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Int. braz. j. urol ; 48(2): 363-364, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364954


ABSTRACT Background: Reports in the literature describe lymphocele formation in up to half of patients following pelvic lymph node dissection (PLND) (1) in robotic-assisted radical prostatectomy (RARP), with 1-2% requiring intervention (2). The advantage of surgical approach is permanent excision of the lymphocele capsule and fewer days with pelvic drains compared to percutaneous drainage. This study aims to describe the step-by-step surgical management of symptomatic lymphoceles using a less invasive robotic platform, the Da Vinci® Single Port (SP). Material and Methods: We describe the technique of lymphocelectomy and marsupialization with the Da Vinci® SP for symptomatic lymphocele. For this study, several treatment modalities for symptomatic lymphoceles were available, including percutaneous drainage, sclerosing agents, and surgical marsupialization. All the data for this study were obtained through the procedure via Da Vinci® SP. Results: Operative time for the case was 84 minutes. Blood loss was 25ml. No intra- or post- operative complications were reported. The patient had his drain removed in under 24 hours after surgery. The mean follow-up period was 7.7 months. There were no complications or lymphocele recurrence. Conclusion: Da Vinci® SP lymphocelectomy is safe and feasible with satisfactory outcomes. The SP enables definitive treatment of the lymphocele sac (3), reducing the number of days with abdominal drains and allows further decrease in surgical invasiveness with fewer incisions and better cosmesis.

Humans , Male , Robotics , Lymphocele/surgery , Lymphocele/etiology , Robotic Surgical Procedures/adverse effects , Prostatectomy/methods , Drainage/adverse effects , Drainage/methods , Lymph Node Excision/methods
Int. braz. j. urol ; 48(2): 212-219, March-Apr. 2022. graf
Article in English | LILACS | ID: biblio-1364948


ABSTRACT Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.

Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Robotic Surgical Procedures/methods , Erectile Dysfunction/etiology , Erectile Dysfunction/prevention & control , Prostate/surgery , Prostatectomy/adverse effects , Prostatectomy/methods , Treatment Outcome
Int. braz. j. urol ; 48(2): 369-370, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364947


ABSTRACT Introduction: Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been proposed by several authors (1). However, even with the robotic surgery advantages, functional outcomes following RARP, especially erection recovery, still challenge surgeons and patients (2, 3). In this scenario, we have described different ways and grades of neurovascular bundle preservation (NVB) using the prostatic artery as a landmark until our most recent technique with lateral prostatic fascia preservation and modified apical dissection (4-6). In this video compilation, we have illustrated the anatomical and technical details of different grades of NVB preservation. Surgical technique: After the anterior and posterior bladder neck dissection, we lift the prostate by the seminal vesicles to access the posterior aspect of the prostate. Then, we incise the Denonvilliers layers and work between an avascular plane to release the posterior NVB from 5 to 1 and 7 to 11 o'clock positions on the right and left sides, respectively6. In sequence, we access the prostate anteriorly by incising the endopelvic fascia bilaterally (close to the prostate) until communicating the anterior and posterior planes. Finally, we control the prostatic pedicles with Hem-o-lok clips and then proceed for the apical dissection preserving the maximum amount of urethra length and periurethral tissues. Considerations: Potency recovery following radical prostatectomy remains a challenge due to its multifactorial etiology. However, basic concepts for nerve-sparing are crucial to achieving optimal outcomes, such as minimizing the amount of traction used on dissection, avoiding excessive cautery, and neural preservation based on anatomical landmarks (arteries and planes of dissection).

Humans , Male , Prostatic Neoplasms/surgery , Robotic Surgical Procedures , Prostate/surgery , Prostatectomy/methods , Penile Erection
Int. braz. j. urol ; 48(1): 198-199, Jan.-Feb. 2022.
Article in English | LILACS | ID: biblio-1356291


ABSTRACT Introduction: The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal plate, or an abnormality in the fusion of the vaginal component of mullerian duct with the urogenital sinus results in TVS (1, 3, 4). High CUVF occurs due to the persistent communication between the urogenital sinus and utero-vaginal primordium at the tubercle sinus, whereas low CUVF is due to excessive apoptosis of the vaginal plate during channelling (5). The principles of management of CUVF with TVS include: 1) TVS resection, 2) Create a neovagina. We present a case of CUVF with TVS managed by robotic assistance. Material and methods: A 24-year-old female, married for 3 years, presented with cyclical hematuria since menarche, dyspareunia and primary infertility. Examination revealed blind ending vagina 4cm from the introitus. Magnetic resonance imaging revealed a fistulous communication between urethra and vagina, and TVS. Cystourethroscopy confirmed a proximal urethra-vaginal fistula. Urethroscopy guided puncture of the TVS was performed, tract dilated and a catheter was placed across it. Robotic assisted transvaginal approach was planned. Air docking of robot was performed. Traction on the catheter was given to identify the incised edges of the septum. Vaginal flaps were raised laterally, fistulous tract was excised. Proximal vagina mucosa was identified and vaginoplasty was performed. Result: Patient's postoperative recovery was uneventful. Urethral catheter was removed after 5 days. She had normal voiding and menstruation. Vaginoscopy performed at 1st month follow-up, revealed an adequate vaginal lumen. Vaginal moulds were advised for 6 weeks during the night, following which she resumed her sexual activity. She conceived 6 months post-surgery, and delivered a child by caesarean section. Conclusion: We successfully managed this case by resection of septum, neovagina creation and thereby achieving normal menstruation and conception. The advantages of robotic approach were magnification, precision and manoeuvrability in a limited space, avoiding a vaginal release incision.

