Robot-assisted Laparoscopy Research Articles

Comparing robotic, laparoscopic, and laparotomy in endometrial cancer: a network meta-analysis.

This study aims to assess the comparative effectiveness and safety of robotic-assisted surgery (RAS), laparoscopy (LPS), and laparotomy (LPT) in improving perioperative indicators, lymph node dissection, and tumor survival outcomes in patients with Endometrial carcinoma (EC) through a systematic review and network meta-analysis. We searched China National Knowledge Infrastructure, Wanfang, WeiPu, China Biology Medicine Disc, Embase, PubMed, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and Cohort studies (CSs) involving RAS, LPS and LPT in individuals with EC. The network meta-analysis employed a Bayesian framework to integrate direct and indirect evidence, calculating Odds Ratios (OR) and Mean Difference (MD). Markov chain Monte Carlo methods generated posterior distributions, comparing and ranking treatments using Surface Under the Cumulative Ranking (SUCRA) values. Regression and sensitivity analyses assessed the impact of different variables on the results. 37 eligible trials involving 3 surgical techniques and 6,558 participants were included in this network meta-analysis. Our data showed that RAS was the most effective way for reducing estimated blood loss (MD-193; 95% CI [-279.38 to-106.95]; SUCRA 80.3%), length of hospital stay (MD-3.8; 95% CI [-5.37 to-2.31]; SUCRA 90.2%), transfusion rate (OR 0.13; 95% CI [0.06 to 0.28]; SUCRA 87%), intraoperative complications(OR 0.23; 95% CI [0.06 to 0.8]; SUCRA 91.3%), postoperative complications (OR 0.29; 95% CI [0.18 to 0.51]; SUCRA 98.8%), and total complications (OR 0.24; 95% CI [0.1 to 0.61]; SUCRA 96%). However, the analysis showed no significant differences in the dissection of lymph nodes and tumor survival outcomes. Our results showed that RAS was the most effective surgical method for improving perioperative indicators in EC. If hospital resources are limited, LPS is a suitable alternative. Further research is needed to confirm these findings and ensure that the benefits of minimally invasive surgeries extend to long-term survival outcomes.

Outcomes from 306 consecutive robotic ventral hernia repairs in the community setting

Robotic assisted laparoscopy is increasingly popular for primary ventral and incisional hernia repair. A variety of robotic techniques have been described. More data is needed to evaluate the indications and benefits of these approaches. This is a retrospective analysis of patients who underwent robotic hernia repair over a 2-year period in the community setting. Techniques included: intraperitoneal onlay mesh repair with fascial defect closure (IPOM +), ventral transabdominal preperitoneal repair (vTAPP), and retrorectus (RR) repairs with or without transverse abdominis release (TAR). Follow up was obtained at minimum 6 months postoperatively. Outcomes data included complications, readmissions, reoperations, and hernia recurrences. This study included 306 consecutive robotic ventral hernia repairs: 63 IPOM + , 199 vTAPP, and 44 RR of which 25 (57%) required TAR. Average console times were similar between IPOM + and vTAPP groups (63 vs. 62 min, p = 0.71) and longer for RR repairs without vs. with TAR (107.8 vs. 184.4 min, p < 0.001). There were few intraoperative (0.6%) and immediate postoperative (0.3%) complications. Same day discharge was feasible in most patients (95%). Follow up was completed in 81.0% of patients with an average follow up time of 13.3 months (range 6–27 months). Rates of complications (1.3%), readmissions (1.0%), and reoperations (1.0%) were recorded. There were no hernia recurrences. Robotic ventral hernia repair is a safe and effective strategy for treatment of most abdominal wall hernias with low complication and recurrence rates in medium term follow up.

Synchronous bilateral adrenalectomy for ACTH-independent Cushing's syndrome in children: multidisciplinary management.

