 robot-assisted procedures were performed over the entire period. Robotic surgeries were performed using the new Versius robotic platform by Cambridge Medical Robotics (UK). All surgical procedures were performed according to the same principles as well as the pattern Authors have previously adopted from the very beginning of their own experience with the Versius system. In all cases, three robotic ports were used: a single 12 mm trocar for optics (openly inserted at the level of the umbilicus) and two 5 mm trocars for robotic manipulators. Additionally, a 5-mm laparoport was installed for the assistant to work during the robotic operation. The study recorded patients' perioperative parameters related to demographics, surgical details and both early- and long-term outcomes. Results: 19 patients were included in the study (11 (58 [34; 80]%) boys/8 (42 [20; 66]%) girls) with the age the surgery was performed in 10.4±4.2 years old (median - 10.0 [7.0; 14.5] y/o) and the weight at the surgery 41.0±16.2 kg (median - 41.0 [27.0; 54.3] kg). Robot-assisted operations in pediatric urology were represented by the following procedures: pyeloplasty in 6 (32 [13; 57]%); removal of a kidney cyst in 5 (26 [9; 51]%); nephrectomy in 4 (21 [6; 46]%); Hellström-Chapman in 1 (5 [0; 26]%) and resection of the bladder diverticulum in 1 (5 [0; 26]%) patient. The mean duration of surgical intervention was 142.2±49.7 min (median - 140.0 [110.0; 160.0] min). Interventions were not accompanied by intraoperative complications. No significant complications were noted in both early and late postoperative periods. Conclusion: initial experience with robotic-assisted surgery confirmed that robotics can be safely and effectively used in children with urological pathology.

Robot-Assisted Urological Oncology Procedures, Outcomes, and Safety in Frail Patients: A Narrative Review of Available Studies.

In this study, we assess the impact of frailty on the success rate and risk of complications of robot-assisted urological procedures and introduce effective preoperative screening tools to evaluate frail patients' fitness to tolerate robot-assisted urological surgery. We performed a search of electronic databases for available studies, published up to August 2023, investigating the outcomes of robot-assisted urological oncology procedures and their safety in frail patients. Sixteen studies were ultimately selected, investigating the implications of frailty in robot-assisted radical cystectomy, robotassisted partial nephrectomy, and robot-assisted radical prostatectomy. All the studies used the Clavien-Dindo classification of complications with serious complications considered as Clavien-Dindo 3. Frail patients significantly benefit from robot-assisted urological procedures in comparison to open surgery, with lower rates of blood transfusion and a shorter length of stay. However, they also have a higher risk of postoperative complications than non-frail patients, as well as increased rates of conversion to open, total hospital costs, and in-hospital mortality after robot-assisted procedures. Robot-assisted urological procedures can improve the postoperative recovery of frail patients in comparison to open surgery. Reliable frailty indexes such as the Johns Hopkins indicator and simplified frailty index, as well as the Geriatric 8 screening tool, should be routinely used in the preoperative assessment of frail patients to optimize surgical decision-making.

Pyeloplasty in Children with Ureteropelvic Junction Obstruction and Associated Kidney Anomalies: Can a Robotic Approach Make Surgery Easier?

Robot-assisted pyeloplasty is widely used in pediatric surgery because of its well-known advantages over open or laparoscopic surgery. The aim is to explore our experience and evaluate the achievements we have made. We evaluated patients undergoing robotic pyeloplasty from January 2016 to November 2021, including those who presented with a ureteropelvic junction obstruction associated with other anomalies of the kidney. The parameters examined were: age, weight, associated renal malformations, conversion rate, operative time, and intra- and postoperative complications. Of 39 patients, 7 (20%) were included, of whom 5 (71%) were male and 2 (29%) were female. The mean age at surgery was 84 months (range 36-180 months), and the mean weight at surgery was 24.4 kg (range 11-40 kg). In five (71%) patients the ureteropelvic junction obstruction (UPJO) was left-sided and in two (29%) it was right-sided. In four (57%) cases, UPJO was associated with a horseshoe kidney, right-sided in one (25%) patient, and left-sided in the other three (75%). A 180° rotation of the kidney was present in one (14%) patient. Nephrolithiasis was present in two (29%) patients. The mean operative time was 160 min (range 140-240 min). The average bladder catheter dwell time was 1 day (range 2-3 days), while the average abdominal drainage dwell time was 2 days (range 2-4 days). The mean hospitalization time was 4 days (range 3-9 days). On average, after 45 days (range 30-65) the JJ ureteral stent was removed cystoscopically. No intraoperative complications were reported, while one case of persistent macrohematuria with anemia requiring blood transfusion occurred postoperatively. Ureteropelvic junction obstruction might be associated with other congenital urinary tract anomalies such as a duplicated collecting system, horseshoe kidney, or pelvic kidney. These kinds of malformations can complicate surgery and require more attention and accuracy from the surgeon. Our experience shows that, with regards to the robotic learning curve required for pyeloplasty, the treatment of the ureteropelvic junction in these situations does not present insurmountable difficulties nor is burdened by complications. The application of robot-assisted surgery in pediatric urology makes difficult pyeloplasties easier.