Humans , Male , Female , Vaginal Diseases , Vaginal Fistula/surgery , Robotic Surgical Procedures , Urethra/surgery , Urethra/diagnostic imaging , Vagina/surgery
Int. braz. j. urol ; 48(1): 196-197, Jan.-Feb. 2022.
Article in English | LILACS | ID: biblio-1356285


ABSTRACT Background: Inferior vena cava (IVC) invasion from renal cell carcinoma (RCC) occurs at a rate of 4-10% (1). IVC thrombectomy (IVC-TE) can be an open procedure because of the need for handling of the IVC (2). The first reported series of robotic management of IVC-TE started in 2011 for the management of Level I - II thrombi with subsequent case reports in recent years (2-5). Materials and Methods: The following is a patient in his 50's with no significant medical history. Magnetic resonance imaging and IR venogram were performed preoperatively. The tumor was clinical stage T3b with a 4.3cm inferior vena cava thrombus. The patient underwent robotic assisted nephrectomy and IVC-TE. Rummel tourniquets were used for the contralateral kidney and the IVC. The tourniquets were created using vessel loops, a 24 French foley catheter and hem-o-lock clips. Results: The patient tolerated the surgical procedure well with no intraoperative complications. Total surgical time was 274 min with 200 minutes of console time and 22 minutes of IVC occlusion. Total blood loss in the surgery was 850cc. The patient was discharged from the hospital on post-operative day 3 without any complications. The final pathology of the specimen was pT3b clear cell renal cell carcinoma Fuhrman grade 2. The patient followed up post-operatively at both four months and six months without disease recurrence. The patient continues annual follow-up with no recurrence. Conclusions: Surgeon experience is a key factor in radical nephrectomy with thrombectomy as patients have a reported 50-65% survival rate after IVC-TE (4).

Humans , Carcinoma, Renal Cell/surgery , Robotic Surgical Procedures , Kidney Neoplasms/surgery , Tourniquets , Vena Cava, Inferior/surgery , Retrospective Studies , Thrombectomy , Nephrectomy
Int. braz. j. urol ; 48(1): 122-130, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356274


ABSTRACT Purpose: To analyze the association between obesity and urinary incontinence rate in men submitted to robot-assisted radical prostatectomy (RARP) in a high-volume cancer center. Materials and Methods: We reported 1.077 men who underwent RARP as the primary treatment for localized prostate cancer from 2013 to 2017. Patients were classified as non-obese (normal BMI or overweight) or obese men (BMI ≥30kg/m2). They were grouped according to the age, PSA level, D'Amico risk group, Gleason score, ASA classification, pathological stage, prostate volume, salvage/adjuvant radiotherapy, perioperative complications, and follow-up time. Urinary continence was defined as the use of no pads. For the analysis of long-term urinary continence recovery, we conducted a 1:1 propensity-score matching to control confounders. Results: Among the obese patients, mean BMI was 32.8kg/m2, ranging 30 - 45.7kg/m2. Only 2% was morbidly obese. Obese presented more comorbidities and larger prostates. Median follow-up time was 15 months for the obese. Complications classified as Clavien ≥3 were reported in 5.6% of the obese and in 4.4% of the non-obese men (p=0.423). Median time for continence recovery was 4 months in both groups. In this analysis, HR was 0.989 for urinary continence recovery in obese (95%CI=0.789 - 1.240; p=0.927). Conclusions: Obese can safely undergo RARP with similar continence outcomes comparing to the non-obese men when performed by surgeons with a standardized operative technique. Future studies should perform a subgroup analysis regarding the association of obesity with other comorbidities, intending to optimize patient counseling.

Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Obesity, Morbid , Robotic Surgical Procedures/adverse effects , Prostate/surgery , Prostatectomy/adverse effects , Treatment Outcome , Recovery of Function , Propensity Score
Rev. Col. Bras. Cir ; 49: e20223063, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365386


ABSTRACT Objective: to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. Methods: patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. Results: nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. Conclusions: on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.