ACTH-independent Cushing's syndrome (CS) in children is very rare but potentially fatal. In bilateral nodular hyperplasia, synchronous bilateral adrenalectomy (SBA) represents the definitive treatment to correct hypercortisolism. We aim to report the multidisciplinary management of this rare condition. Presentation, management, and outcomes of all children with ACTH-independent CS who underwent SBA in a tertiary reference centre between 1992-2022 were retrospectively analysed. Ten children were included: six with McCune Albright syndrome, four with primary pigmented nodular adrenocortical disease (three with Carney complex). Presentation varied according to age at diagnosis. In infants (n=7), failure to thrive with anorexia (n=7), cushingoid facies (n=7), arterial hypertension (n=6), hypotonia (n=5), hyperglycaemia (n=4), liver dysfunction (n=4), and hypercalcemia with nephrocalcinosis (n=4) were the main reasons for urgent hospitalization. Prepubertal children (n=3) presented with linear growth arrest associated with obesity, cushingoid facies, and hirsutism. SBA was indicated in severe neonatal hypercortisolism, or in those that were non-responsive to medical treatment. SBA was performed by robot-assisted laparoscopy (n=6), laparoscopy (n=2) or laparotomy (n=2). One post-operative complication occurred (seroma in the adrenal bed). During follow-up (median: 4.8 years) no deaths or acute adrenal crisis occurred. Paediatric CS must be referred to a paediatric centre with medical and surgical expertise. Shared-decision making regarding SBA must be prompt to allow rapid cure of CS, even if it implies lifelong steroid replacement. This avoids long-term complications of hypercortisolism, particularly cognitive decline. Robot-assisted SBA is feasible and safe, even in infants when performed by an experienced robotic team.

Primary Ovarian Lymphoma Treated with Da Vinci Robotic-Assisted Laparoscopy: A Rare Malignant Tumor of the Ovary.

Primary Ovarian Lymphoma Treated with Da Vinci Robotic-Assisted Laparoscopy: A Rare Malignant Tumor of the Ovary.

Comparison of robotic assisted and laparoscopic radical resection for rectal cancer with or without left colic artery preservation

The preservation of the left colic artery (LCA) during rectal cancer resection remains a topic of controversy, and there is a notable absence of robust evidence regarding the outcomes associated with LCA preservation. And the advantages of robotic-assisted laparoscopy (RAL) surgery in rectal resection remain uncertain. The objective of this study was to assess the influence of LCA preservation surgery and RAL surgery on intraoperative and postoperative complications of rectal cancer resection. Patients who underwent laparoscopic (LSC) or RAL with or without LCA preservation resection for rectal cancer between April 2020 and May 2023 were retrospectively assessed. The patients were categorized into two groups: low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was operative findings, operative morbidity, and postoperative genitourinary function. A total of 612 patients were eligible for this study, and propensity score matching yielded 139 patients in each group. The blood loss of the LL group was significantly less than that of the HL group (54.42 ± 12.99 mL vs. 65.71 ± 7.37 mL, p<0.001). The urinary catheter withdrawal time in the LL group was significantly shorter than that in the HL group (4.87 ± 2.04 d vs. 6.06 ± 2.43d, p<0.001). Anastomotic leakage in the LL group was significantly lower than that in HL group (1.44% vs. 7.91%, p = 0.011). The rate of urinary dysfunction and sexual dysfunction in LL group is both significantly lower than HL group. Blood loss and number of harvested lymph nodes (LNs) of both RAL subgroups in LL and HL groups were significantly more than that in LSC subgroups. The anastomotic leakage in the RAL subgroup of HL group was significantly lower than that in LSC subgroup (0% vs. 14.89%, p = 0.018). LCA preservation surgery for rectal cancer may help reduce the blood loss, urinary catheter withdrawal time, the rate of anastomotic leakage and ileus, and postoperative genitourinary function outcomes. RAL can reduce the probability of blood loss and improve harvest LNs in patients with rectal cancer.

Novel Minimally Invasive Surgical Approaches to Endometriosis and Adenomyosis: A Comprehensive Review.

Endometriosis and adenomyosis are chronic gynecological conditions that significantly impact women's quality of life, leading to symptoms such as pelvic pain, dysmenorrhea, and infertility. Despite ongoing research, a definitive cure for these conditions remains elusive, and treatment often focuses on managing symptoms. Minimally invasive surgery is considered the gold standard for surgical management, but novel surgical techniques are continuously being developed to enhance outcomes. These innovations aim to reduce disease recurrence, improve fertility rates, and provide better long-term symptom relief. In addition, techniques like robot-assisted laparoscopy (RAS) have revolutionized the treatment of complex cases, such as deep infiltrating endometriosis (DIE), offering improved precision and effectiveness. This review explores the latest advancements in surgical approaches, their clinical efficacy, and future directions, emphasizing the need for individualized multidisciplinary care to optimize patient outcomes.

