Robotic Single-port Research Articles

MP70-10 PEDIATRIC SINGLE PORT ROBOTIC PYELOPLASTY COMPARED TO OPEN AND MULTIPORT COHORTS

You have accessJournal of UrologyCME1 Apr 2023MP70-10 PEDIATRIC SINGLE PORT ROBOTIC PYELOPLASTY COMPARED TO OPEN AND MULTIPORT COHORTS Jordan Smith, Alexandra Hernandez, Brian Wiseman, Christopher Bayne, and Romano Demarco Jordan SmithJordan Smith More articles by this author , Alexandra HernandezAlexandra Hernandez More articles by this author , Brian WisemanBrian Wiseman More articles by this author , Christopher BayneChristopher Bayne More articles by this author , and Romano DemarcoRomano Demarco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Da Vinci SP® (single port) surgical system has been used widely in adult urology with comparable peri-operative outcomes compared to multi-port (MP) robotic surgery. However, reports in pediatric urology are limited. We sought to compare operative outcomes in a single pediatric urologist’s open, MP, and SP pyeloplasty experience. METHODS: A retrospective review was performed of all pyeloplasties by a single pediatric urologist in patients <18 y at a tertiary academic center from January 2021 to July 2022. Cases were categorized by approach: open, multiport (MP), or single port (SP). The primary outcomes were entire operative time (OT; defined as cystoscopy to incision close), length of hospital stay (LOS), inpatient opioid use, and post-operative complications (≤30 days). Surgical success (defined as improved nuclear renography drainage or improved renal collecting system dilatation on ultrasonography with resolution of pain) was evaluated as a secondary outcome. RESULTS: During the study period, 6 open, 5 MP, and 11 SP cases were performed. Open cases were performed via flank incision. MP cases were performed via mix of midline port placement and hidden incision endoscopic surgery (HIdES) approach with 3 or 4 trocars. Technique for SP cases evolved during the period. The SP cohort included older children (median 16 y) and larger children (60.1 kg) than open (2.3 mo; 5.7 kg) and MP (4 mo; 6.6 kg) cases. There was no difference in LOS, opioid use, or complications between groups. SP cases were notably longer (median 390 min [376–480 min]) than both open (240 min [240–360 min]) and MP (300 min [200–258 min]) cases. OT for SP cases improved over the last 5 cases (median 388 min) versus the initial 6 (median 405 min). All cases have continued to show a successful repair at a minimum 3 months. Due to sample size, inferential statistics were not able to be performed. CONCLUSIONS: In this single-surgeon experience during early adoption of the SP robot in pediatric urology, SP pyeloplasty cases took substantially longer. This may represent the early learning curve of developing a novel technique. There was no noted difference in other outcomes or complications. Multicenter collaboration of open, MP, and SP data would help account for individual surgeon differences and generate robust samples sizes for inferential statistical analysis. Knowledge of patient-centered opinions regarding the SP incision is warranted to justify SP pyeloplasty over current MP techniques. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1007 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Smith More articles by this author Alexandra Hernandez More articles by this author Brian Wiseman More articles by this author Christopher Bayne More articles by this author Romano Demarco More articles by this author Expand All Advertisement PDF downloadLoading ...

