Peritoneal Distraction Technique to Reduce Symptomatic Lymphoceles after Retzius-Sparing Robot-Assisted Radical Prostatectomy.

Background: In Retzius-sparing robot-assisted radical prostatectomy (RARP), lymphocele formation is a troublesome complication. The use of peritoneal flaps has emerged as a promising novel technique to tackle this complication. We explored this technique by suturing both the medial peritoneal flaps to each other and keeping them distracted so that the lymphadenectomy beds are left wide open. Objective: To assess the efficacy of our peritoneal distraction technique on lymphocele rates following Retzius-sparing RARP. Materials and Methods: This retrospective study included patients with localized prostate carcinoma who underwent Retzius-sparing RARP with standard pelvic lymph node dissection between May 2014 and September 2022 at Aster Medcity, Kochi, India. Based on the use of the technique, patients were divided into two groups: peritoneal distraction and closed groups. Both groups were matched using the propensity scoring method in a 1:1 ratio. Results: A total of 272 patients were included, of which 89 (32.7%) belonged to the peritoneal distraction group. Although the overall incidence of lymphocele between the two groups were comparable, none of the patients in the peritoneal distraction group required any intervention for lymphocele management, as opposed to 7 patients from the closed group (3.9%; P = 0.015). No significant association was found between lymphocele formation and serum prostate-specific antigen level, Gleason score, and the number of lymph nodes harvested. Conclusions: This study found that peritoneal distraction stitch is a simple and effective technique to reduce the incidence of symptomatic lymphocele that require intervention after Retzius-sparing RARP.

The impact of transition from conventional robot-assisted radical prostatectomy to retzius sparing robot-assisted radical prostatectomy: A retrospective multivariate analysis.

INTRODUCTION: To assess the outcomes of Retzius sparing robotic-assisted radical prostatectomy (RS-RARP) in comparison with the conventional RARP. MATERIALS AND METHODS: A retrospective analysis of 320 cases of RARP, performed from 2014 April to 2019 April, was performed. The predictor variables included age, body mass index, clinical stage, prostate-specific antigen, Gleason score category in biopsy, D'Amico risk category, presence of the median lobe, prior transurethral resection of the prostate, and the ability to perform the RS-RARP. The outcome variables included console time, blood loss, blood transfusion, nerve sparing, bladder neck sparing, positive surgical margins (PSM), number and the site of PSMs, extracapsular invasion, seminal vesicle involvement, complications, continence, erectile function, biochemical recurrence, and adjuvant treatment. Regression analysis was performed using the linear regression for the continuous variables and binary logistic regression for the categorical variables with two levels. RESULTS: Three hundred and twenty patients underwent radical prostatectomy from 2014 April to 2019 April. We started the RS-RARP program in December 2016. Twenty-three patients who did not meet the inclusion criteria were excluded and a total of 297 patients were studied. Multivariate analysis demonstrated that RS-RARP was a strong positive independent predictor for continence recovery at 3 months, 6 months, and 12 months. RS-RARP was an independent predictor of reduced console time and increased probability of bladder neck sparing. RS-RARP was also independently associated with increased PSM in the posterolateral, anterolateral, and the apical regions. CONCLUSION: RS-RARP has better continence rates up to 12 months compared with the conventional approach, but is associated with increased PSM at certain locations.

Robotic-assisted dual kidney transplantation.

AIM: The aim of this study was to report the feasibility of robotic-assisted dual kidney transplantation (DKT) in a marginal donor. MATERIALS AND METHODS: The case was a 53-year-old male, who with IgA nephropathy underwent a robotic-assisted robotic DKT. RESULTS: The total operating time was 265 min, total console time was 215 min, and anastomotic time was 39 min for both the kidneys, and blood loss was 220 ml. The total drain output was 150 ml on the 1st day. The drain was removed after 48 h and Foley catheter was removed after 5 days. Nadir creatinine was 1.1 mg/dl and time to nadir creatinine was 7 days. The patient received one unit of blood transfusion. Total postoperative hospital stay was 7 days and bilateral ureteric stents were removed after 14 days. At the end of 3 months, creatinine was 1.0 mg% and epidermal growth factor receptor was 82 ml/min/1.73 m2. CONCLUSION: Robotic DKT offers solutions to the challenges faced in open DKT.

Robotic-assisted renal transplantation with total extraperitonealization of the graft: experience of 34 cases.

The aim of the study is to elucidate the method of complete extraperitonealization of the graft while performing transperitoneal robotic renal transplant recipient operation. This is a retrospective study of 34 robotic-assisted kidney transplant (RAKT) utilizing our technique from July 2015 to June 2017. The study is performed in a quaternary private hospital setting. The surgery was performed using our novel peritoneal flap technique allowing complete extraperitonealization of the kidney. Total of 34 patients underwent RAKT in our hospital. Mean age was 40.6 ± 8.1 years, there were 25 males and 9 females. 30 had single vessel and four had double vessels. 27 patients received living donor graft while seven had deceased donor. The mean blood loss was 88 ± 51 mL, mean anastomotic time was 32 ± 3.3 min, mean total operative time was 145 ± 15 min, mean hospital stay was 5.8 ± 2.3 days, time to nadir creatinine was 4.3 ± 1.9 days, median creatinine level at the end of 6 months was 1.3 mg/dL. There were three open conversions in our series, one of which had delayed graft function requiring hemodialytic support. Total extraperitonealization of the graft reproduces closely the technique of open kidney transplant with good graft function. This would be a step toward the ultimate goal of performing a complete extraperitoneal robotic transplant. Further refinements in robotic instruments would make this a reality in near future.