The Impact of Exclusively Virtual Preoperative Evaluation on Complications of Gynecologic Surgery

Study ObjectiveTo evaluate the impact of virtual versus in-person preoperative evaluation on perioperative complication rates in a minimally invasive gynecologic surgery (MIGS) practice. DesignRetrospective cohort study. SettingQuaternary care academic hospital in the United States. ParticipantsPatients who underwent surgery with a MIGS surgeon between January 2016 and May 2023. InterventionsPatients underwent either in-person or virtual preoperative visits (defined as the initial consultation and any subsequent follow-up or preoperative counseling visits). Those who had both an in-person and virtual preoperative visit were excluded. Complication rates among the virtual and in-person cohorts were compared, and logistic regression was performed to adjust for potential confounders. ResultsThe analysis included 2,947 patients, 1,196 (40.6%) with exclusively virtual preoperative visits and 1,751 (59.4%) with exclusively in-person visits. Following the implementation of telemedicine in 3/2020, 80.6% of patients had all their preoperative visits conducted virtually via videoconference. Surgical approach included conventional laparoscopy (78.8%), robotic-assisted laparoscopy (3.8%), laparotomy (2.1%), and other gynecologic procedures without abdominal entry (15.3%). The most common procedures were endometriosis excision (43.1%), myomectomy (34.0%), and hysterectomy (24.8%). Composite perioperative complication rates were similar between cohorts (5.9% virtual vs. 6.3% in-person, adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.58-1.17). There were no significant differences for major complications (2.3% virtual vs. 1.2% in-person, aOR 1.52, 95% CI 0.85-2.74) or minor complications (5.7% virtual vs. 6.1% in-person, aOR 0.83, 95% CI 0.59-1.19). Conversion to laparotomy was rare in both groups (0.1% virtual vs. 0.2% in-person). ConclusionImplementation of virtual preoperative visits within a MIGS practice did not impact composite surgical complication rates. For subspecialized gynecologic surgeons, a virtual preoperative evaluation may offer a safe alternative to the traditional in-person visit.

Oncologic and surgical outcomes of robotic-assisted versus conventional laparoscopy for the treatment of clinically uterine-confined high-grade endometrial carcinoma

Oncologic and surgical outcomes of robotic-assisted versus conventional laparoscopy for the treatment of clinically uterine-confined high-grade endometrial carcinoma

Sacrocolpopexy: Alternatives to Mesh Grafts.

The ongoing pelvic mesh controversy, coupled with a regulatory pause in using pelvic mesh in some countries, has created a need for mesh-free alternatives for sacrocolpopexy (SCP). This article provides an overview of mesh-free alternatives for SCP. MEDLINE and PubMed searches were conducted to identify studies reporting on autologous and non-autologous biologic grafts for SCP. Identified studies were reviewed by two of the authors (CY and MR). Emerging evidence on autologous fascia lata (AFL) and rectus sheath (ARS) for SCP is promising, with low donor site morbidity. Non-autologous biologic grafts for SCP are mostly reported to be inferior to mesh. Emerging evidence suggests that AFL and ARS might be safe and effective alternative options to mesh SCP. The main advantages of AFL for SCP over ARS are laparoscopy or robot-assisted laparoscopy approaches, and that a larger graft can be safely harvested. The benefits of utilising allografts and xenografts are limited by their reduced durability compared with mesh and patient acceptability.

Outcomes of Laparoscopic versus Robotic-Assisted Sacrocolpopexy for Pelvic Organ Prolapse-A Comprehensive Retrospective Analysis.