Exploring the Applications of Indocyanine Green in Robot-Assisted Urological Surgery: A Comprehensive Review of Fluorescence-Guided Techniques

This comprehensive review aims to explore the applications of indocyanine green (ICG) in robot-assisted urological surgery through a detailed examination of fluorescence-guided techniques. An extensive literature search was conducted in PubMed/MEDLINE, EMBASE and Scopus, using keywords such as “indocyanine green,” “ICG”, “NIRF”, “Near Infrared Fluorescence”, “robot-assisted”, and “urology”. Additional suitable articles were collected by manually cross-referencing the bibliography of previously selected papers. The integration of the Firefly® technology in the Da Vinci® robotic system has opened new avenues for the advancement and exploration of different urological procedures. ICG is a fluorophore widely used in near-infrared fluorescence-guided techniques. The synergistic combination of intraoperative support, safety profiles and widespread availability comprises an additional asset that empowers ICG-guided robotic surgery. This overview of the current state of the art illustrates the potential advantages and broad applications of combining ICG-fluorescence guidance with robotic-assisted urological surgery.

STEREOSCOPIC AUGMENTED REALITY FOR INTRAOPERATIVE GUIDANCE IN ROBOTIC SURGERY

Augmented reality (AR) technology is increasingly adopted in the surgical field and recently it has been also introduced in robotic-assisted urologic surgery. This work describes the design and development of an AR intraoperative guide system with stereoscopic visualization (SAR, stereoscopic augmented reality) for the Da Vinci surgical robot. As a major novelty, the developed SAR system allows the surgeon to have the virtual 3D model of patient anatomy superimposed on the real field, without losing the stereoscopic view of the operative field. The workflow starts with the 3D model generation of the anatomical district of interest for surgery, from patient diagnostic imaging. Then, the 3D model is uploaded in the developed SAR application, navigated using a 3D space mouse, and superimposed to the operative field using computer vision algorithms. The SAR system was tested during 30 robot-assisted surgeries, including 20 partial nephrectomies, 1 kidney explant, and 9 radical prostatectomies. The SAR guidance system received overall great appreciation from surgeons and helped in localizing hidden structures, such as arteries or tumoral masses, increasing the understanding of surgical anatomy with depth perception, and facilitating intraoperative navigation. Future efforts will be addressed to improve the automatic superimposition of digital 3D models on the intraoperative view.

Fragility of statistically significant findings from randomized trials in comparing laparoscopic versus robotic abdominopelvic surgeries.

Utility of robotic over laparoscopic approach has been an area of debate across all surgical specialties over the past decade. The fragility index (FI) is a metric that evaluates the frailty of randomized controlled trials (RCTs) findings by altering the status of patients from an event to non-event until significance is lost. This study aims to evaluate the robustness of RCTs comparing laparoscopic and robotic abdominopelvic surgeries through the FI. A search was conducted in MEDLINE and EMBASE for RCTs with dichotomous outcomes comparing laparoscopic and robot-assisted surgery in general surgery, gynecology, and urology. The FI and reverse fragility Index (RFI) metrics were used to assess the strength of findings reported by RCTs, and bivariate correlation was conducted to analyze relationships between FI and trial characteristics. A total of 21 RCTs were included, with a median sample size of 89 participants (Interquartile range [IQR] 62-126). The median FI was 2 (IQR 0-15) and median RFI 5.5 (IQR 4-8.5). The median FI was 3 (IQR 1-15) for general surgery (n = 7), 2 (0.5-3.5) for gynecology (n = 4), and 0 (IQR 0-8.5) for urology RCTs (n = 4). Correlation was found between increasing FI and decreasing p-value, but not sample size, number of outcome events, journal impact factor, loss to follow-up, or risk of bias. RCTs comparing laparoscopic and robotic abdominal surgery did not prove to be very robust. While possible advantages of robotic surgery may be emphasized, it remains novel and requires further concrete RCT data.

