scholarly journals Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e8166
Author(s):  
Qing Wang ◽  
Yuchao Lu ◽  
Henglong Hu ◽  
Jiaqiao Zhang ◽  
Baolong Qin ◽  
...  
Keyword(s):  
Blood Loss ◽  
Success Rate ◽  
Operative Time ◽  
Open Group ◽  
Ureteral Stricture ◽  
Robot Assisted ◽  
Open Procedure ◽  
Pain Scores ◽  
Estimated Blood Loss ◽  
Ureteral Surgery

Background Management of recurrent ureteral stricture is challenging. Consensus on the best surgical choice has not been demonstrated. In this study, we aim to report our experience in treating recurrent ureteral stricture and demonstrate whether robot-assisted procedure for redo ureteral surgery is as effective as open procedure while remaining less invasive. Methods We retrospectively assessed 41 patients (22 robot-assisted surgeries and 19 open surgeries) who underwent consecutive robot-assisted and open procedures for redo ureteral surgery from January 2014 to 2018 in our institution. Perioperative outcomes, including demographics, operative time, estimated blood loss, complications, pain scores, success rate and cost, were compared between two groups. Results There was no significant intergroup difference in terms of age, body mass index, gender composition and American Society of Anesthesiologists scores. A total of 31 patients underwent redo pyeloplasty and ten underwent redo uretero-ureterostomy. Compared with open group, robot-assisted group showed shorter operative time (124.55 min vs. 185.11 min, p < 0.0001), less estimated blood loss (100.00 mL vs. 182.60 mL, p = 0.008) and higher cost (61161.77¥ vs. 39470.79¥, p < 0.0001). Complication rate and pain scores were similar between two groups. Median follow-up periods were 30 and 48 months for robot-assisted and open group respectively. Success rate in the robot-assisted (85.71%) and the open group (82.35%) was not significantly different. Conclusions Robot-assisted surgery for recurrent stricture after previous ureteral reconstruction is as effective as open procedure and is associated with shorter operative time and less estimated blood loss.

Robotic and Laparoscopic Approaches for Adrenal Surgery in Obese Patients

2020 ◽  
pp. 000313482095149
Author(s):  
Hosam Shalaby ◽  
Mohamed Abdelgawad ◽  
Mahmoud Omar, MD ◽  
Ghassan Zora, MD ◽  
Saad Alawwad ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Obese Patients ◽  
Adrenal Surgery ◽  
Robotic Approach ◽  
Robot Assisted ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Objective Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the robotic and laparoscopic adrenalectomy, particularly in obese patients. Materials and Methods A retrospective analysis was performed on all consecutive patients undergoing adrenalectomy for benign disease by a single surgeon using either a laparoscopic or robotic approach. Adrenal surgeries for adrenal cancer were excluded. Demographics, operative time, length of hospital stays, estimated blood loss (EBL), and intraoperative and postoperative complications were evaluated. Patients were divided into 2 groups; obese and nonobese. A sub-analysis was performed comparing robotic and laparoscopic approaches in obese and nonobese patients. Results Out of 120, 55 (45.83%) were obese (body mass index ≥ 30 kg/m2). 14 (25.45%) of the obese patients underwent a laparoscopic approach, and 41 (74.55%) underwent a robotic approach. Operative times were longer in the obese vs. nonobese groups (173.30 ± 72.90 minutes and 148.20 ± 61.68 minutes, P = .04) and were associated with less EBL (53.77 ± 82.48 vs. 101.30 ± 122, P = .01). The robotic approach required a longer operative time when compared to the laparoscopic approach (187 ± 72.42 minutes vs. 126.60 ± 54.55 minutes, P = .0102) in the obese but was associated with less blood loss (29.02 ± 51.05 mL vs. 138.30 ± 112.20 mL, P < .01) and shorter hospital stay (1.73 ± 1.23 days vs. 3.17 ± 1.27 days, P < .001). Conclusion Robot-assisted adrenal surgery is safe in obese patients and appears to be longer; however, it provides improvements in postoperative outcomes, including EBL and shorter hospital stay.