MP31-13 ROBOTIC SINGLE PORT RENAL AUTOTRANSPLANT CONFERS POSTOPERATIVE ADVANTAGES COMPARED TO OPEN APPROACH

You have accessJournal of UrologyCME1 Apr 2023MP31-13 ROBOTIC SINGLE PORT RENAL AUTOTRANSPLANT CONFERS POSTOPERATIVE ADVANTAGES COMPARED TO OPEN APPROACH Shree Agrawal-Patel, Sherry Mortach, Evonne Pei, Yi-Chia Lin, Jaya Sai Chavali, Ethan Ferguson, Roxana Ramos, Venkatesh Krishnamurthi, Alvin Wee, Jihad Kaouk, and Mohamed Eltemamy Shree Agrawal-PatelShree Agrawal-Patel More articles by this author , Sherry MortachSherry Mortach More articles by this author , Evonne PeiEvonne Pei More articles by this author , Yi-Chia LinYi-Chia Lin More articles by this author , Jaya Sai ChavaliJaya Sai Chavali More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Alvin WeeAlvin Wee More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal autotransplant has been done historically with an open approach. With the advent of the single port robot (SP), this procedure can be done in a minimally invasive manner to potentially improve peri-operative morbidity and the patient experience. The purpose of this study is to compare this novel SP approach with the standard open approach. METHODS: We retrospectively assessed patients who have undergone SP autotransplant from 2020-2021 with matched patients who underwent open autotransplant from 2006-2019 at a single institution who did not undergo additional operative interventions during the index surgical admission. We performed descriptive analyses on patient characteristics, postoperative complications and readmissions with chi-square and t-test analyses. RESULTS: Nine patients underwent SP autotransplant and were matched to 26 patients in the open approach. In the matched SP and open groups, average ages were 41 (SD 11) and 42 (SD 9) years respectively (p=0.72), and 8 (31%) were male in the open and 3 (30%) in the SP group (p=0.89). Nephrolithiasis history was present in 18 (69%) patients in the open and 8 (89%) in the SP group (p=0.25). A majority of patients had history of percutaneous nephrostomy tube or ureteral stent – 20 (77%) in the open and 9 (100%) in the SP groups (p=0.11). Nineteen (73%) in the open and 9 (100%) in the SP groups had ureteral stent placement intraoperatively (p=0.08). In Table 1, there were no significant differences between the open and SP groups regarding operative time (533 vs. 539 minutes, p=0.92), postoperative creatinine (0.98 vs. 0.96, p=0.87), or postoperative complications (14 (54%) vs. 2 (22%), p=0.10), which included bleeding requiring transfusion. Significant differences between open and SP approaches were estimated blood loss (EBL) (910 vs. 147 milliliters, p=0.006), post- and intraoperative bleeding prompting transfusion (13 (50%) vs. 0 (0%), p=0.007), and length of stay (8 vs. 5 days, p=0.006). CONCLUSIONS: In this novel approach, SP renal autotransplant demonstrates lower EBL, bleeding complications, length of stay, and postoperative complications, compared to the traditional open approach. Additional studies are warranted to determine if a minimally invasive approach can improve patient outcomes longitudinally. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e434 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shree Agrawal-Patel More articles by this author Sherry Mortach More articles by this author Evonne Pei More articles by this author Yi-Chia Lin More articles by this author Jaya Sai Chavali More articles by this author Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Venkatesh Krishnamurthi More articles by this author Alvin Wee More articles by this author Jihad Kaouk More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF downloadLoading ...

