Robotic Surgery as Applied to Functional and Reconstructive Urology

Osman, Nadir I.; Mangır, Naşide; Mironska, Emma; Chapple, Christopher R.

doi:10.1016/j.euf.2019.06.016

Cited by 15 publications

(7 citation statements)

References 53 publications

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“…Laparoscopic/robotic surgery has the advantages of the abdominal approach while reducing invasiveness [11] . While success rates are reportedly similar to those for open surgery (71.4–100%), the series are generally small and likely to be highly selected [12] , [13] .…”

Section: Discussionmentioning

confidence: 99%

Contemporary Outcomes of Surgery for Primary and Recurrent Genitourinary Fistulae in a Well-resourced Country

Osman

Hillary

Gulamhusein

et al. 2021

European Urology Open Science

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Background Urinary fistula (UF) is a global health problem but less common in well-resourced countries. Over the past decade there has been a trend toward managing UF in dedicated centres. Most of the evidence for surgical treatment is from individual case series, with few publications that involve high numbers. We describe the repair of recurrent and complex UF cases and outcomes in a tertiary referral setting. Objective To describe UF aetiology, repair techniques, and outcomes. Design, setting, and participants This is a retrospective study of a series of patients undergoing UF repair at a specialist unit. Outcome measurements and statistical analysis We describe the aetiology, cure rate, complications, and postoperative urinary incontinence rates for the series of UF cases. Results and limitations A consecutive series of 98 patients was identified, all of whom were tertiary referrals. Of these, 31 (31.6%) had at least one prior attempt at repair at another centre. The median age was 48 yr (interquartile range [IQR] 40–60.25). The median time from occurrence to repair was 12 mo (IQR 6–12). UF occurred most commonly following hysterectomy (48.0%), Caesarean section (9.2%), other gynaecological surgery (7.1%), and anti-incontinence surgery (7.1%). Complex fistulae (eg, repeat cases, radiation, ureteric involvement) comprised 41 of the cases (41.8%). Most patients with vesicovaginal fistula underwent repair via a transabdominal approach (70.4%). Tissue interposition was used in 96 cases (98%). There were no Clavien-Dindo grade >3 complications. Two patients (2%) had a persistent UF postoperatively. Two patients (2%) developed recurrence more than 2 yr after their initial repair, and both were successfully repaired at our centre. Twelve patients (12.3%) developed de novo overactive bladder, 22 (22.5%) developed stress urinary incontinence (13 had subsequent incontinence surgery), and two (2%) developed bladder pain (both had a subsequent cystectomy). Conclusions Despite a high rate of recurrent and complex UF, successful lasting closure was achieved in 96% of our cases. A minority of patients developed other problems such as de novo overactive bladder and stress urinary incontinence that may require further treatment. Patient summary Urinary fistula is an abnormal opening or connection in the urinary tract and is less common in well-resourced countries. As a consequence, management of this condition is more frequently undertaken at specialist units. Even patients with a complex fistula and those who have had multiple attempts at repair can experience a cure. Urinary leakage is a common complication after the operation but can be successfully managed with surgery.

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Section: Discussionmentioning

confidence: 99%

Contemporary Outcomes of Surgery for Primary and Recurrent Genitourinary Fistulae in a Well-resourced Country

Osman

Hillary

Gulamhusein

et al. 2021

European Urology Open Science

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“…The advanced instrumentation and enhanced visualization of the robotic platform has been a catalyst for innovation, reducing operative morbidity, and introducing promising treatments to patients with challenging upper and lower urinary tract obstruction. Though awaiting long-term data, early results for these procedures show great promise as valuable and long-lived additions to the reconstructive armamentarium [38,39].…”

Section: Discussionmentioning

confidence: 99%

The emerging role of robotics in upper and lower urinary tract reconstruction

Zhao

Shakir

Zhao

2021

Current Opinion in Urology

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Purpose of review Developments in robotic reconstructive urology have introduced novel treatments for complex upper and lower urinary tract disease. Short-term and mid-term data demonstrates excellent outcomes and minimal morbidity, suggesting the advanced instrumentation and visualization of robotics represent a new treatment paradigm in patients that are historically difficult to treat. Here we review recent developments in the robotically assisted surgical management of urethral and ureteral strictures. Recent findings The minimally invasive approach, enhanced precision and reach, and near-infrared fluorescence imaging capabilities of robotic platforms have proven to be valuable additions in reconstructive urology where perfusion is often compromised, or anatomy is distorted. These benefits are leveraged heavily in recent descriptions of robotic-assisted posterior urethroplasty and ureteroplasty. Short-term to mid-term follow-up data for these procedures show excellent patency rates with low morbidity and complication rates when compared with open approaches. Long-term data for these procedures are not yet available. Summary The role of robotics in reconstructive urology is being actively investigated. Initial findings demonstrate excellent results with low morbidity in the treatment of upper and lower urinary tract disease. Long-term data will ultimately determine the role of robotics in the reconstructive armamentarium.

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“…Multiple studies 16–18 have demonstrated comparable outcomes with a reduction in operating time for the robotic approach compared to open pyeloplasty surgery, the relative ease of suturing being the key advantage 1 . Data on RAS ureteric reimplant surgery demonstrates similar complication rates, re‐stricture rates and operative times but with decreased blood loss and length of stay 19,20 .…”

Section: Application Of Ras In Reconstructive Urologymentioning

confidence: 99%

What credentials are required for robotic‐assisted surgery in reconstructive and functional urology?

Harley

Fong²,

Yao

et al. 2023

BJUI Compass

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IntroductionThe increasing popularity of robotic assisted surgery (RAS) as it is implemented in to sub specialities poses many challenges to ensuring standards in quality and safety. The area of Reconstructive and Functional Urology (RFU) has a wide range and largely complex heterogeneous procedures. In recent years RFU has started to incorporate RAS as the primary method to undertake these procedures due to improved vision, dexterity, and access to deep cavities. To ensure patient safety majority of institutions maintain minimal requirements to operate using RAS however across specialities and institutions these greatly vary.MethodsA narrative review of all the relevant papers known to the author was conducted.ResultsSpecific challenges facing RFU is the inability to rely on case numbers as a surrogate means to measure competency as well the ongoing consideration of how to differentiate between surgeons with robotic training and those with the clinical experience specific to RFU.ConclusionThis review explores current models of training and credentialling and assess how it can be adapted to suggest a standardised guideline for RFU to ensure the highest standards of patient care.

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Robotic Surgery as Applied to Functional and Reconstructive Urology

Cited by 15 publications

References 53 publications

Contemporary Outcomes of Surgery for Primary and Recurrent Genitourinary Fistulae in a Well-resourced Country

Contemporary Outcomes of Surgery for Primary and Recurrent Genitourinary Fistulae in a Well-resourced Country

The emerging role of robotics in upper and lower urinary tract reconstruction

What credentials are required for robotic‐assisted surgery in reconstructive and functional urology?

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