A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System / 亚洲男科学杂志(英文版)

To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy (epR-spRP) and extraperitoneal robotic multiport radical prostatectomy (epR-mpRP) performed with the da Vinci Si Surgical System, comparison was performed between 30 single-port (SP group) and 26 multiport (MP group) cases. Comparisons included operative time, estimated blood loss (EBL), hospital stay, peritoneal violation, pain scores, scar satisfaction, continence, and erectile function. The median operation time and EBL were not different between the two groups. In the SP group, the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients (P < 0.001). The median postoperative hospital stay in the SP group was shorter than that in the MP group (P < 0.001). The rate of peritoneal damage in the SP group was less than that in the MP group (P = 0.017). The pain score and overall need for pain medications in the SP group were lower than those in the MP group (P < 0.001 and P = 0.015, respectively). Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively (P = 0.007). At 3 months, the cancer control, recovery of erectile function, and urinary continence rates were similar between the two groups. It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system. Therefore, epR-spRP can be a treatment option for localized prostate cancer. Although epR-spRP still has a learning curve, it has advantages for postoperative pain and self-assessed cosmesis. In the absence of the single-port robotic surgery platform, we can still provide minimally invasive surgery for patients.

Application of R. E. N. A. L. scoring system in robotic laparoscopic partial nephrectomy / 第二军医大学学报

Objective To evaluate the clinical value of R. E. N. A. L. scoring system in analyzing the tumor anatomical feature and indication characteristics of patients undergoing robotic laparoscopic partial nephrectomy (RPN). Methods The clinical data of 70 consecutive RPNcases done between March 2012 and September 2013 by the same surgeon at our institution were analyzed in this study. The 70 patients (47 males and 23 females) had a mean age of (52. 8 ± 10. 3) years, a mean body mass index (BMI) of (24. 8 ± 3. 25) kg/m2, a mean ASA score of 2. 0 ± 0. 4, and a mean age-weighted Charlson comorbidity index of (0. 7 ± 1. 03). Therewere 38 cases on the left (with 1 case of solitary kidney) and 32 cases on the right (also with 1 case of solitary kidney). All the tumors were solitary ones, with the maximal diameter being (3. 7 ± 1. 31) cm and a mean R. E. N. A. L. score of (8. 1 ± 1. 31). The patients were divided into three groups according to the R. E. N. A. L. scores, and the clinical variables were compared between groups. Results One patient was transferred to open surgery due to intraoperative hemorrhage and the rest were successfully completed. The operative time was (230 ± 48. 3) min, estimated blood loss was (154 ± 135. 9) mL, renal ischemia timewas (23. 0 ± 9. 30) min, and the mean postoperative hospital stay was (11. 4 ± 4. 44) days. The overall transfusion ratewas 8. 5 7 % (6/70) and the complication rate was 17. 1% (12/70). Pathological examination revealed no positive surgical margin; there were 58 cases with renal carcinoma, 4 with angiomyolipoma and 8 with other benign renal lesions. All patients were alive and had no local recurrence or distant metastasis at the latest follow-up. Nevertheless, the estimatedglomerular filtration rate (eGFR) was significantly different before and after operation (P = 0. 003). Significant differences were also found among the low, moderate and high tumor complexity groups (according to R. E. N. A. L. scores) regarding the cases finished in the first ten cases (50. 0% vs 10. 9% vs 11. 1%, P = 0. 033), operative time ([213 ± 35. 5] vs [225 ± 48. 9] vs [269 ± 31.7] min, P = 0. 008), estimated blood loss ([86 ± 31.3] vs [158 ± 148. 5] vs [172. 0 ± 66. 7] mL, P = 0. 032), and renal ischemia time ([18. 9 ± 7. 54] vs [22. 2 ± 8. 88] vs [30. 4 ± 9. 76] min, P = 0. 019). Conclusion R. E. N. A. L. nephrometry score is closely correlated with the surgical outcomes of RPN. Preoperative application of R. E. N. A. L. scoring system to identify tumor complexity can help to guide the clinical use of da Vinci surgical system for partial nephrectomy.