RESUMO Objetivo: descrevemos nossa experiência com uso da plataforma robótica no tratamento das recidivas operadas previamente por laparoscopia, mantendo assim uma proposta minimamente invasiva a esses pacientes, apesar de haver uma predileção pela via anterior e aberta nestes casos. Métodos: foram incluídos pacientes submetidos a hernioplastia inguinal robótica transabdominal pré-peritoneal como tratamento de recidiva e que foram operados previamente por laparoscopia, entre dezembro de 2015 e setembro de 2020 e mantidos em uma base de dados ambulatorial prospectiva. Variáveis de interesse incluíram dados demográficos, características herniárias, detalhes operatórios, ocorrências do sítio cirúrgico em 30 dias (com ou sem necessidade de intervenção), infeção do sítio cirúrgico, tempo de seguimento e taxa de recidiva. Resultados: dezenove pacientes (95% masculino, média de idade de 55 anos, média de índice de massa corporal 28kg/m2) e 27 hérnias operadas (N=8 bilaterais). Média de tempo cirúrgico 168.9±49.3 min (variando 90-240). N=2 complicações intraoperatórias por lesão de vasos epigástricos inferiores. N=2 seromas e N=1 hematoma foram identificados no pós-operatório; N=1 paciente apresentou dor crônica pós operatória. Após um tempo de seguimento médio de 35.7 meses (intervalo entre quartis 13-49), nenhuma recidiva foi diagnosticada. Conclusões: o uso da plataforma robótica parece ser seguro e efetivo no tratamento das recidivas operadas previamente laparoscopia, nesse pequeno grupo de pacientes selecionados, apesar de requerer expertise em cirurgia robótica. Outros estudos com maiores casuísticas são necessários para estabelecer o papel desta técnica no cenário das hérnias inguinais recidivadas.

Humans , Male , Female , Laparoscopy/methods , Robotic Surgical Procedures/methods , Hernia, Inguinal/surgery , Recurrence , Surgical Mesh , Retrospective Studies , Treatment Outcome , Herniorrhaphy/methods , Groin , Middle Aged
Rev. colomb. anestesiol ; 49(4): e201, Oct.-Dec. 2021. tab
Article in English | LILACS, COLNAL | ID: biblio-1341237


Abstract Introduction Prostatectomy is the standard treatment for patients with clinically localized prostate cancer. Currently, robot-assisted radical prostatectomy (RARP) is widely used for its advantages, as it provides better visualization, precision, and reduced tissue manipulation. However, RARP requires a multidisciplinary approach in which anesthesia and analgesia management are especially important. Objective This study aims to describe our experience delivering anesthesia for the first cases of patients undergoing RARP in a teaching hospital in Bogotá, Colombia. Methodology An observational study was conducted. We included all patients undergoing RARP from September 2015 to December 2019 at Fundación Santa Fe de Bogotá. All patients with incomplete data were excluded. Patient demographics were recorded, and significant perioperative events were reviewed. Results A total of 301 patients were included. At our institution, the mean age for patients undergoing RARP was 61.4 ± 6.7 years. The mean operative time was 205 ± 43 min and mean blood loss was 300 [200400] mL. Only 6 (2%) patients required transfusion. Age and BMI were not associated with clinical outcomes. Conclusions An adequate perioperative approach in RARP is important to minimize complications, which in this study and in this institution were infrequent.

Resumen Introducción La prostatectomía es el tratamiento estándar para pacientes con cáncer de próstata localizado. Actualmente, la prostatectomía radical asistida por robot es ampliamente utilizada por sus ventajas en visualización, precisión y manipulación de los tejidos. Sin embargo, este abordaje requiere un manejo multidisciplinario, pues el enfoque analgésico y anestésico es fundamental para optimizar los desenlaces. Objetivo Describir los primeros casos de prostatectomía radical asistida por robot realizadas en un hospital universitario de cuarto nivel en Bogotá, Colombia. Metodología Estudio observacional en el cual se incluyeron todos los pacientes sometidos a prostatectomía radical asistida por robot (PRAR) en el hospital Fundación Santa Fe de Bogotá entre septiembre de 2015 y diciembre de 2019. Se excluyeron los pacientes con historia clínica incompleta. Se registraron los datos demográficos y se revisaron los eventos perioperatorios importantes. Resultados Se analizaron 301 pacientes. La edad media de pacientes sometidos a PRAR fue 61,4 ± 6,7 años. El tiempo quirúrgico promedio fue 205 ± 43 minutos y la pérdida sanguínea media fue 300 [200-400] mL. Solo 6 pacientes (2 %) requirieron transfusión. La edad y el IMC no mostraron una asociación relevante con los desenlaces clínicos. Conclusiones El adecuado abordaje perioperatorio en PRAR es importante para minimizar las complicaciones, las cuales en este estudio y en esta institución fueron infrecuentes.