Advantages and disadvantages of robotic-assisted urologic surgery vs. laparoscopic surgery in the COVID-19 Pandemic

Advantages and disadvantages of robotic-assisted urologic surgery vs. laparoscopic surgery in the COVID-19 Pandemic

MP68-13 THE PREVALENCE OF PORT-SITE INCISIONAL HERNIA AFTER UROLOGIC ROBOT-ASSISTED LAPAROSCOPIC SURGERY: A SINGLE-CENTER RETROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP68-13 THE PREVALENCE OF PORT-SITE INCISIONAL HERNIA AFTER UROLOGIC ROBOT-ASSISTED LAPAROSCOPIC SURGERY: A SINGLE-CENTER RETROSPECTIVE STUDY Lek Hong Tan, Guan Heng Chen, Chao Hsiang Chang, Chi Rei Yang, Chi Ping Huang, and Hsi Chin Wu Lek Hong TanLek Hong Tan More articles by this author , Guan Heng ChenGuan Heng Chen More articles by this author , Chao Hsiang ChangChao Hsiang Chang More articles by this author , Chi Rei YangChi Rei Yang More articles by this author , Chi Ping HuangChi Ping Huang More articles by this author , and Hsi Chin WuHsi Chin Wu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Port-site incisional hernia is a rare but potentially dangerous complication following laparoscopic surgery. However, only sporadic studies reported this complication after robotic surgery. Therefore, this study investigates the prevalence of port-site incisional hernia after urologic robot-assisted laparoscopic surgery. METHODS: This is a retrospective, single-center, observational study. Medical records were reviewed for 1295 patients who underwent urologic robot-assisted laparoscopic surgery from September 2013 to September 2021. The prevalence of port-site incisional hernia of robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), robot-assisted radical cystectomy (RARC), and robot-assisted radical nephroureterectomy with bladder cuff excision (RANUBCE) was computed. In addition, the association between uremic status and the post-operative port-site incisional hernia was shown with an odd ratio (OR) against a reference group. RESULTS: Among 527 patients who underwent RARP, 9 patients suffered from port-site incisional hernia (1.71%; 95% CI: 0.90%, 3.22%), 1 out of 154 patients in RAPN (0.65%; 95% CI: 0.11%, 3.59%), 4 out of 46 patients in RARC (8.70%; 95% CI: 3.44%, 20.33%), and 4 out of 136 patients in RANUBCE (2.94%; 95% CI: 1.15%, 7.32%). For all 4 patients who suffered from port-site incisional hernia after undergoing RARC, their neobladders were constructed extracorporeally, of which 2 performed ileal conduit, Studer pouch in 1 patient, and another one underwent J-pouch construction. The average time to occurrence of port-site incisional hernia was 366 days and the longest time to occurrence was 1129 days. Most of the incisional hernia occurred at the camera port site (70.59%; 95% CI: 46.87%, 86.72%), and uremic status is associated with a higher tendency to suffer from port-site incisional hernia (OR= 3.68, p<0.05). CONCLUSIONS: RARC has a higher prevalence rate of port-site incisional hernia, among other types of urologic robot-assisted surgery. Incisional hernia tends to occur in RARC with extracorporeal neobladder construction. In addition, the port-site incisional hernia is associated with the larger port size and the uremic status of the patients. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e958 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lek Hong Tan More articles by this author Guan Heng Chen More articles by this author Chao Hsiang Chang More articles by this author Chi Rei Yang More articles by this author Chi Ping Huang More articles by this author Hsi Chin Wu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP33-12 COMPARING PERIOPERATIVE OUTCOMES AFTER ROBOT ASSISTED VIDEO ENDOSCOPIC INGUINAL LYMPHADENECTOMY (RAVEIL) WITH OPEN INGUINAL LYMPH NODE DISSECTION (O-ILND) USING PROPENSITY SCORE MATCH ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP33-12 