Minimally invasive abdominal sacrocolpopexy (SC) is the gold standard for managing symptomatic pelvic organ prolapse (POP). Robot-assisted laparoscopy (RSC) offers a promising surgical option compared to conventional laparoscopy (LSC). This study compares the clinical and operative outcomes of these techniques to determine if RSC is superior to LSC. We conducted a retrospective, single-center study in the Gynecology Department at the Citadelle Hospital in Liège, Belgium. Data from all patients who underwent SC between January 2019 and December 2023 were collected. We evaluated demographic and clinical data, perioperative complications, operative time (OT), length of stay, risk of recurrence and follow-up duration. Statistical analysis was performed to compare outcomes between the groups. Data from 208 patients (97 LSC and 111 RSC) were analyzed. No significant differences were found between the groups. A higher body mass index trend was observed in the RSC group (mean BMI: 26.63, range: 20-43) compared to the LSC group (mean BMI: 25.45, range: 15-34; p = 0.0625). The median OT was similar (LSC: 111min vs RSC 119min; p = 0.104), with a notable reduction in OT compared to the literature. Additionally, more RSC procedures could be performed per day (3 RSC vs. a maximum of 2 for LSC). Robot-assisted laparoscopy was not demonstrated to be superior to LSC. However, both procedures had comparable OT, significantly shorter than previously reported. RSC's operational efficiency might allow for a higher number of daily procedures, translating into practical benefits in clinical settings.

Robotic-assisted laparoscopic modified ureteroplasty using lingual mucosa grafts or appendiceal flaps for the management of complex ureteral strictures: a retrospective cohort study

ObjectiveTo evaluate the feasibility, safety and efficacy of robot-assisted laparoscopic modified ureteroplasty using a lingual mucosa graft (LMG) or an appendiceal flap (AF) for complex ureteral strictures and summarize our experience.MethodsA total of 16 patients with complex ureteral strictures (range: 1.5–5 cm) who underwent robotic-assisted laparoscopic-modified ureteroplasty and were admitted to our hospital from May 2022-October 2023 were retrospectively analyzed. We used modified presuture methods in patients who needed the posteriorly augmented anastomotic technique to reduce anastomotic tension. Perioperative variables and outcomes were recorded for each patient.ResultsThe operation under robot-assisted laparoscopy was successfully performed in all sixteen patients (12 with LMG ureteroplasty and 4 with AF ureteroplasty) without conversion to open surgery. The mean length of the ureteral structure was 2.90 ± 0.90 cm (range: 1.5–5 cm), the mean operation duration was 209.69 ± 26.74 min (range: 170–255 min), the median estimated blood loss was 75 (62.5) ml (range: 50–200 ml), and the duration of postoperative hospitalization was 10.44 ± 2.10 d (range: 7–14 d). The follow-up time in this group was 6 ~ 21 months. The success rate of the surgery was 100%.ConclusionRobot-assisted laparoscopic modified ureteroplasty using AF or LMG is a safe and feasible operation for complex ureteral strictures and deserves to be popularized.

Treatment of Renal Artery Aneurysm by ex situ Repair and Autotransplantation: A Nationwide Cohort Study

Introduction: Renal artery aneurysm (RAA) is a rare vascular disease with a mortality rate of up to 80% upon rupture. This study aimed to investigate the safety and efficacy of ex situ repair and autotransplantation for endovascularly untreatable RAA. Methods: A retrospective nationwide cohort study was conducted in RAA patients undergoing ex situ repair and autotransplantation in the Netherlands. Surgical techniques, postoperative complications, and graft outcomes were assessed. Results: Ex situ repair was performed in 9 patients with 11 RAAs. Eight RAAs were located at the first bifurcation, one on the main trunk, one on the first branch, and one on the second branch. Nephrectomy was performed via laparoscopy (n = 7), robotic-assisted laparoscopy (n = 1), and laparotomy (n = 1). Postoperative complications were recorded in 4 patients, including bowel obstruction, delirium, pneumonia, and hydronephrosis due to double-J dislocation. The median estimated glomerular filtration rate was 83 mL/min/1.73 m2 pretransplant and 88 mL/min/1.73 m2 posttransplant. By an average follow-up of 32 months, 2 patients had died due to lung adenocarcinoma and stroke, while all autotransplanted kidneys had good patency and remained functional. Conclusions: Ex situ repair and autotransplantation are safe and feasible for endovascularly untreatable RAA cases. Larger cohorts with longer follow-up periods are necessary to further evaluate the role of this surgical approach.