V01-04 SINGLE-PORT ROBOTIC EXTRAPERITONEAL RIGHT URETERAL REIMPLANTATION WITH BOARI FLAP

You have accessJournal of UrologyCME1 Apr 2023V01-04 SINGLE-PORT ROBOTIC EXTRAPERITONEAL RIGHT URETERAL REIMPLANTATION WITH BOARI FLAP Melissa Moran, Alain Kaldany, Krishna Doppalapudi, Arnav Srivastava, and Sammy Elsamra Melissa MoranMelissa Moran More articles by this author , Alain KaldanyAlain Kaldany More articles by this author , Krishna DoppalapudiKrishna Doppalapudi More articles by this author , Arnav SrivastavaArnav Srivastava More articles by this author , and Sammy ElsamraSammy Elsamra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with multiple abdominal surgeries often harbor hostile abdomens with significant bowel adhesions. It is thus difficult to obtain safe transperitoneal access when placing robotic trocars. An extraperitoneal approach, in contrast, allows for safe entry into the abdomen. In the case of a mid to distal ureteral stricture requiring extraperitoneal Boari flap ureteral reimplantation, the conventional multiport approach would be suboptimal as arm spacing would be insufficient. Here we demonstrate our surgical technique and the feasibility of a single port (SP) extraperitoneal Boari flap ureteral reimplantation. METHODS: A 70-year-old female with a history of rectal cancer treated with multiple abdominal surgeries and chemoradiation was diagnosed with a distal right ureteral stricture. She was offered SP robotic ureteral reimplantation for definitive management. The patient was positioned in steep Trendelenburg with a left-sided tilt. A 4 centimeter (cm) incision was created over the right lateral aspect of the abdomen 8 cm above the anterior superior iliac spine, and the retroperitoneal space was entered. The SP access port was placed and the robot was docked. The ureter was identified crossing the iliac vessels and was dissected proximally and distally. Once scar tissue was encountered, the ureter was transected. The bladder was mobilized and the medial umbilical ligament was cut. The distance from the ureter to the bladder was measured, and a Boari flap of this length was created. The posterior ureter was then spatulated and a Boari flap anastomosis was performed. The bladder was closed in a Heineke-Mikulicz fashion and a double-J ureteral stent was placed in the right ureter. The bladder was distended to ensure a watertight closure. A drain was placed and the Foley catheter was exchanged. RESULTS: The operative time was roughly three hours, with 50 milliliters of estimated blood loss. On post-operative day one, the drain was removed and patient was discharged home. Imaging two weeks later showed improved hydronephrosis with no urine extravasation, and the Foley catheter was removed. The ureteral stent was removed at four weeks post-operatively. Ultrasound and renal scan three months later demonstrated improved hydronephrosis with preserved renal function and no evidence of obstruction. CONCLUSIONS: To our knowledge, this is the first video demonstrating an SP extraperitoneal Boari flap ureteral reimplantation. This approach is feasible and allows a surgeon to safely and effectively perform a primarily retroperitoneal procedure without entering a hostile abdomen. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e80 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Melissa Moran More articles by this author Alain Kaldany More articles by this author Krishna Doppalapudi More articles by this author Arnav Srivastava More articles by this author Sammy Elsamra More articles by this author Expand All Advertisement PDF downloadLoading ...

Single Port Versus Multiport Robot-assisted Simple Prostatectomy: A Multi-institutional Study From the Single-port Advanced Research Consortium (SPARC)

To compare robot-assisted simple prostatectomy intraoperative and postoperative.ßoutcomes between single-port (SP) and multiport (MP) robotic systems in a multi-institutional setting. We analyzed all-consecutive robot-assisted simple prostatectomy cases done in 5 centers from January 2017 to October 2022. Data were analyzed with descriptive statistics and compared with appropriate tests depending on the type of variable and distribution. Statistical significance was considered when P.ß<.05. A total of 405 cases were analyzed:.ß249 and 156 were MP and SP, respectively. Operative times were similar between groups (P.ß=.ß.62). Estimated blood loss during surgery was significantly lower with the SP robot (P.ß<.001). Postoperatively, the SP approach required a significantly shorter hospital stay, less use of opioids, and a shorter duration of Foley catheter (P.ß<.001). There was no significant difference between the post-operative Clavien-Dindo ...3 complication rate (P.ß=.ß.30). The 30-day readmission rate of MP (10.8%) was significantly higher than for SP (0%) (P.ß<.001). De novo urge incontinence was more common in the MP group (P.ß=.ß.02). The SP robotic approach to simple prostatectomy is advantageous when it comes to postoperative comfort for patients. Specifically, it requires a shorter hospital stay, less use of opioids, and a shorter Foley catheter duration.

Single port robot assisted total laparoscopic hysterectomy with bilateral uterine artery double ligation at the isthmic level of uterus

Single port robot assisted total laparoscopic hysterectomy with bilateral uterine artery double ligation at the isthmic level of uterus

Single-port laparoscopic versus single-port robotic right hemicolectomy: Postoperative short-term outcomes.

This study aimed to compare the short-term postoperative outcomes of single-port robotic (SPR) using da Vinci SP® system and single port laparoscopic (SPL) right hemicolectomy and determine whether the novel SPR system is safe and feasible. From January 2019 to December 2020, a total of 141 patients (41 patients for SPR and 100 patients for SPL) who electively underwent right hemicolectomy for colon cancer performed by a single surgeon were included in the study. The time to the first bowel movement was 3 (range, 1-4) days after surgery in the SPR group and 3 (2-9, range) days in the SPL group (p=0.017). However, there were no differences in pathologic outcomes or postoperative complications. SPR is a safe and feasible surgical technique and has an advantage in the time to first postoperative bowel movement over SPL with no other complications.

