Robotic-assisted radical prostatectomy with the Senhance® robotic platform: single center experience.

OBJECTIVE: To describe our institution's initial experience with robot-assisted radical prostatectomy (RARP) using the Senhance® robotic system. PATIENTS AND METHODS: A prospective analysis of 127 robot-assisted radical prostatectomies was performed. Patient demographics, preoperative and intraoperative parameters, histopathological examination results, intraoperative and early postoperative complications were obtained and analyzed. RESULTS: The median patient age was 61.0 ± 6.36 (from 37 to 73) years, with a mean body mass index of 26.2 ± 3.79 kg/m2. Of 127 patients, 16.5% (n = 21) underwent a pelvic lymph node dissection, 29.1% (n = 37) underwent one sided or bilateral nerve sparing. Post-operative extracapsular invasion (≥ pT3) was found in 15% (n = 19) of the cases and a Gleason score ≥ 7 in 74.8% of all patients. Our median operative time was 180 ± 41.98 min [interquartile range (IQR) 150-215], and median blood loss was 250 ± 236 (IQR 175-430) ml. Of 127 patients, 33.9% (n = 43) had positive margins, of them 28.7% in pT2 and 57.9% in pT3. Fifteen patients (11.8%) experienced complications, of them only three had Clavien-Dindo ≥ 3. Operation time decreased by about 60 min and estimated blood loss decreased by about 200 ml from the initial experience of each surgeon. CONCLUSIONS: Robotic prostatectomy using a Senhance® robotic system is feasible, and warrants further study to determine whether it can improve patient outcomes.

Robotic surgery using Senhance® robotic platform: single center experience with first 100 cases.

Until recently, robotic surgery has been associated only with the da Vinci robotic system. A novel Senhance® robotic system (TransEnterix Surgical Inc., Morrisville, NC, USA) was introduced almost 5 years ago. Published reports on experience using this robotic platform are very limited. We present a prospective analysis of the first 100 robotic surgeries in abdominal surgery, gynecology, and urology in Klaipeda University Hospital, Klaipeda, Lithuania. Out of 100 operated patients during the mentioned period, 49 were female and 51 men, age range 27-79 years, on an average 55 years. 39 underwent robotic abdominal surgical procedures, 31-urological, and 30 gynecological surgeries. Duration of surgery varied from 30 min to 6 h and 5 min, on an average 2 h 25 min. Almost half 49 (49%) were operated on for malignant diseases: prostate cancer-27, renal cell carcinoma-1, endometrial cancer-7, ovarian cancer-1, colorectal cancer-13 (7 colon and 6 rectum). In-hospital stay was on an average 4 days, range 1-15 days. There were 3 (3%) conversions: two to laparoscopy (both undergoing robotic radical prostatectomy) and one to open (undergoing total hysterectomy). 6 (6%) complications occurred during 30 postoperative days, 2 demanding surgery. According to the Clavien-Dido classification, they were grade II in 3, grade III a in 1 and grade III b in 2 cases. There was no mortality in this patient population. Our experience with different types of robotic surgeries allows us to state that the Senhance® robotic system is feasible and safe in general surgery, gynecology, and urology, and wider implementation of this system worldwide is simply a question of time.

Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers.

Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also proves the decreased usage of painkillers in the group of the patients with the surgical treatment. All the patients (n=44) have had sleep disorders because of the ulcers. In the group of surgically treated patients, ulcers did not disturb the sleep after more than 3 months, and in the group, treated conservatively, the problem remained. We also found that after surgical treatment the patients were more optimistic and cried less. That shows the recovery of their emotional status. We have also found that the patients knew from the surgeon first than from the family doctor or other medical personnel about this disorder. We have made conclusions, that with the reduction of the ulcer area the pain is also reduced. Surgical treatment of ulcers (autodermoplasty) reveals a statistically reliable positive effect on patient life quality (sleep and emotions), but even 50% of patients are unaware of the real leg ulceration causes.

Results of treatment of extrahepatic cholangiocarcinoma at Kaunas University of Medicine Hospital.

Adenocarcinoma of the extrahepatic bile ducts is considered to be a rare cause of obstructive jaundice. Prognosis is poor and only radical surgery can prolong the life of such patients. The aim of study was to evaluate the outcome of treatment of patients having extrahepatic carcinoma of the bile ducts. Patients underwent treatment at Kaunas University of Medicine Hospital. A retrospective study was performed of 57 patients suffering from cancer of extrahepatic bile ducts in 1996-2001. Diagnosis was established by ultrasonography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and computed tomography. Sixteen patients (25%) received symptomatic treatment. Thirty-three patients (61%), receiving palliative therapy, underwent a biliodigestive bypass (n=14), an intraoperative biliary stenting (n=10), an endoscopic biliary drainage (n=6), or percutaneous transhepatic biliary drainage (n=3). Eight patients (14%) underwent radical resections of bile ducts: five patients had resections of bile ducts with D2 lymphonodectomy, two patients had bile duct resections in combination with pancreatoduodenal resection and one patient had resection of the bile ducts in combination with right hepatectomy. Histological examinations of the resected specimens revealed a curative effect in seven out of eight cases. There were no deaths in the group of radically treated patients. In the group of patients receiving palliative therapy 8 patients died: four patients died because of cardiovascular complications, two patients died of hepatorenal syndromes, one patient died because of multiorgan failure and one died of peritonitis. Five patients died in the group receiving symptomatic treatment. Assessing remote results of treatment, median survival time of patients who underwent resection was 89 days. Survival results of patients who had curative resections were much better (ranging from 277 to 1084 days). Median survival time of patients, receiving palliative treatment, was 65 days and 29 days of group, receiving symptomatic treatment. Recent progress made in surgical techniques and in perioperative management of extrahepatic cholangiocarcinomas as well as modern diagnostic achievements has greatly contributed to the outcomes of radical surgery. The main aim of the treatment is to perform resection of the bile ducts cancer.