COMPARING PERIOPERATIVE OUTCOMES AFTER ROBOT ASSISTED VIDEO ENDOSCOPIC INGUINAL LYMPHADENECTOMY (RAVEIL) WITH OPEN INGUINAL LYMPH NODE DISSECTION (O-ILND) USING PROPENSITY SCORE MATCH ANALYSIS Sheshang Kamath, Abhinav Veerwal, Akash Shah, and Thyavihally Yuvaraja Sheshang KamathSheshang Kamath More articles by this author , Abhinav VeerwalAbhinav Veerwal More articles by this author , Akash ShahAkash Shah More articles by this author , and Thyavihally YuvarajaThyavihally Yuvaraja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the advent of robot, the indications for performing robot assisted surgery in urology have been expanding. Although open inguinal lymph node dissection (O-ILND) still remains the gold standard for management of inguinal lymph nodes in carcinoma of penis, the post-operative complications, time to drain removal and lymphocoele formation remain a drawback even in high volume centers. In this study, we intend to compare these perioperative parameters of (O-ILND) with RAVEIL using propensity score match analysis (PSM). METHODS: This study is retrospectively analyzed from a prospectively maintained cancer registry of the oncology department in our tertiary care institute. The data was obtained between 2008 and July 2022 from a single center operated by a single surgeon to avoid surgeon and institution bias. Patients with incomplete data set and no follow up for at least 3 post-operative months were excluded from the study. Univariate analysis was performed for baseline parameters, pathologic and perioperative outcomes among the two groups using Chi square test for categorical variables and student t-test was used for continuous variables. Multivariate logistic regression analysis was then performed. Propensity score match analysis (PSM) 1:1 was used to independently evaluate postoperative complications of Clavien dindo grade 3 and above and time to drain removal and skin complications after matching for the patient and pathologic characteristics. The value of p considered significant was <0.05. Statistical analysis were performed using SPSS version 23 and propensity score match analysis was performed using XLSTAT. RESULTS: Among 86 patients, 154 inguinal node dissections (68 O-ILND and 86 RAVEIL) were performed. Median age of patient was 60 (IQR 54-62) in O-ILND and 58 (IQR 56-61) in RAVEIL. Most common tumor stage for both arms was T2 (68.2 % in O-ILND vs 71% in RAVEIL) and most common grade was poorly differentiated (56.2 % in O-ILND vs 48.6% in RAVEIL). The operative time among both groups was comparable (100 minutes in O-ILND vs 92 minutes in RAVEIL) Perioperative factors significantly improved among RAVEIL group was preservation of saphenous vein, Clavien Dindo complications 3 or more and skin complications. PSM 1:1 done for 64 inguinal node dissections matched for baseline patient and pathologic variables found Clavien Dindo complications 3 or more and skin complications to be significantly lesser in the RAVEIL group. CONCLUSIONS: Although few previous studies in recent years have already mentioned the non-inferior oncologic outcomes and lesser morbidity with RAVEIL, this study is the first to our knowledge which uses PSM to match patient and tumor characteristics and thereby identify specific benefits of RAVEIL statistically. This study can also be used as a platform for a larger multi centric evaluation prospective analysis and thereby broaden the application of RAVEIL in near future. Source of Funding: We have no source of funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e454 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sheshang Kamath More articles by this author Abhinav Veerwal More articles by this author Akash Shah More articles by this author Thyavihally Yuvaraja More articles by this author Expand All Advertisement PDF downloadLoading ...