Upper Urinary Tract Surgery Through Robotic Single-Port System vs Multiport and Laparoendoscopic Single-Site Systems: A Systematic Review and Meta-Analysis.

Purpose: We aimed to make a general comparison between the safety and feasibility of a novel robotic platform, da Vinci® single-port (SP) system with conventional robotic multiport (MP) and laparoendoscopic single-site systems (da Vinci Xi or Si) in three upper urinary tract procedures including robot-assisted partial nephrectomy (RAPN), robot-assisted pyeloplasty (RAP), and robot-assisted adrenalectomy (RA). Materials and Methods: After systematical searching of the literature up to October 2022 in PubMed®, Web of Science™, and the Cochrane Library and Scopus® databases, we extracted and processed the data in eligible literature for operative time, warm ischemia time (WIT), morphine milligram equivalent (MME), postoperative complications, and positive surgical margins (PSMs). Results: A total of 752 patients who underwent robotic surgery for SP or MP from 11 articles were included in this meta-analysis. There was no statistically significant difference in operative time for either RAPN (standardized mean difference [SMD] -0.14, 95% confidence interval [CI] -0.30 to 0.03) or RA (SMD -0.51, 95% CI -1.08 to 0.06). However, for RAP, SP can save operation time (SMD -0.73, 95% CI -1.24 to -0.22). The introduction of SP did not increase complications to any degree, including total complication (risk ratio [RR] 0.89, 95% CI 0.52-1.53), minor complication (RR 0.43, 95% CI 0.13-1.36), and major complication (RR 0.85, 95% CI 0.34-2.09), nor the incidence of PSMs (RR 1.04, 95% CI 0.54-1.99). It is worth noting that although the SP system increased WIT (SMD 0.44, 95% CI 0.26-0.62), it had the benefit of reducing intraoperative pain for RAPN with regard of MME (SMD -0.40, 95% CI -0.71 to -0.09). Conclusions: In terms of postoperative pain, SP robotic surgery is beneficial for RAPN but will make WIT prolonged. RAP is probably the most suitable upper urinary tract procedure for which SP is an option, which helps to shorten the surgery time and achieve a minimally invasive wound at the same time. Our study has been registered in PROSPERO (Registration No.: CRD42022350317).

Robotic single-port multiquadrant surgery to treat renal tumors and benign abdominal conditions.

Multiquadrant procedures are technically more demanding than sequential operations. The new single port (SP) system allows to work in every abdominal quadrant maintaining an adequate triangulation without the need for changes in the port positioning. In February 2020, two patients underwent a robotic SP partial nephrectomy for malignancy combined with a cholecystectomy and a left inguinal hernia repair respectively. Both procedures were successfully completed with one robotic docking and without the need for conversion. The operative time was 213 minutes for the right partial nephrectomy (126 min) with cholecystectomy (18 min), and 257 minutes for the left partial nephrectomy (161 min) with inguinal hernia repair (35 min). Estimated blood loss was 200 (150-250) mL, while the total warm ischemia time was 15 minutes for the right partial nephrectomy and 53 minutes for the left partial nephrectomy. There were no intraoperative complications or perioperative transfusions. The postoperative course was uneventful, and the postoperative hospital stay was 1 and 2 days. Both resections had free margins and the median tumor size was 2.5 (1.5-3.5) cm. Histopathology analysis revealed chronic cholecystitis and renal cell carcinomas with free margins and a median tumor size of 2.5 (1.5-3.5) cm. After a mean follow-up of 24 months, no surgical-related complications or recurrence were detected. The robotic SP approach facilitates the completion of combined surgical procedures in multiple abdominal quadrants through a single 25mm incision.

Pericardial reconstruction during thymectomy using the robotic single-port system via subxiphoid approach.

Pericardial reconstruction during thymectomy using the robotic single-port system via subxiphoid approach.

Do Skills Naturally Transfer Between Multiport and Single-Port Robotic Platforms? A Comparative Study in a Simulated Environment.