Humans , Male , Middle Aged , Prostatectomy , Natural Orifice Endoscopic Surgery , Robotic Surgical Procedures , Anesthesia, General , Prostatic Neoplasms , Observational Studies as Topic , Analgesia
Rev. ecuat. pediatr ; 22(3): 1-10, 30 de diciembre del 2021.
Article in Spanish | LILACS | ID: biblio-1352456


Introducción: La resección hepática sigue siendo el método más efectivo de tratamiento de tumores hepáticos. Actualmente, el abordaje laparoscópico se considera como el estándar de oro frente al abordaje abierto; sin embargo, el surgimiento de la cirugía robótica brinda una nueva opción de abordaje mínimamente invasiva con aparentes mejores resultados. El objeti-vo de esta revisión sistemática es valorar los beneficios de la hepatectomía robótica frente a la hepatectomía laparoscópica en la resección de tumores hepáticos. Metodología: En esta revisión sistemática se incluirán estudios comparativos, de cohorte, de casos y controles, con recolección de datos prospectivos o retrospectivos. Los participantes de los estudios serán pacientes diagnosticados con tumores hepáticos benignos o malignos, in-cluidos niños y adolescentes, no cirróticos o cirróticos compensados sometidos a intervencio-nes de hepatectomía robótica y hepatectomía laparoscópica. Las medidas de resultado pri-marias son: 1. Pérdida de sangre estimada durante el acto quirúrgico, 2. Tiempo operatorio, 3. Tasa de conversión a laparotomía, 4. Tasa de mortalidad intraoperatoria, 5. Tasa de morbili-dad (complicaciones postquirúrgicas), 6. Estancia hospitalaria postquirúrgica. Las búsquedas electrónicas se realizarán en PUBMED, MEDLINE, SCIENCEDIRECT (2010 hasta el presente). Se usará la evaluación del riesgo de sesgo de estudios de Cochrane. Como medidas de efecto del tratamiento se utilizarán las diferencias de medias (DM) y los intervalos de confianza (IC) del 95. La evaluación de heterogeneidad se realizará mediante la inspección visual del diagrama de embudo. La evaluación de la calidad de la evidencia y tablas de 'Resumen de hallazgos' se usará el test GRADE.

Introduction: Liver resection remains the most effective method of treating liver tumors. Currently, the laparoscopic approach is considered the gold standard compared to the open approach; however, the emergence of robotic surgery offers a new minimally invasive approach option with apparently better re-sults. The objective of this systematic review is to assess the benefits of robotic hepatectomy versus laparo-scopic hepatectomy in the resection of liver tumors. Methodology: This systematic review will include comparative, cohort, case-control studies with prospec-tive or retrospective data collection. Study participants will be patients diagnosed with benign or malignant liver tumors, including children and adolescents, noncirrhotic or compensated cirrhotic, undergoing robotic hepatectomy and laparoscopic hepatectomy procedures. The primary outcome measures are: 1. Estimated blood loss during surgery, 2. Operative time, 3. Laparotomy conversion rate, 4. Intraoperative mortality rate, 5. Morbidity rate (postoperative complications), 6. Post-surgical hospital stay. Electronic searches will be conducted on PubMed, Medline, and ScienceDirect (2010 to present). The Cochrane study risk of bias as-sessment will be used. The mean differences (MD) and the 95 confidence intervals (CI) will be used as measures of the treatment effect. The evaluation of heterogeneity will be carried out by visual inspection of the funnel diagram. The evaluation of the quality of the evidence and 'Summary of findings' tables will be used by the GRADE test.

Humans , Child , Adolescent , Adult , Robotic Surgical Procedures , Hepatectomy , Treatment Outcome , Laparoscopy , Liver Neoplasms
Int. braz. j. urol ; 47(6): 1272-1273, Nov.-Dec. 2021.
Article in English | LILACS | ID: biblio-1340035


ABSTRACT Purpose: Three-dimensional (3D) virtual models have recently gained consideration in the partial nephrectomy (PN) field as useful tools since they may potentially improve preoperative surgical planning and thus contributing to maximizing postoperative outcomes (1-5). The aim of the present study was to describe our first experience with 3D virtual models as preoperative guidance for robot-assisted PN. Materials and methods: Data of patients with renal mass amenable to robotic PN were prospectively collected at our Institution from January to April 2020. Using a dedicated web-based platform, abdominal CT-scan images were processed by M3DICS (Turin, Italy) and used to obtain 3D virtual models. 2D CT images and 3D models were separately assessed by two different highly experienced urologists to assess the PADUA score and risk category and to forecast the surgical strategy of the single cases, accordingly. Results: Overall, 30 patients were included in the study. Median tumor size was 4.3cm (range 1.3-11). Interestingly, 8 (26.4%) cases had their PADUA score downgraded when switching from 2D CT-scan to 3D virtual model assessment and 4 (13.4%) cases had also lowered their PADUA risk category. Moreover, preoperative off-clamp, selective clamping strategy and enucleation resection strategy increased from CT-scan to 3D evaluation. Conclusion: 3D virtual models are promising tools as they showed to offer a reliable assessment of surgical planning. However, the advantages offered by the 3D reconstruction appeared to be more evident as the complexity of the mass raises. These tools may ultimately increase tumor's selection for PN, particularly in highly complex renal masses. Disclosure of potential conflicts of interest: The authors declare they do not have conflict of interests. Informed consent: Informed consent was obtained from all individual participants included in the study. All the procedures were in accordance with the ethical standards of the institutional and national research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Humans , Robotics , Laparoscopy , Robotic Surgical Procedures , Kidney Neoplasms/surgery , Treatment Outcome , Nephrectomy
Int. braz. j. urol ; 47(6): 1279-1280, Nov.-Dec. 2021.
Article in English | LILACS | ID: biblio-1340031