The complexity analysis of cerebral oxygen saturation during pneumoperitoneum and Trendelenburg position: a retrospective cohort study

BackgroundThe human brain is a highly complex and nonlinear system, nonlinear complexity measures such as approximate entropy (ApEn) and sample entropy (SampEn) can better reveal characteristics of brain dynamics. However, no studies report complexity of perioperative physiological signals to reveal how brain complexity associates with age, varies along with the development of surgery and postoperative neurological complications.AimThis study examined the complexity of intraoperative regional cerebral oxygen saturation (rSO2), aiming to reveal brain dynamics during surgery.MethodsThis retrospective cohort study enrolled patients who scheduled for robot-assisted urological surgery. Intraoperative rSO2 was continuously monitored throughout the surgery. Postoperative delirium (POD) was diagnosed by the Confusion Assessment Method. ApEn and SampEn were used to characterize the complexity of rSO2. Pearson correlation coefficients were used to measure the correlation between complexity of rSO2 and age. The association between complexity of rSO2 and POD was examined using T tests.ResultsA total of 68 patients (mean [SD] age, 63.0 (12.0) years; 47 (69.1%) males) were include in this analysis. There was a significant reverse relationship between the complexity of rSO2 and age (The correlation coefficients range between − 0.32 and − 0.28, all p < 0.05). Patients  ≥ 75 years showed significantly lower complexity of rSO2 than the other two groups. Older age remained an independent factor influencing complexity of rSO2 after adjusting for a number of covariates. Six patients (8.8%) developed POD, and POD patients had lower complexity of rSO2 compared with non-POD patients.ConclusionsThe complexity of rSO2 may serve as a new candidate marker of aging and POD prediction.

Analysis of Operating Room Efficiency During Robot-Assisted Urologic Surgeries Utilizing Fixed (Nonprocedural) Operative Times.

Objective: To analyze operating room (OR) efficiency by evaluating fixed OR times for three common urologic robot-assisted procedures. Methods: Over a 24-month period, we prospectively collected intraoperative data for 635 consecutive robot-assisted surgeries. Fixed (nonprocedural) OR times were evaluated for robot-assisted partial nephrectomy (RAPN) (n = 146), robot-assisted radical cystectomy (RARC) (n = 77), and robot-assisted radical prostatectomy (RARP) (n = 412). Fixed OR times were defined as nonprocedural time in the OR, including in-room time to anesthesia release time (IRAT), anesthesia release to cut time (ARCT), in-room time to cut time (IRCT; IRAT+ARCT), and close time to wheels out time (CTWO). The effects of operation time of day and the number of anesthesia personnel (AP) present in procedure on fixed OR times were also analyzed. Results: Fixed OR times occupied 15.1% (IQR: 12.9%-17.1%) (RARC), 26.6% (22.9%-30.8%) (RAPN), and 20.1% (17.4%-23.1%) (RARP) of total OR time. Time of day did not have a negative effect on fixed OR times for robotic urologic surgeries. Median AP count was highest for RARC (median: 3 and range: 1-7). We did not find any association between AP count and fixed OR times for any of the procedures (p ≥ 0.19). Conclusions: Fixed OR times made up a significant percentage of total OR time for robot-assisted procedures and should be incorporated into OR efficiency analyses. The number of AP per case and time of day of procedure did not negatively impact fixed OR times in urologic robotic surgeries.

[Does robotic radical cystectomy affect oncological outcomes in bladder cancer patients?]

Robot-assisted surgery in urology is now being used in a wide range of procedures. In addition to reconstructive procedures, tumour surgery such as radical cystectomy is of particular importance. While studies on the perioperative quality of robotic-assisted radical cystectomy suggest a favorable impact on morbidity (and thus mortality), the question remains as to what extent the oncological quality is influenced by this procedure in terms of recurrence-free and overall survival.In this context, following a comprehensive literature review, this paper presents data from retrospective cohort comparisons of open and robotic cystectomy, registry data and single centre series on robotic and open cystectomy, and the results of prospective randomised trials.In summary, from an oncological point of view, robotic cystectomy is not inferior to open cystectomy. Overall survival, cancer-specific survival, and progression-free survival data do not differ in retrospective cohort studies, in indirect comparisons of registry data and/or large series, or in prospective studies to date. With regard to the occurrence of atypical metastases after robotic cystectomy, prospective data are currently lacking and retrospective analysis produce conflicting data. However, general oncological outcome seems not to be affected.Thus, robotic-assisted cystectomy is also from an oncological point of view a good option for patients who have an indication for radical cystectomy.

[Medico-economic evaluation of the impact of measures to adapt to the switch to surgery robot-assisted in urology].