Introduction and Objective: With introduction of the da Vinci single-port (SP) system, we evaluated which multiport (MP) robotic skills are naturally transferable to the SP platform. Methods: Three groups of urologists: Group 1 (5 inexperienced in MP and SP), Group 2 (5 experienced in MP without SP experience), and Group 3 (2 experienced in both MP and SP) were recruited to complete a validated urethrovesical anastomosis simulation using MP followed by SP robots. Performance was graded using both GEARS and RACE scales. Subjective cognitive load measurements (Surg-TLX and difficulty ratings [/20] of instrument collisions camera and EndoWrist movement) were collected. Results: GEARS and RACE scores for Groups 1 and 3 were maintained on switching from MP to SP (Group 3 scored significantly higher on both systems). Surg-TLX and difficulty scores were also maintained for both groups on switching from MP and SP except for a significant increase in SP camera movement (+7.2, p = 0.03) in Group 1 compared to Group 3 that maintained low scores on both. Group 2 demonstrated significant lower GEARS (-2.9, p = 0.047) and RACE (-5.1, p = 0.011) scores on SP vs MP. On subanalysis, GEARS subscores for force sensitivity and robotic control (-0.7, p = 0.04; -0.9, p = 0.02) and RACE subscores for needle entry, needle driving, and tissue approximation (-0.9, p = 0.01; -1.0, p = 0.02; -1.0, p < 0.01) significantly decreased. GEARS (depth perception, bimanual dexterity, and efficiency) and RACE subscores (needle positioning and suture placement) were maintained. All participants scored significantly lower in knot tying on the SP robot (-1.0, p = 0.03; -1.2, p = 0.02, respectively). Group 2 reported higher Surg-TLX (+13 pts, p = 0.015) and difficulty ratings on SP vs MP (+11.8, p < 0.01; +13.6, p < 0.01; +14 pts, p < 0.01). Conclusions: The partial skill transference across robots raises the question regarding SP-specific training for urologists proficient in MP. Novices maintained difficulty scores and cognitive load across platforms, suggesting that concurrent SP and MP training may be preferred.

Single-port robotic partial nephrectomy: impact on perioperative outcomes and hospital stay.

Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SP-robotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both via a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multi-arms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional 'multi-arms' robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic versus multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN.

Comparative study of extraperitoneal singe-port robot-assisted radical prostatectomy and transperitoneal multiport robot-assisted radical prostatectomy using propensity score matching.

With the introduction of the da Vinci single-port (SP) robot platform, surgery in a narrow space has become easier, and using this, extraperitoneal radical prostatectomy has been frequently performed recently. However, studies comparing it with existing methods are still lacking. Therefore, in this study, we compared the initial extraperitoneal single-port robot-assisted radical prostatectomy (spRARP) with intraperitoneal multiport robot-assisted radical prostatectomy (mpRARP) and tried to investigate the feasibility of extraperitoneal spRARP. We retrospectively analyzed patients who underwent RARP performed between January 2019 and April 2023. A total of 184 consecutive patients were enrolled in this study: 64 underwent spRARP and 120 underwent mpRARP. Patient characteristics before and after surgery were investigated, and period of passing gas, foley maintenance period, length of hospital stay, and pain changes were compared and analyzed to estimate post-surgery recovery. To address inherent biases stemming from differing patient characteristics at baseline, we performed an additional analysis after propensity score matching (PSM) (ratio, 1:1). After PSM, both the spRARP and mpRARP groups consisted of 64 patients each. On preoperative examination, there were no significant differences in prostate-specific antigen level, Gleason score (GS), prostate volume, magnetic resonance imaging T stage, or Prostate Imaging-Reporting and Data System score between the two groups. Following surgery, there were no significant differences in operative and console time between the two groups. Notably, the estimated blood loss was considerably lesser in the spRARP group than in the mpRARP group (P=0.049). When comparing pathologic outcomes, the GS, T stage, positive surgical margin, extracapsular extension, and seminal vesicle invasion rates showed no significant differences between the two groups. Four patients who underwent spRARP and six who underwent mpRARP suffered Clavien-Dindo classification grade 3 and 4 complications. After 3 months, there were no significant differences in incontinence or potency between the two groups. However, even after PSM, the period of passing gas was earlier in the spRARP group than in the mpRARP group. In this study, both the extraperitoneal spRARP and transperitoneal mpRARP groups exhibited similar complication rates and surgical outcomes. Furthermore, the spRARP group had a short surgical time and demonstrated early recovery. Therefore, extraperitoneal spRARP is a feasible procedure that is expected to become increasingly popular in the future.