ABSTRACT Introduction: Salvage Radical Prostatectomy after radiation therapy is challenging and associated with high rates of serious complications (1, 2). The novel Retzius-Sparing RARP (RS-RARP) approach has shown excellent continence outcomes (3, 4). Purpose: To describe step-by-step our Salvage Retzius-Sparing RARP (sRS-RARP) operative technique and report feasibility, safety and the preliminary oncological and continence outcomes in the post-radiation scenario. Materials and Methods: Twelve males presenting local prostate cancer recurrence after radiotherapy that underwent sRS-RARP were included. All patients performed preoperative multiparametric MRI and PSMA-PET. Surgical technique: 7cm peritoneum opening at Douglas pouch, Recto-prostatic space development, Seminal vesicles and vas deferens isolation and section, Extra-fascial dissection through peri-prostatic fat, Neurovascular bundle control, Bladder neck total preservation and opening, Anterior dissection at Santorini plexus plane, Apex dissection with urethra preservation and section, Prostate release, Vesicouretral modified Van Velthoveen anastomosis, Rocco Stitch, Oncological and continence outcomes reported with minimum 1-year follow-up. Results: Ten patients had previously received external beam radiation (EBR) whereas two received previous brachytherapy plus EBR. At 1, 3 and 12 months after surgery, 25%, 75% and 91.6% of the men used one safety pad or less, respectively. No major complications or blood transfusions were reported. Final pathology reported pT2b 41.6%, pT2c 33.3% and pT3a 25%, positive surgical margins 25%, positive lymph nodes were not found, biochemical recurrence 16.6%. Conclusion: Salvage Retzius-Sparing Robotic Assisted Radical Prostatectomy approach appears to be technically feasible and oncologically safe with potential to provide better continence outcomes.

Humans , Male , Prostatic Neoplasms/surgery , Robotic Surgical Procedures , Prostate , Prostatectomy , Brazil , Treatment Outcome , Organ Sparing Treatments
Int. braz. j. urol ; 47(6): 1277-1278, Nov.-Dec. 2021.
Article in English | LILACS | ID: biblio-1340016


ABSTRACT Background: High risk upper tract urothelial carcinoma (UTUC) is typically managed with radical nephroureterectomy, however, renal preservation can be attempted when UTUC is localized to the distal ureter in the presence of chronic kidney disease (1-3). Distal ureterectomy is typically managed with a ureteral reimplantation and psoas hitch in order to maintain urothelial continuity, to avoid comprising the contralateral ureter, and reducing risk of chronic urinary tract infections and electrolyte abnormalities (4). We present our case of distal ureteral UTUC managed robotically with a distal ureterectomy with ureteral reimplantation. Technique and Follow-Up: Initially, an Orandi needle on a resectoscope circumscribed the left ureteral orifice. Next, robotically, the retroperitoneum was exposed and a left sided pelvic lymphadenectomy was completed. The left ureter was mobilized and the diseased ureteral segment was transected. The mobilized bladder was sutured to psoas fascia. After a cystotomy, the ureter was re-anastomosed to the bladder. The patient was discharged on postoperative day three and re-evaluated one week later with a cystogram. Final pathology was downgraded to non-invasive low-grade papillary urothelial carcinoma with negative lymph nodes and margins. Conclusion: High risk UTUC localized to the distal ureter in the setting of chronic kidney disease can be managed with a distal ureterectomy (3). Robotic distal ureterectomy with ureteral reimplantation can be assisted by an Orandi needle to achieve negative margins. Utilizing a robotic technique can offer challenges with the ureteral spatulation and reanastomosis (5-7). By fixating the ureter to the bladder prior to reanastomosis, our technique offers a solution for these difficulties.