The development of robot-assisted urological surgery is held back by the lack of robust medico-economic analyses and their heterogeneity. We conducted a medico-economic study to evaluate the implementation of measures to optimize the transition to robotic surgery. We carried out a single-center, controlled study from the point of view of the public healthcare establishment for 4 years. Economic data collection was based on a micro-costing method and revenues from stay-related groups. Clinical data corresponded to mean lengths of stay, operating duration, complications and stays in intensive care. The measures to optimize the transition to robotic, implemented mid-study period, enabled before/after comparison. Altogether, 668 patients undergoing robotic surgery were included. Robotic activity increased significantly from periods 1 to 2 to 256% (P=<0.001) as did the overall proportion of robotic by 45% to 85% (P=<0.001). The mean lengths of stay fell significantly, 6.8 d vs. 5.1 d (P<0.001). Costs and revenues increased significantly, resulting in a persistent deficit for the activity €226K vs. €382K (P=<0.001). With increased volume of activity, the deficit per operation and the cost per minute of robotic operating room fell significantly, €3,284 vs. €1,474/procedure (P=<0.001) and €27 vs €24/min (P=<0.029), tending towards a break-even point (=zero deficit) at 430 operations per year. Robotic-assisted surgery can be significantly optimized by implementing measures for the robotic turn to reach a break-even point at 430 operations per year. A better multidisciplinary case mix could lower the break-even volume of activity in short term. 3.

A0020 - The use of abdominal drain after robot-assisted surgery in urology: Impact on postoperative pain

A0020 - The use of abdominal drain after robot-assisted surgery in urology: Impact on postoperative pain

Accurate Parameter Estimation for Master–Slave Operation of a Surgical Robot

In this paper, a parameter estimation method is proposed to predict the simultaneous joint dynamics of a surgical robotic arm that is tracking trajectories. It mainly deals with the design, modeling, prototyping and control of a serial robotic arm for robot-assisted urological surgery. This robot is composed of many joints mounted in series with the surgical tool end performing both a translational workspace and a cone-shaped orientation workspace. The joints dynamics is obtained by trajectory planning of the tool end in the virtual prototype modeling environment. The motor drive system is parameterized for design, and its comprehensive performance in motion is predicted accurately. The heterogeneous master–slave control system was built, and the performances of the master–slave prototype were experimentally evaluated by measuring the positioning error of the virtual fixed point and the surgical tool end along the planned trajectory.

Pediatric Robotic Adrenalectomy for Virilizing Adrenal Tumor in a 4-year-old Female

Adrenocortical tumors in children are rare, with approximately 90% of children presenting with endocrine syndromes, most commonly virilization. The standard treatment remains an open resection, although there is increasing use of the minimally invasive approach. With the advent of robotic surgery, its advantages over open and conventional laparoscopy make it a viable option in select patients. Despite the adoption of robot-assisted surgery in pediatric urology, limited literature regarding robotic pediatric adrenal surgery exists, with only a few small case series. We present a female child with virilizing features due to a large functional adrenal tumor managed by robot-assisted adrenalectomy.

Well leg compartment syndrome following robot-assisted radical cystectomy in the lithotomy position: a case report

BackgroundThe indications for robot-assisted urologic surgeries have expanded due to their low invasiveness. However, complicated surgical procedures lead to prolonged surgical duration, requiring patients to remain in the lithotomy position for an extended time. Well leg compartment syndrome (WLCS) is a known severe postoperative complication related to the lithotomy position.Case presentationWe report a case of WLCS after robot-assisted radical cystectomy (RARC), in which the patient recovered without neurological sequelae. A 55-year-old, obese male who underwent RARC complained of right leg pain and paresthesia 3 h after the surgery that lasted for 481 min. Emergency evaluation revealed unilateral WLCS in the anterior and lateral compartments. Urgent fasciotomy was performed 4 h after symptom onset. He thereafter recovered completely and was discharged without any neuromuscular dysfunction.ConclusionsEarly detection of WLCS, surgical treatment, and additional measures are crucial to prevent its life-threatening and/or disabling outcomes.

Current Status of Robot-Assisted Surgery in Urology

Current Status of Robot-Assisted Surgery in Urology