Scholarly Publishing With the American Urological Association—The Expansion of the “Voice of Urology” Into Open Access With the Journal of Urology Open Plus

Scholarly Publishing With the American Urological Association—The Expansion of the “Voice of Urology” Into Open Access With the Journal of Urology Open Plus

Multi-institutional surgical outcomes of robotic single-port surgery: a Korean experience.

The da Vinci single-port system (SPS) has been applied in several fields of surgery; however, only a few studies have reported its applications in general thoracic surgery. This retrospective study aimed to investigate the multi-institutional experiences of applications of SPS in Korea. The surgical outcomes of three institutions in Korea were collected and retrospectively reviewed. A total of 39 surgeries were performed using SPS without conversion to multiport surgery. The patients included 16 males, and the mean age was 54.2±12.4 years. The most common pathological diagnoses were thymoma (18 cases) and benign cystic lesions (10 cases). The approach used for SPS was subxiphoid, subcostal, and intercostal in 26, 10, and 3 cases, respectively. All patients underwent the surgeries without postoperative complications. The median operation time and peak pain score were 121.4±45.4 min and 3.1±1.1. The median duration of in situ chest tube and hospital stay was 1.3±0.6 and 2.9±1.2 days, respectively. The application of SPS for general thoracic surgery was safe and feasible, whereas its applications remain limited to simple cases. To enable the widespread use of SPS surgery, alleviation of cost-related problems and technical improvement of SPS for complex procedures are required.

Author Reply

It is well-known that robotic cystectomy has not improved outcomes to the extent hoped by early adopters. Robotic cystectomy modestly reduces blood loss, wound infections, and venous thromboembolisms but it's debatable whether these benefits are worth the extra cost and time under anesthesia. We recently reported our initial experience with robotic single-port cystectomy, and at first glance, there's no obvious indication that this will change the calculus either. So to Dr. Laviana's point, what then is the rationale to continue investing in robotic applications to radical cystectomy?

Learning curve for single-port robot-assisted colectomy.

Since the introduction of robotic surgery, robots for colorectal cancer have replaced laparoscopic surgery, and a single-port robot (SPR) platform has been launched and is being used to treat patients. We analyzed the learning curve and initial complications of using an SPR platform in colorectal cancer surgery. We reviewed 39 patients who underwent SPR colectomy from April to October 2019. All surgeries were performed by the same surgeon using an SPR device. A learning curve was generated using the cumulative sum methodology to assess changes in total operation time, docking time, and surgeon console time. We grouped the patients into 3 groups according to the time period: the first 11 were phase 1, the next 11 were phase 2, and the last 17 were phase 3. The mean age of the patients was 61.28±13.03 years, and they had a mean body mass index of 23.79±2.86 kg/m2. Among the patients, 23 (59.0%) were male, and 16 (41.0%) were female. The average operation time was 186.59±51.30 minutes, the average surgeon console time was 95.49±35.33 minutes, and the average docking time (time from skin incision to robot docking) was 14.87±10.38 minutes. The surgeon console time differed significantly among the different phases (P<0.001). Complications occurred in 8 patients: 2 ileus, 2 postoperation hemoglobin changes, 3 urinary retentions, and 1 complicated fluid collection. In our experience, the learning curve for SPR colectomy was achieved after the 18th case.