Oncologic and Perioperative Outcomes of Robot-Assisted Versus Conventional Laparoscopy for the Treatment of Clinically Uterine-Confined High-Grade Adenocarcinoma.

The aim of this study was to compare oncologic and perioperative outcomes of robot-assisted laparoscopy (RA) and conventional laparoscopy (LSC) in apparent clinically uterine-confined, high-grade adenocarcinoma. A retrospective review was conducted to identify patients with newly diagnosed high-grade uterine adenocarcinoma treated at our institution between 1 January 2009 and 30 June 2021. Exclusion criteria included bulky extrauterine disease, no lymph node assessment, or synchronous tumors. Clinicopathologic details were obtained from medical records. Postoperative complications were classified using the Memorial Sloan Kettering Cancer Center Surgical Secondary Events system, and statistical analysis was performed using appropriate tests. Of 901 patients identified, 748 (83%) underwent RA and 153 (17%) underwent LSC. Median age was 65 years (range 25-92) and median body mass index was 30 kg/m2 (range 15-60). Overall, 650 patients (72%) had 2009 International Federation of Obstetrics and Gynecology (FIGO) stage I disease. Forty-one patients (4.6%) converted to laparotomy-26 (3.5%) from RA versus 15 (9.8%) from LSC (p=0.02). Postoperative complications occurred in 81 patients (9.0%), with no significant differences in type or rate between groups. Median operative time was 192mins (range 88-936) for RA versus 168 mins (range 90-372) for LSC (p=0.002). Median follow-up was 52 months (range 1-163) for RA and 66 months (range 7-165) for LSC. Four-year progression-free survival (PFS) and disease-specific survival (DSS) were similar between groups. Multivariate analysis showed stage, histology, peritoneal cytology, and lymphovascular invasion predicated a decrease in PFS and DSS. RA demonstrated comparable oncologic outcomes to LSC in patients with high-grade endometrial carcinoma, with no significant difference in postoperative complications or long-term survival.

Confocal Laser Endomicroscopy as a method for assessing endometriosis: A pilot study

ObjectivesTo validate probe-based Confocal Laser Endomicroscopy (pCLE) as a method in assessing endometriosis during conventional and robot-assisted laparoscopy. Study DesignPilot study, including five women in Hospital Moriah, São Paulo, Brazil. During laparoscopic procedures, pCLE was used to assess endometriosis lesions, complemented by subsequent histological evaluations. 214 optical biopsies were performed. These assessments contributed to the development of a comparative atlas, which was used by surgeons to respond to a questionnaire to identify specific cellular structures related to endometriosis in selected confocal images. ResultsThe patients had an average age of 35, exhibiting predominant symptoms like dysmenorrhea and dyspareunia. Despite varied familiarity with pCLE, surgeons demonstrated positive acceptance of the method, with 63.1% recommending its use for intraoperative diagnosis. The technique was particularly noted for its ability to provide real-time, detailed images aiding the identification of endometriosis and associated structures like adipocytes and vascularization, with average evaluation scores exceeding 8 of 10. ConclusionsThis study underscores pCLE’s potential as a transformative diagnostic tool in minimally invasive gynecological surgery. It highlights the feasibility and initial acceptance among surgeons, emphasizing the need for further improvements in device durability and cost-effectiveness. pCLE promises significant advancements in the diagnosis and management of endometriosis, suggesting a future direction for clinical applications and technological refinement.

Impact of No-Clamping Partial Nephrectomy on Early Estimated Glomerular Filtration Rate Preservation.