The role of bedside assistant during robot assisted radical prostatectomy: Is more experience better? Analysis on perioperative and clinical outcomes

2020 ◽  
pp. 039156032095108
Author(s):  
Mario Salvatore Mangano ◽  
Claudio Lamon ◽  
Francesco Beniamin ◽  
Alberto De Gobbi ◽  
Matteo Ciaccia ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Bedside Assistant ◽  
The Impact

Objectives: To analyze the impact of the bedside assistant’s experience during RARP. It is believed that the outcome of robotic surgery during Robot Assisted Radical Prostatectomy (RARP) for prostate cancer depends not only on the console surgeon’s experience. Materials and Methods: All consecutive RARPs from January 2017 to March 2018 were sourced from a prospectively maintained database. All cases were performed by the same surgeon. He was supported by three bedside assistants: one with bedside and console experience, one only with relevant bedside experience, one basically inexperienced. The patient’s parameters analyzed: age, Body Mass Index (BMI), previous abdominal surgery, prostate volume (by TRUS), pre-operative PSA, bioptic grading. Surgical outcomes analyzed included skin-to-skin operative time and estimated blood loss; clinical outcomes included length of hospital stay and time to catheter removal; the oncological outcome was represented by positive surgical margin rate. Results: A total of 116 RARPs were identified: 38 RARPs were performed with the console experienced bedside assistant, 38 with the experienced one, 40 with the novice one. The variables were similar between the three groups. As far as outcomes are concerned, there were no statistically significant differences between the three bedside assistants in terms of operative time, estimated blood loss, length of stay, days of catheterization, positive surgical margin rate.

scholarly journals Peri-Operative Outcomes after Open and Robot-Assisted Radical Cystectomy by Using an Advanced Bipolar Seal and Cut Technology (Caiman®): A Prospective, Comparative, and Multi-Institutional Study

2018 ◽  
Vol 12 (2) ◽  
pp. 64-69 ◽  
Author(s):  
Marco Borghesi ◽  
Riccardo Schiavina ◽  
Alessandro Antonelli ◽  
Carlo Buizza ◽  
Antonio Celia ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Radical Cystectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Transfusion Rate ◽  
Robot Assisted ◽  
Operative Outcomes ◽  
Estimated Blood Loss ◽  
Significant Difference

Objective: To report and compare the peri-operative outcomes of patients undergoing open (ORC) and robotic-assisted radical cystectomy (RARC) for bladder cancer performed with a radiofrequency seal and cut device (Caiman®). Materials and Methods: Data of patients undergoing ORC or RARC between January 2015 and March 2016 at 6 Italian institutions were prospectively recorded and analyzed. Thirty-and 90-day complications were stratified according to the Martin's criteria and graded according to the Clavien-Dindo classification. Data on operative time, blood loss, transfusion rate, complications, and length of stay were evaluated and compared between the ORC and RARC groups. Results: Thirty-three (66%) and 17 (34%) patients were treated with ORC and RARC, respectively. The median age was 72 (64-78) years. Overall operative time was longer in RARC compared to ORC (389 ± 80.1 vs. 242 ± 62.2 min, p < 0.001), while the estimated blood loss during cystectomy was higher after ORC (370 ± 126.8 vs. 243.3 ± 201.6 ml, p = 0.03). The transfusion rate was significantly higher in the ORC compared to RARC (24.2 vs. 5.9%, p = 0.04). Eight (19%) and 7 (16.7%) patients experienced 30- and 90-day post-operative complications, with no significant difference between ORC and RARC. Length of stay was significantly shorter in RARC group (median 7 vs. 14 days, p < 0.001). Conclusion: Open and robot-assisted procedures were safely performed by using a new advanced bipolar seal and cut technology (Caiman®). RARC demonstrated to be superior to ORC in terms of bleeding, transfusion rates and length of hospital stay, despite longer operative time.

scholarly journals Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Changwei Ji ◽  
Qun Lu ◽  
Wei Chen ◽  
Feifei Zhang ◽  
Hao Ji ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Laparoscopic Adrenalectomy ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Transfusion Rate ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Minimally Invasive Adrenalectomy

Abstract Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

Regrowth of the adenoids after adenoidectomy down to the pharyngobasilar fascial surface

2015 ◽  
Vol 129 (7) ◽  
pp. 662-665 ◽  
Author(s):  
L Wei ◽  
M Wang ◽  
N Hua ◽  
K Tong ◽  
L Zhai ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Blood Loss ◽  
Success Rate ◽  
Operation Time ◽  
Early Complications ◽  
Estimated Blood Loss ◽  
Endoscopic Guidance ◽  
Pharyngobasilar Fascia