Humans , Ureter/surgery , Ureteral Neoplasms/surgery , Laparoscopy , Robotic Surgical Procedures , Replantation , Urologic Surgical Procedures , Treatment Outcome
Rev. SOBECC (Online) ; v26(n4): 253-261, 31-12-2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1367642


Objetivo: Identificar e mapear os cuidados de enfermagem no período perioperatório para com o paciente submetido a cirurgias oncológicas robóticas. Método:Revisão de escopo, com base nas recomendações do Joanna Briggs Institute, realizada entre outubro e dezembro de 2020 nas bases de dados Biblioteca Virtual em Saúde (BVS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine (PubMed) e Scopus. A delimitação temporal dos estudos foi de 2010 a 2020. Resultados: Foram identificadas 84 publicações, tendo-se incluído oito na amostra. Os resultados apontaram a importância da avaliação de enfermagem pré-operatória e do esclarecimento dos efeitos colaterais da cirurgia. No transoperatório, houve recomendações acerca do registro do processo de enfermagem, da prevenção da hipotermia periope-ratória e de lesões relativas ao posicionamento, bem como da educação continuada da equipe. Os achados evidenciaram o papel da enfermagem nas disfunções do assoalho pélvico e na identificação de déficits no autocuidado e no domínio sexual, especialmente no pós-operatório de pacientes submetidos a prostatectomias. Conclusão: As reco-mendações identificadas são capazes de minimizar os impactos negativos das cirurgias oncológicas e, consequentemente, melhorar a assistência de enfermagem perioperatória.

Objective: To identify and map perioperative nursing care for patients submitted to robotic cancer surgeries. Method: This is a scoping review based on recommen-dations from the Joanna Briggs Institute, held between October and December 2020 in the following databases: Virtual Health Library (VHL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine (PubMed), and Scopus. The study time frame spans from 2010 to 2020. Results: We identified 84 publications and included eight in the sample. The results indicated the importance of preoperative nursing evaluation and clarification of surgery side effects. Recommendations for the intraoperative period included recording the nursing process, preventing perioperative hypothermia and positioning injuries, as well as continuing education for the team. The findings evidenced the role of nursing in pelvic floor dysfunctions and in identifying deficits in self-care and sexuality, especially in the postoperative period of patients submitted to prostatectomies. Conclusions: The recommendations identified can minimize the negative impacts of cancer surgeries and, consequently, improve perioperative nursing care.

Objetivo: Identificar y mapear los cuidados de enfermería en el período perioperatorio de los pacientes sometidos a cirugía robótica oncológica. Método:Revisión del alcance, en base a las recomendaciones del Instituto Joanna Briggs, realizada entre octubre y diciembre de 2020, en las bases de datos Biblioteca Virtual en Salud (BVS), CINAHL, PubMed y Scopus. La delimitación temporal de los estudios fue de 2010 a 2020. Resultados: Se identificaron 84 publicaciones, incluidas ocho en la muestra. Los resultados mostraron la importancia de la evaluación de enfermería preoperatoria y el esclarecimiento de los efectos secundarios de la cirugía. Durante el transoperatorio, hubo recomendaciones en cuanto al registro del proceso de enfermería, prevención de hipotermia perioperatoria y lesiones relacionadas con el posicionamiento, así como la educación continua del equipo. Los hallazgos evidenciaron el papel de la enfermería en los trastornos del suelo pélvico y en la identifica-ción de déficits en el autocuidado y en el dominio sexual, especialmente en el postoperatorio de pacientes sometidas a prostatectomías. Conclusión: Las recomenda-ciones identificadas son capaces de minimizar los impactos negativos de las cirugías oncológicas y, en consecuencia, mejorar la atención de enfermería perioperatoria.

Humans , Robotic Surgical Procedures , Medical Oncology , Nursing Care , Postoperative Period , Perioperative Period , Intraoperative Period
J. coloproctol. (Rio J., Impr.) ; 41(2): 163-167, June 2021. tab, ilus
Article in English | LILACS | ID: biblio-1286988


Background: Transanal minimally invasive surgery (TAMIS) is a surgical technique used for the excision of rectal neoplasia that gained popularity during the last decade. Due to the technical difficulty (non-articulated instruments, reduced workspace) and the long learning curve associated with this technique, the use of robotic platforms to improve resection results has been suggested and reported, at the same time that the learning curve decreases and the procedure is facilitated. Materials and Methods: From March 2017 to December 2019, all patients with rectal lesions eligible for TAMIS were offered the possibility to receive a robotic TAMIS (RTAMIS). We used a transanal GelPoint Path (Applied Medical Inc., Santa Margarita, CA, USA) in the anal canal to be able to do the Da Vinci Si (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform docking, which we used to perform the excision of the rectal lesion as well as the resection site defect. Results: Five patients between 34 and 79 years of age underwent R-TAMIS. The mean distance to the anal verge was 8.8 cm. There were no conversions. The mean surgery time was 85 minutes, and the mean docking time was 6.6minutes. Conclusions: Robotic TAMIS is a feasible alternative to TAMIS, with a faster learning curve for experienced surgeons in transanal surgery and better ergonomics. Further studies are needed to assess the cost-benefit relationship. (AU)