Incidences of kidney cancers are steadily increasing. The surgical resection of renal tumors remains the treatment of choice, and different techniques provide similar oncological outcomes. Minimally invasive methods, especially partial nephrectomy (PN), have emerged as the preferred method of tumor resection, both in traditional and robot-assisted laparoscopy. PN may be performed as an open or laparoscopic operation. On-clamp PN is a variant of PN that includes the clamping of renal vessels; off-clamp PN is performed without any ischemia. Objectives: To assess the short-term loss of eGFR after on-clamp and off-clamp PN. Methods: Data from 2021 to 2024 were retrospectively collected from a hospital database. The patients included in the study had a diagnosed kidney tumor that was confirmed by MRI or CT imaging. The patients were divided into two groups depending on the type of treatment they received: on-clamp PN or off-clamp PN. Hematocrit (HCT), hemoglobin (Hb) and eGFR were measured and compared. Results: Both groups had comparable preoperative HTC, Hb, and eGFR. eGFR loss 24 h after the procedure was 35.4% lower in the off-clamp group compared to the on-clamp group (p = 0.027). Conclusions: Off-clamp PN is a safe and viable method for kidney tumor resection, both in traditional and robot-assisted laparoscopy. This technique results in a smaller perioperative loss of eGFR, which relates to better short-term functional outcomes than on-clamp PN.

Advantages of Robotic Surgery for Patients of Reproductive Age with Endometrial Cancer.

This review presents current knowledge on the surgical treatment of endometrial cancer in young patients. Endometrial cancer is the most common gynecological cancer in Europe. Higher morbidity is correlated with obesity, hypertension and diabetes, which are growing worldwide. However, endometrial cancer at an early age is very rare. The first line of treatment for this cancer is radical hysterectomy, which is controversial in young women. There is an alternative method of fertility-sparing treatment. However, there is a group of young patients for whom surgical treatment is recommended. According to European guidelines, minimally invasive surgery is recommended for endometrial cancer. The aim of the study was to present the advantages of robotic surgery for endometrial cancer detected at a young age. The procedure of radical treatment with robot-assisted laparoscopy is more precise. Better visualization and stabilization of instruments allow a shorter procedure time, a brief hospital stay and fewer complications. Quality of life may be at a similar level. Incisions after trocars are painless and more esthetic than a classical wound. Bilateral adnexectomy in endometrial cancer depends on age, molecular status of the cancer, stage, genetic risk factors and individual decision. Conclusions: Robotic surgery seems to be a better surgical method for endometrial cancer in younger patients.

Assessing underlying pulsatile structures with laparoscopic tools using proximal vibroacoustic sensing

Abstract This work presents a novel approach for detecting underlying pulsatile structures with laparoscopic tools by using proximal vibroacoustic sensing. This new method could detect pulsations at a depth of up to 1.5 cm. The outcome of this work indicates the potential of identifying deep-seated pulsatile structures during robot-assisted laparoscopy, where haptic feedback is highly limited, to help surgeons prevent vascular damage that may lead to injuries.

ICG mapping of postoperative lymphatic leakage in the groin: a video article and literature review.

Inguinofemoral lymphoceles are a common postoperative complication after inguinofemoral lymphadenectomy (LNE) and a challenge for patients as well as physicians. We report here our preliminary experience in the surgical management of a recurrent lymphocele using indocyanine green (ICG) detection, followed by robotic-assisted closure of the lymphatic leaks. The aim of this article is to illustrate the surgical steps of ICG-assisted detection of inguinal lymphatic leaks and their surgical treatment by means of robot-assisted suturing. Furthermore, the feasibility of the approach will be evaluated. A 59-year-old woman with locally advanced squamous cell carcinoma of the vulva and previous conventional bilateral inguinofemoral LNE presented with symptomatic therapy-resistant lymphoceles in the groin. After a lengthy and frustrating course of standard therapy, she was offered the off-label option surgical treatment with ICG detection and subsequent robot-assisted ligation of the leaks, using the Da Vinci robotic system™. Perioperative data, specific aspects of the surgical approach specifics, objective and subjective outcomes of the new approach. The procedure was performed as planned, with no intraoperative complications or device-related issues. The postoperative course was uneventful, and the patient developed no further lymphoceles. Visualisation of the leakage by ICG combined with minimally invasive robotic-assisted laparoscopy is a promising therapy option. The pictures and videos demonstrate our experience in regard of the safety, feasibility, and usefulness of this procedure. Further studies will be needed, to prove the absolute efficacy of the technique and express a general recommendation in regard of this approach for the treatment of inguinofemoral lymphoceles.

