Single Institution Experience with Robot-Assisted Laparoendoscopic Single-Site Renal Procedures

Khanna, Rakesh; Stein, Robert J.; White, Michael A.; Isac, Wahib; Laydner, Humberto; Autorino, Riccardo; Hillyer, Shahab; Spana, Gregory; Shah, Gaurang; Haber, Georges-Pascal; Kaouk, Jihad

doi:10.1089/end.2011.0187

Cited by 37 publications

(10 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Khanna et al reviewed the Cleveland Clinic's experience with robot-assisted LESS for renal surgery [47]. Twenty-eight procedures were analyzed, including radical nephrectomies (n = 11), partial nephrectomies (5), nephroureterectomies (3), pyeloplasties (7), simple nephrectomy (1), and renal cyst decortication (1).…”

Section: Spidermentioning

confidence: 99%

ENDOUROLOGY Laparo-endoscopic single-site surgery: recent advances in urology

et al. 2012

Self Cite

View full text Add to dashboard Cite

Significant advances have been achieved in the field of urologic laparo-endoscopic single-site surgery (LESS) since the first reported clinical series in 2007. The aim of the present review paper is to summarize and critically analyze the most recent advances in the field of urologic LESS. A literature review was performed using PubMed to retrieve publications related to LESS in urology over the last two years (from January 2011 to May 2012). In the free-text protocol, the following terms were applied: LESS; single port laparoscopy; single incision laparoscopy. Despite unsolved challenges, LESS can be regarded as an emerging trend in minimally invasive urologic surgery and it has significantly evolved, becoming a widely applicable technique in a relatively short time. Outcomes demonstrate that a broad range of procedures can be effectively and safely done, given a solid laparoscopic surgical background and stringent patient-selection criteria. The recent introduction of a purpose-built instrumentation is likely to further foster the application of robotics to LESS. Further improvements are needed before this technique might reach a widespread adoption. Future advances in the field of robotic technology are expected to overcome the current limitations of LESS.

show abstract

Section: Spidermentioning

confidence: 99%

ENDOUROLOGY Laparo-endoscopic single-site surgery: recent advances in urology

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…5 To date, only few retrospective studies have been published, with limited sample size (ranging from 11 to 43), originating from tertiary referral centres, where results may not be representative of the American population at large. [6][7][8][9][10][11] In the face of such little data, we wanted to examine short-term outcomes of RANU compared with LNU using a large contemporary cohort of patients representative of the United States population. Specifically, we focused on perioperative complications, blood transfusions, prolonged length of stay, in-hospital mortality and hospitalization costs.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Trudeau

Gandaglia

Shiffmann

et al. 2014

CUAJ

View full text Add to dashboard Cite

Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large populationbased cohort of patients with upper-tract urothelial carcinoma (UTUC). Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures. Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade. Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU. IntroductionUpper-tract urothelial carcinoma (UTUC) accounts for about 5% of all urothelial carcinomas.1 According to treatment guidelines, radical nephroureterectomy (RNU) represents the treatment of choice for localized disease.2 Based on equal efficacy and easier convalescence compared to the open procedure, many urologists have advocated minimally invasive approaches as the standard of care. 2,3 In this context, laparoscopic nephroureterectomy (LNU) and robotic-assisted nephroureterectomy (RANU) are available; the robotic approach is being increasingly adopted for several other urologic malignancies.4 That being said, there is little data evaluating the safety and feasibility of RANU.5 To date, only few retrospective studies have been published, with limited sample size (ranging from 11 to 43), originating from tertiary referral centres, where results may not be representative of the American population at large. [6][7][8][9][10][11] In the face of such little data, we wanted to examine short-term outcomes of RANU compared with LNU using a large contemporary cohort of patients representative of the United States population. Specifically, we focused on perioperative complications, blood transfusions, prolonged length of stay, in-hospital mortality and hospitalization costs. (NIS) database were abstracted. The NIS is a 20% stratified probability sample that encompasses about 8 million ...

show abstract

“…The instruments were extremely limited during intracorporeal needling and knotting. Crossing manipulation of articulating instruments requires another learning curve that needs to be overcome [5]. These factors had a big impact on all the course of procedure, and which could make no difference among groups.…”

Section: Discussionmentioning

confidence: 99%

“…LESS is technically challenging because the surgeon must pass all of his instruments through a single port to provide limited triangulation [4]. To overcome this challenge, surgeons can operate either using one instrument, or using articulating instruments that cross over each other [5]. These limitations increase the challenge of learning LESS, which requires considerable practice.…”

Section: Introductionmentioning

confidence: 99%

The influence of prior laparoscopic experience on learning laparoendoscopic single site surgery: a prospective comparative preliminary study using cystorraphy in a live porcine model

Lee

Kim

et al. 2017

BMC Urol

View full text Add to dashboard Cite

BackgroundThe purpose of this study is to assess the impact of prior laparoscopic experience on the ability to learn laparoendoscopic single site surgery (LESS) skills.MethodsA total of 33 urologists who completed a training program in LESS surgery were recruited for this study. After completing the educational course and training, the study participants demonstrated LESS suturing and knot-tying via a 2-cm cystotomy in a live porcine model for 15 min. An objective structured assessment of technical skills (OSATS) was used to evaluate videos of each participant’s procedure. The participants were divided according to laparoscopic experience; advanced experienced group (AS), intermediate experienced group (IS), novice group (NS).ResultsThree participants in the NS group completed the porcine cystorrhaphy in 15 min (30.0%), 3 (25.0%) completed the task in the IS group, and 3 (27.2%) completed it in the AS group. There were no statistically significant differences in the mean total OSATS quality score (NS; 16.7, IS; 18.5, AS; 16.8) among the 3 groups. Concerning all each assessment, there were also no statistically significant difference. Additionaly, the mean total OSATS quantity score (NS; 4.1, IS; 3.5, AS; 4.3) did not differ significantly among groups. The NS group succeeded a mean of 1.4 knots, the IS group succeeded 0.9, and the AS group 1.3 (p = 0.727).ConclusionsThere was no significant difference among the groups in LESS proficiency after training. Surgeons who were novices in conventional laparoscopic surgery reached comparable scores to those of experienced laparoscopic surgeons after training.

show abstract

Single Institution Experience with Robot-Assisted Laparoendoscopic Single-Site Renal Procedures

Abstract: We present a large experience with robot-assisted LESS kidney surgery demonstrating the wide variety of procedures that can be performed. Further follow-up of this patient population is needed to document continued oncologic efficacy and durability of results.

Cited by 37 publications

References 12 publications

ENDOUROLOGY Laparo-endoscopic single-site surgery: recent advances in urology

ENDOUROLOGY Laparo-endoscopic single-site surgery: recent advances in urology

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

The influence of prior laparoscopic experience on learning laparoendoscopic single site surgery: a prospective comparative preliminary study using cystorraphy in a live porcine model

Contact Info

Product

Resources

About