Outcomes of single port robotic sacrocolpopexy compared with multi-port approaches

ImportanceScientific literature currently lacks data on surgical outcomes of single-port robotic sacrocolpopexy compared with traditional multi-port approaches. ObjectivesTo evaluate feasibility and surgical outcomes for the single-port robotic approach to sacrocolpopexy when compared with traditional multi-port approaches. Study designRetrospective chart review of fifty patients who underwent minimally invasive sacrocolpopexy with a single urogynecologist between 2018 and 2021 ​at an academic tertiary care hospital. Patients were divided into three cohorts: laparoscopic multi-port (LMP), robotic multi-port (RMP), and robotic single-port (RSP). Outcome measures were operative time, number of adverse events, and severity of adverse events by Clavien-Dindo. ResultsAll patients underwent at least one concomitant procedure; however, LMP had more concomitant procedures compared to RMP and RSP (p ​< ​0.001). RMP had higher incidence of prior hysterectomy (p ​< ​0.001) and prior vaginal surgery (p ​= ​0.002) compared to LMP and RSP. There were no significant differences in age, BMI, ethnicity/race, pre-operative POPQ stage, number of prior laparoscopies/laparotomies, or prior hernia repair. Linear and Poisson regression models were used to assess between-group differences in the outcome measures while adjusting for confounders. LMP had significantly higher adverse event severity than RSP (RR ​= ​2.23, p ​= ​0.044). 62.5% of the RSP group had no adverse events. No other statistically significant differences were observed. ConclusionThis retrospective study demonstrates feasibility and safety of the single-port robotic approach for sacrocolpopexy when compared with traditional multi-port approaches. Larger, prospective studies are indicated to better understand post-operative outcomes.

Robotic Surgery for Stone Disease.

To evaluate recent literature regarding the role of robotic technology in the treatment of nephrolithiasis with particular attention to complex technical procedures. Robotic platforms including single-port robotics have been widely adopted in urological practice for the treatment of both malignant and benign conditions and has led to an expansion of the utilization of robot-assisted surgery to tackle challenging clinical scenarios such as bladder neck reconstruction, upper urinary tract reconstruction, and more recently complex stone disease. Presently, the American Urological Association guidelines on the surgical management of stones advise against using robotic, open, or laparoscopic techniques as a first-line approach for most patients with stone disease with the exception for patients with anatomical abnormalities, large or complex stones, or patients requiring a concomitant reconstructive operation. Clinicians have demonstrated the safety and feasibility of surgical robotics in the treatment of stone disease for a variety of operations including robotic pyeloplasty, pyelolithotomy, ureterolithotomy, and surgical interventions in urinary diversions as well as novel technologies for robotic ureteroscopy and percutaneous access. Numerous clinicians have demonstrated the safety and feasibility of using robot-assisted surgery to treat nephrolithiasis, mainly in complex renal anatomy. Further research is necessary to identify the best candidates for utilization of robotics in complex stone disease, and further technological developments will continue to further advance the use of these platforms in the treatment of nephrolithiasis.