Introdução: A cirurgia transanal minimamente invasiva (TAMIS, na sigla em inglês) é uma técnica que se tornou popular na última década para a excisão local de neoplasias no reto. Devido à dificuldade técnica (instrumentos não articulados, espaço de trabalho reduzido) e à longa curva de aprendizado representada por essa técnica, o uso de plataformas robóticas para melhorar os resultados da ressecção tem sido sugerido e relatado, aomesmo tempo emque a curva de aprendizado diminui e o procedimento é facilitado. Materiais e Métodos: De março de 2017 a dezembro de 2019, foi oferecida aos pacientes comlesões retais candidatos aoTAMIS a possibilidade de ressecção transanal robótica (R-TAMIS). Foi utilizada uma porta de acesso transanal GelPoint Path (Applied Medical Inc. Santa Margarita, CA, EUA), que foi introduzida no canal anal para posteriormente criar pneumoperitônio e realizar o acoplamento do sistema robótico Da Vinci Si (Intuitive Surgical, Sunnyvale, CA, EUA) para realizar a ressecção e o fechamento do defeito por robótica. Resultados: Cinco pacientes entre 79 e 34 anos foram submetidos à R-TAMIS. A distânciamédia àmargemanal foi de 8,8 cm. Não houve conversões. O tempo cirúrgico médio foi de 85 minutos, e o tempo médio de acoplamento foi de 6,6 minutos. Conclusões: A R-TAMIS é uma alternativa à TAMIS convencional, com menor curva de aprendizado para cirurgiões experientes em cirurgia transanalminimamente invasiva e melhor ergonomia para ressecção e fechamento. Outros estudos são necessários para avaliar a relação custo-benefício. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Colorectal Surgery/methods , Robotic Surgical Procedures , Rectal Neoplasms/surgery , Laparoscopy
J. coloproctol. (Rio J., Impr.) ; 41(2): 198-205, June 2021.
Article in English | LILACS | ID: biblio-1286989


Abstract Rectal cancer is an important cause of morbidity and mortality worldwide. The most effective and curative treatment is surgery, and the standard procedure is total mesorectal excision, initially performed by open surgery and posteriorly by minimally invasive techniques. Robotic surgery is an emerging technology that is expected to overcome the limitations of the laparoscopic approach. It has several advantages, including a stable camera platform with high definition three-dimensional image, flexible instrumentswith seven degrees of freedom, a third arm for fixed retraction, fine motion scaling, excellent dexterity, ambidextrous capability, elimination of physiological tremors and better ergonomics, that facilitate a steady and precise tissue dissection. The main technical disadvantages are the loss of tactile sensation and tensile feedback and the complex installation process. The aim of the present study is to review the importance and benefits of robotic surgery in rectal cancer, particularly in comparison with the laparoscopic approach. Intraoperative estimated blood loss, short and long-term outcomes as well as pathological outcomes were similar between robotic and laparoscopic surgery. The operative time is usually longer in robotic surgery and the high costs are still itsmajor drawback. Robotic surgery for rectal cancer demonstrated lower conversion rate to open surgery and benefits in urinary and sexual functions and has been established as a safe and feasible technique.

Resumo O cancro do reto é uma importante causa de morbidade e mortalidade em todo o mundo. O único tratamento curativo e mais eficaz é a cirurgia, sendo que o procedimento padrão é a excisão total do mesoreto, inicialmente realizada por cirurgia aberta e mais tarde por técnicas minimamente invasivas. A cirurgia robótica é uma tecnologia emergente que pretende ultrapassar as limitações da laparoscopia. As vantagens incluem plataforma de câmera estável, imagem tridimensional com alta definição, instrumentos flexíveis com sete graus de liberdade, terceiro braço para retração fixa, movimentos finos, excelente destreza, ambidestria, eliminação do tremor fisiológico e maior conforto ergonômico, que facilitam uma disseção firme e precisa dos tecidos. As principais desvantagens técnicas são a perda da sensação táctil e feedback tensional e o complexo processo de instalação. O objetivo deste estudo é fazer uma revisão bibliográfica da importância e dos benefícios da cirurgia robótica no cancro do reto, particularmente em comparação coma cirurgia laparoscópica. A perda estimada de sangue intraoperatória, os outcomes a curto e longo-prazo e os outcomes patológicos foram equivalentes entre a cirurgia robótica e laparoscópica. O tempo operatório é geralmente mais longo na cirurgia robótica e os elevados custos são a sua principal desvantagem. A cirurgia robótica no cancro do reto demonstrou menor taxa de conversão para cirurgia aberta e benefícios nas funções urinária e sexual e está estabelecida como uma técnica segura e viável.