(325) SINGLE-PORT ROBOTIC APPROACH TO RETRIEVAL OF MIGRATED INTRAVESICAL INFLATABLE PENILE PROSTHESIS RESERVOIR

Abstract Introduction Migration of an IPP reservoir into the bladder is a rare, but known complication of penile prosthesis surgery with few documented cases over the past 25 years. Management options include retrograde removal via a penoscrotal/infrapubic approach without cystotomy closure and prolonged foley placement, versus an antegrade, open approach via an open cystotomy, closure of the bladder defect, and a similarly prolonged foley placement. The patient is a 67-year-old male with a non-functional IPP. He underwent a complete IPP explanation and replacement with a new device via a penoscrotal approach. The surgery was uncomplicated, and the patient was discharged home on post-operative day 1. The patient presented to the Emergency Department 4 days later with erythema spreading from the surgical site, concerning for cellulitis and possible infection. A CT scan demonstrated significant soft tissue changes as well as migration of the IPP reservoir into the urinary bladder. The decision was made to proceed with complete explantation of the penile prosthesis. Due to the complexity of the patient’s surgical history, body habitus, and the reservoir location, we proceeded with robotic-assisted laparoscopy via a transvesical approach using the Da Vinci SP platform. Objective We present a novel approach for removal of an intravesical IPP reservoir and cystotomy closure using the Da Vinci SP platform. Methods This video details the surgical approach to IPP explantation and removal of migrated intravesical IPP reservoir. The Single-Port Da Vinci robotic system was used for an intravesical approach to removal of the migrated reservoir and closure of the iatrogenic cystotomy. Results Post-operatively, the patient’s hospital course was complicated by an ileus which resolved with 3 days of nasogastric tube and bowel rest, as well as a popliteal DVT for which he was started on Eliquis. He was discharged on post-operative day 7 and foley catheter was removed post-operative day 10. Conclusions There were several benefits to using the single-port robotic approach. We had better visualization of the iatrogenic cystotomy than would have been possible via an open or laparoscopic approach. The single-port robot also required a much smaller incision than an open approach, allowing decreased morbidity of the procedure. Finally, there was the benefit of shorter foley catheter duration, as it was removed after 10 days. In conclusion, the single-port robotic approach was a successful and less morbid approach to retrieval of a migrated intravesical IPP reservoir. Disclosure No.

Impact of Robotic Assistance on Minimally Invasive Surgery for Type II Endometrial Cancer: A National Cancer Database Analysis.

The objective of this study is to compare the overall survival (OS) and surgical outcomes between conventional laparoscopy and robot-assisted laparoscopy (RAL) in women with type II endometrial cancer. We identified a large cohort of women who underwent hysterectomy for type II endometrial cancer between January 2010 and December 2014 using the National Cancer Database (NCDB). The primary outcome was to compare the OS of conventional laparoscopy versus RAL. Secondary outcomes included the length of hospital stay, 30-day readmission rate, 90-day mortality, rates of lymph node retrieval, rates of node positivity, and rates of conversion to laparotomy. Cohorts were compared and multivariable logistic regression was used to determine characteristics with statistically significant predictors of outcome. We identified 7168 patients with stage I-III type II endometrial cancer who had minimally invasive surgery as primary treatment between 2010 and 2014. A total of 5074 patients underwent RAL. Women who underwent RAL were less likely to have stage III disease (26.4% vs. 29.9%, p = 0.008) and had smaller primary tumors (4.6 vs. 4.1 cm, p < 0.001). In a multivariable model, there was no difference in OS between conventional laparoscopy and RAL. With regard to postoperative outcomes, RAL was associated with a decreased risk for conversion to laparotomy (2.7% vs. 12%, p < 0.001), a shorter hospital stay (1 vs. 2 days, p < 0.001), a decreased 90-day mortality (1.3% vs. 2.2%, p = 0.004), and an increased number of lymph nodes sampled (14 vs. 12, p < 0.001). In multivariable analysis, the use of RAL was independently associated with a reduced rate of conversion to laparotomy. In conclusion, there was no difference in OS between conventional laparoscopy and RAL in type II endometrial cancer in a large retrospective cohort of patients from the NCDB. RAL was associated with a decreased risk of conversion to laparotomy.