8881 Outcomes of Single Port Robotic Sacrocolpopexy Compared with Traditional Multi-Port Approaches

Study Objective As technology continues to advance, surgeons must evaluate risks and benefits of new instrumentation. The single-port robotic (SPR) system is a new approach which is FDA-approved for urologic procedures but is not yet FDA-approved for gynecology. We believe the single-port robotic approach is beneficial for use in sacrocolpopexy. The goal of our study is to compare surgical outcomes for the SPR approach to multi-port approaches for sacrocolpopexy. Design Retrospective chart review, with primary outcome of operative time. Secondary outcomes include number and severity of adverse events. Setting Academic tertiary care hospital. Patients or Participants Fifty patients who underwent minimally invasive sacrocolpopexy with a single urogynecologist between 2018-2021. Patients were divided into three cohorts: laparoscopic multi-port (LMP), robotic multi-port (RMP), and robotic single port (RSP). Interventions LMP, RMP, and RSP sacrocolpopexy with concomitant procedures. Measurements and Main Results All patients underwent at least one concomitant procedure. LMP had more concomitant procedures compared to RMP and RSP (p < 0.001). RMP had higher incidence of prior hysterectomy (p < 0.001) and prior vaginal surgery (p = 0.002) compared to LMP and RSP. There were no significant differences in age, BMI, ethnicity/race, pre-operative POPQ stage, number of prior laparoscopies/laparotomies, or prior hernia repair. Linear and Poisson regression models were used to assess between-group differences in the outcome measures while adjusting for confounders. LMP had significantly higher adverse event severity than RSP (RR = 2.23, p = 0.044). 62.5% of the RSP group had no adverse events. No other statistically significant differences were observed. Mean operative time was 3 hours for RSP, 3.3 hours for LMP, and 2.7 hours for RMP (p>0.05). Conclusion This retrospective study demonstrates feasibility and safety of the SPR approach for sacrocolpopexy when compared with traditional multi-port approaches. Larger studies are indicated to better understand long-term outcomes. As technology continues to advance, surgeons must evaluate risks and benefits of new instrumentation. The single-port robotic (SPR) system is a new approach which is FDA-approved for urologic procedures but is not yet FDA-approved for gynecology. We believe the single-port robotic approach is beneficial for use in sacrocolpopexy. The goal of our study is to compare surgical outcomes for the SPR approach to multi-port approaches for sacrocolpopexy. Retrospective chart review, with primary outcome of operative time. Secondary outcomes include number and severity of adverse events. Academic tertiary care hospital. Fifty patients who underwent minimally invasive sacrocolpopexy with a single urogynecologist between 2018-2021. Patients were divided into three cohorts: laparoscopic multi-port (LMP), robotic multi-port (RMP), and robotic single port (RSP). LMP, RMP, and RSP sacrocolpopexy with concomitant procedures. All patients underwent at least one concomitant procedure. LMP had more concomitant procedures compared to RMP and RSP (p < 0.001). RMP had higher incidence of prior hysterectomy (p < 0.001) and prior vaginal surgery (p = 0.002) compared to LMP and RSP. There were no significant differences in age, BMI, ethnicity/race, pre-operative POPQ stage, number of prior laparoscopies/laparotomies, or prior hernia repair. Linear and Poisson regression models were used to assess between-group differences in the outcome measures while adjusting for confounders. LMP had significantly higher adverse event severity than RSP (RR = 2.23, p = 0.044). 62.5% of the RSP group had no adverse events. No other statistically significant differences were observed. Mean operative time was 3 hours for RSP, 3.3 hours for LMP, and 2.7 hours for RMP (p>0.05). This retrospective study demonstrates feasibility and safety of the SPR approach for sacrocolpopexy when compared with traditional multi-port approaches. Larger studies are indicated to better understand long-term outcomes.

Single Port Robotic Hysterectomy after the Previous Robotic Radical Trachelectomy

<h3>Study Objective</h3> The basic treatment for cervix cancer is hysterectomy. For nullipara women, trachelectomy may be considered. In this video, we described the technique of a single port robotic hysterectomy to a patient who underwent a multi-port robotic radical trachelectomy previously. <h3>Design</h3> Case Report. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> This 32-year-old woman presented with a recurrence of cervical cancer. She had a history of robotic radical trachelectomy with pelvic lymphadenectomy for stage IA1 cervical cancer 9 years earlier. <h3>Interventions</h3> At first, we described the typical multi-port robotic radical trachelectomy which preserved the main uterine artery and round ligament. There was no recurrence in follow up MRI and colposcopy after the surgery. But in December 2021, her pap-smear revealed adenocarcinoma. MRI of the pelvis and PET CT were all normal. After careful consideration, our team used DaVinci SP system to perform the hysterectomy and BS. The operation was similar to a general hysterectomy, but there was an adhesion between the uterus and the ovary due to the previous operation. Although several branches of the uterine artery were ligated, the blood supply to the uterus was sufficient. The uterus and bladder also had moderate adhesion. After the colpotomy, the thread of cervical cerclage in the previous operation was confirmed. The subsequent procedure was similar to that of a typical hysterectomy. <h3>Measurements and Main Results</h3> The operation was performed successfully with no intraoperative complications. <h3>Conclusion</h3> Single port robotic hysterectomy after the previous robotic trachelectomy is a safe and effective approach for the recurrence of cervical cancer patients. There was some difficulty in finding the incision margin between the uterus ithmus and the upper vagina. The bladder and vagina fornix should be carefully dissected. The secondary assistant should push the colpotomizer in the same direction as the incision. Single port Robotics can help to overcome the limitations of laparoscopy, especially in complicated procedures.