Rectal Neoplasms/pathology , Colorectal Surgery/methods , Robotic Surgical Procedures , Rectal Neoplasms/surgery , Laparoscopy
Nursing (Säo Paulo) ; 24(277): 5775-5784, jun.2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1253487


Objetivo: identificar fatores associados a lesões de pele decorrentes de cirurgias urológicas robóticas versus convencionais em adultos/idosos. Método: revisão integrativa, etapas: Construção do protocolo de pesquisa; Formulação da pergunta - prática baseada em evidência, utilizando o acrônimo PICO; Definição dos descritores das estratégias de busca em cada uma das bases de dados selecionadas, que deviam ser variadas; Determinação, seleção e revisão dos critérios de inclusão e exclusão; Avaliação crítica dos estudos; Coleta de dados utilizando instrumentos que analisassem em pares; e Síntese dos resultados/dados agrupados por semelhança. Resultados: a estratégia de busca gerou 207 artigos. Resultando para análise final 7 artigos. Conclusão: são necessários novos estudos clínicos, que abordem os prejuízos e benefícios relacionados ao posicionamento cirúrgico robótico e abertos, direcionando assim, intervenções de enfermagem acuradas aos pacientes sob maior risco.(AU)

Objective: to identify factors associated with skin lesions resulting from robotic versus conventional urological surgery in adults / elderly. Method: integrative review, stages: Construction of the research protocol; Formulation of the question - evidence-based practice, using the acronym PICO; Definition of search strategy descriptors in each of the selected databases, which should be varied; Determination, selection and review of inclusion and exclusion criteria; Critical evaluation of studies; Data collection using instruments that analyzed in pairs; and Summary of results / data grouped by similarity. Results: the search strategy generated 207 articles. Resulting in 7 articles for final analysis. Conclusion: further clinical studies are needed, addressing the losses and benefits related to robotic and open surgical positioning, thus directing accurate nursing interventions to patients at higher risk.(AU)

Objetivo: identificar los factores asociados a las lesiones cutáneas resultantes de la cirugía urológica robótica versus convencional en adultos / ancianos. Método: revisión integradora, etapas: construcción del protocolo de investigación; Formulación de la pregunta - práctica basada en evidencia, utilizando el acrónimo PICO; Definición de descriptores de estrategias de búsqueda en cada una de las bases de datos seleccionadas, que deben ser variadas; Determinación, selección y revisión de criterios de inclusión y exclusión; Evaluación crítica de estudios; Recolección de datos utilizando instrumentos que se analizaron por parejas; y Resumen de resultados / datos agrupados por similitud. Resultados: la estrategia de búsqueda generó 207 artículos. Resultando en 7 artículos para el análisis final. Conclusión: se necesitan más estudios clínicos que aborden las pérdidas y beneficios relacionados con el posicionamiento quirúrgico robótico y abierto, dirigiendo así intervenciones de enfermería precisas a los pacientes de mayor riesgo.(AU)

Humans , Skin/injuries , Robotic Surgical Procedures , Perioperative Nursing , Data Collection
Gac. méd. Méx ; 157(2): 188-193, mar.-abr. 2021. tab
Article in Spanish | LILACS | ID: biblio-1279100


Resumen Antecedentes: La cirugía robótica se utiliza en múltiples especialidades quirúrgicas a nivel mundial. Objetivo: Documentar la experiencia inicial del programa de cirugía robótica en un hospital de práctica privada. Material y método: Se incluyen las primeras 500 cirugías robóticas realizadas en el Centro Médico ABC, abarcando un periodo de tres años. Se documentan especialidades involucradas así como datos transoperatorios principales. Resultados: De 500 pacientes, 367 (73.4%) fueron de sexo masculino y 133 (26.4%) de sexo femenino. Las tres cirugías más realizada fueron prostatectomía radical (269), seguido de histerectomía (64) y plastia inguinal (33). Un total de 40 médicos certificados de cinco especialidades realizaron la totalidad de los procedimientos. Conclusiones: El iniciar un programa en un centro médico privado tiene diversas implicaciones. La creación de un comité de cirugía robótica integrado por médicos especialistas certificados en cirugía robótica de cada especialidad y autoridades del hospital para la acreditación de lineamientos tanto para la certificación como la recertificación de sus médicos puede beneficiar a programas como el nuestro por crear un centro de excelencia de cirugía robótica, disminuyendo complicaciones y mejorando resultados.

Abstract Background: Robotic surgery is used in different surgical specialties worldwide. Objective: To documents the initial experience in a private hospital in the use robotic surgery in different surgical areas. Material and Methods: We included the first 500 robotic surgeries in our hospital in a 3 year period, documenting specialty and operative information. Results: Of the 500 patients, 367 (73.4%) were male and 133 (26.4%) female. The three most frequent surgeries performed were Radical Prostatectomy (269), Hysterectomy (64) an inguinal repair (33). A total of 40 certified surgeons ranging from 5 specialties performed the total number of surgeries. Conclusions: There are several implications in starting a robotic program in a private hospital setting. The creation of a robotic committee, formed by robotic certified physicians and hospital authorities, has helped in the certification process of its staff, lowering the complication rate and obtaining better surgical results.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Robotic Surgical Procedures/statistics & numerical data , Postoperative Complications/epidemiology , Prostatectomy/statistics & numerical data , Time Factors , Hospitals, Private/statistics & numerical data , Age Distribution , Operative Time , Robotic Surgical Procedures/adverse effects , Surgeons/statistics & numerical data , Hysterectomy/statistics & numerical data , Inguinal Canal/surgery , Mexico