AbstractObjectives:This study aimed to explore adenoid regrowth after transoral power-assisted adenoidectomy down to the pharyngobasilar fascial surface.Methods:Transoral adenoidectomy down to the pharyngobasilar fascia surface was performed on 39 patients under endoscopic guidance, using a power-assisted system. The operation time, amount of blood loss and iatrogenic injury, presence of complications, and success and regrowth rates were recorded to assess the feasibility, safety and effectiveness of our surgical technique.Results:In this adenoidectomy procedure, the pharyngobasilar fascia was left intact. The estimated blood loss was 5–50 ml (mean 15 ml), and the success rate was 97.3 per cent. Early complications occurred in 2.3 per cent of patients, while no long-term complications occurred in the cohort. No regrowth was found in the follow-up assessments, which were performed for 18–36 months after surgery.Conclusion:Adenoid regrowth was rare after adenoidectomy down to the pharyngobasilar fascial surface. The pharyngobasilar fascia can therefore be considered a surgical boundary for adenoidectomy.

A team approach to anterior lumbar spine surgery in the military

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 246-251 ◽  
Author(s):  
Anahita Dua ◽  
Jennifer Fox ◽  
Bhavin Patel ◽  
Eric Martin ◽  
Michael Rosner ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Blood Loss ◽  
Operative Time ◽  
Lumbar Spine Surgery ◽  
Team Approach ◽  
Disc Space ◽  
Estimated Blood Loss ◽  
All Cause Mortality ◽  
The Military ◽  
Median Operative Time

We report a five year military experience with anterior retroperitoneal spine exposure combining vascular and neurosurgical spine teams. From August 2005 through April 2010 (56 months), hospital records from a single institution were retrospectively reviewed. Complications, estimated blood loss, transfusions, operative time and length of stay were documented. Eighty-four patients with lumbar spondylosis underwent primary (63, 75%) or secondary exposure (21, 25%) of a single- (66, 79%) or multilevel disc space (18, 21%). Median operative time and estimated blood loss were 127 minutes (range, 30–331 minutes) and 350 mL (range, 0–2940 mL). The overall complication rate was 23.8%. Postoperative complications included six blood transfusions (7%), three patients with retrograde ejaculation (3.57%) or surgical site infection; two with a prolonged ileus (2.38%) or ventral hernia and one each with a bowel obstruction (1, 1.19%), deep venous thrombosis or lymphocele. All-cause mortality was 1%. In conclusion, a team approach can minimize complications while offering the technical benefits and durability of an anterior approach to the lumbar spine.

Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy

2017 ◽  
Vol 12 (6) ◽  
pp. 453-458
Author(s):  
Makoto Hikage ◽  
Masanori Tokunaga ◽  
Rie Makuuchi ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Surgical Outcomes ◽  
Distal Gastrectomy ◽  
Operation Time ◽  
Patient Characteristics ◽  
Clinicopathological Characteristics ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Device Use

Objective Robot-assisted gastrectomy is increasingly used for the treatment of gastric cancer, although it remains a time-consuming procedure. An ultrasonically activated device might be useful to shorten operation times. This study therefore assessed the effect of ultrasonically activated device use on procedural times and on other early surgical outcomes. Methods Consecutive patients (N = 42) who underwent robot-assisted distal gastrectomy for gastric cancer were included. Clinicopathological characteristics and early surgical outcomes were compared between robotic-assisted gastrectomy procedures using an ultrasonically activated device (U group, n = 21) and those without it (NU group, n = 21). Results There were no significant differences in patient characteristics between the groups; however, the median operation time was significantly less in the U group than in the NU group (291 vs 351 minutes, P = 0.006). In detail, the median duration of console time until dividing the duodenum was less in the U group (70 vs 102 minutes, P < 0.001). Estimated blood loss, incidence of postoperative morbidity, and duration of postoperative hospital stay were not different between the groups. Conclusions An ultrasonically activated device reduced the operation time of robot-assisted gastrectomy without increasing blood loss and morbidity.

scholarly journals Tourniquet Use in Wide-Awake Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Sarah E. Sasor ◽  
Julia A. Cook ◽  
Stephen P. Duquette ◽  
Elizabeth A. Lucich ◽  
Adam C. Cohen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Carpal Tunnel ◽  
Local Anesthetic ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Estimated Blood Loss ◽  
Tunnel Syndrome ◽  
Clinically Significant ◽  
Without Tourniquet ◽  
Wide Awake

Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups.

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