Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes

Shukla, Devki; Small, Alexander; Mehrazin, Reza; Palese, Michael

doi:10.1007/s11701-020-01106-2

Cited by 24 publications

(10 citation statements)

References 10 publications

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“…Following Kaouk et al’s initial publication describing the feasibility of robot-assisted partial nephrectomy with the da Vinci SP® Surgical System, 13 several groups have offered subsequent, larger series indicating clinical and cosmetic successes. 14 , 17 Other studies have reported successes performing SP robotic pyeloplasty, kidney transplantation, and autotransplantation. 18 , 19 Takeaways from these series have highlighted advantages with the SP ranging from technical aspects like greater ease with intracorporeal instrumentation and superior camera control, to clinical outcomes like low pain scores and potentially decreased narcotic prescriptions.…”

Section: Discussionmentioning

confidence: 99%

“…The SP platform has been successfully utilized for various urologic procedures with favorable clinical and cosmetic outcomes. 12 – 14 However, to our knowledge, there have been no reports describing use of the SP to perform DN. Here, we describe our initial clinical experience on single-port RADN using the da Vinci SP® Surgical System.…”

Section: Introductionmentioning

confidence: 99%

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Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

Garden¹,

Al-Alao²,

Razdan³

et al. 2021

JSLS

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Objectives: The da Vinci SP® Surgical System received U.S. Food and Drug Administration approval for urological procedures in 2018. Here, we describe the first experience performing single-port robot-assisted donor nephrectomy (RADN) using the da Vinci SP® surgical system, present 90-day clinical outcomes, and discuss tips for operative success. Methods: Seven consecutive patients underwent single-port RADN at a single institution between September 1, 2020 and March 31, 2021. Surgery was performed through a single, 60 mm Pfannenstiel incision with a 12 mm periumbilical assistant port for suction and vascular stapling. Donor characteristics, operative details, 90-day donor clinical outcomes, and recipient renal function were retrospectively evaluated. Results: Four female and three male patients successfully underwent single-port RADN without conversion to standard multiport or open approach. Six cases were left-sided. Estimated blood loss for each procedure was ≤ 50 mL. Mean operative time, warm ischemia time, and extraction time were 218.3 minutes (standard deviation [SD]: 16.3 minutes), 5 minutes 4 seconds (SD: 56 seconds), and 3 minutes 37 seconds (SD: 38 seconds). Mean pre-operative creatinine and estimated glomerular filtration rate were 0.79 mg/dL and 107.3 mL/min/1.73m 2 , respectively. At six week’s follow up, they were 1.22 mg/dL and 66.1 mL/min/1.73m 2 . Average pain score at 48 hours postoperatively was 1.7/10. There were no Clavien-Dindo grade ≥ III complications within 90 days. All recipients experienced immediate and sustained return of renal function post-transplant. Conclusion: Single-port RADN is a technically feasible and safe procedure with the da Vinci SP® system and can confer acceptable functional and cosmetic outcomes. Future studies are needed to define long-term outcomes and compare with previously established techniques for donor nephrectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

Garden¹,

Al-Alao²,

Razdan³

et al. 2021

JSLS

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“…Since the commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both via a transperitoneal and a retroperitoneal approach. [15][16][17][18][19][20][21][22] Note, the SP platform is relatively new, so published SP-robotic PN series are generally based on the preliminary experiences of surgeons with previous experience in conventional multi-arms robotic platforms. [15][16][17][18][19][20][21][22] Inclusion and exclusion criteria (study type, language restrictions, etc.…”

Section: Outcomes Of Sp-robotic Partial Nephrectomymentioning

confidence: 99%

“…Since then, promising perioperative outcomes have been reported in the field of PN. [14][15][16][17][18][19][20][21][22] The history of robotic single-site surgery in urology What led us to the availability (although in the United States and Far East only at the moment) of the SP robotic platform is the hypothesis that a virtually 'scarless' surgery could decrease the morbidity associated with surgical access, given the lower numbers of transcutaneous points of access (i.e. the trocar sites).…”

Section: Introductionmentioning

confidence: 99%

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

Carbonara

Borregales

Caliò

et al. 2023

Therapeutic Advances in Urology

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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.

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“…Only limited case reports have been published on single port robotic-assisted partial nephrectomy (SP-RAPN). Recently, Shukla et al [58 ▪▪ ], described their initial experience in 12 patients. All SP-RAPN were performed using a transperitoneal on-clamp approach, positioning a 26 mm cannula with an open Hasson technique at a minimum of 10 cm from renal hilum and a maximum of 25 cm from the lateral edge of the kidney.…”

Section: New Robotic Approachesmentioning

confidence: 99%

How to improve outcome in nephron-sparing surgery: the impact of new techniques

Cignoli

Fallara

Larcher

et al. 2021

Current Opinion in Urology

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Purpose of reviewNephron-sparing partial nephrectomy is the state of the art for localized small renal mass and it is gaining attention also for more advanced cases. In the present narrative review, we discuss the new developments that have occurred in the advancement of this approach over the past few years.Recent findingsOff-clamp, selective/superselective clamp and early-unclamping techniques are safe and feasible approaches, with potentially superior functional outcomes, and noninferior complications rate and oncological outcomes, when compared with main artery clamping. Renorrhaphy must preserve the physiological vascularization of residual parenchyma. Running sutures, particularly using barbed wires, shorten the operating and ischemia times. A further advantage could derive from avoiding a double-layer suture. Transperitoneal robot-assisted partial nephrectomy (RAPN) and retroperitoneal RAPN can be considered equivalent in terms of perioperative morbidity, functional and oncologic outcomes, regardless of tumor's location, thus the choice of the approach should be driven by the surgeon's expertise. Future improvements should be introduced by the single-port robotic surgery, which seems to be safe and feasibly also in an off-clamp manner.SummarySignificant advances have recently been achieved in nephron-sparing surgery technique. However, future studies with standardized reporting of these new techniques are needed to assess the real impact of them on early and long-term functional outcomes.

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Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes

Cited by 24 publications

References 10 publications

Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

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

How to improve outcome in nephron-sparing surgery: the impact of new techniques

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