Single port robotic radical prostatectomy: a systematic review.

Several studies have assessed the safety and feasibility of single port robot-assisted radical prostatectomy using different and custom built robotic-assisted technology. In part due to the non-standardized nature of these approaches, single site robotic prostatectomy has not been widely adopted. With the recent approval of the da Vinci (Intuitive Surgical, Sunnyvale CA) Single Port (SP) platform, there has been a renewed interest in single site robotic-assisted prostatectomy and several institutions have begun reporting their initial experiences with this technique. In this systematic review, we sought to assess and summarize the literature regarding patient outcomes for single site robotic-assisted prostatectomy and evaluate its role in surgical treatment of prostate cancer. This systematic review was structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies describing the use of any robotic platform, including da Vinci Si, Xi or SP platforms for robotic single-port or single site radical prostatectomy between 2000 and July 15, 2019 were eligible for inclusion in this systematic review. Studies were excluded if they included combined cases with other organ resection, represented use in a non-clinical setting (such as a cadaveric model), or described results for a simple prostatectomy technique. Data was extracted by two authors with concerns resolved by consensus. Primary outcomes were mean operative times, estimated blood loss (mL), and hospital length of stay (days). Secondary outcomes included intraoperative conversion to open surgery, and intraoperative and postoperative complications. Variables of interest included sample size (n), mean age (years), mean prostate size (mL), prostate specific antigen (PSA, ng/mL), Gleason score, clinical and pathological TNM staging [American Joint Commission on Cancer (AJCC)], lymph nodes (n) and perioperative complications as available. A total of 217 studies were reviewed by title and abstract, with 28 selected for full-text review; ultimately, 12 studies were included, with available data from 145 patients. Primary outcomes and preoperative characteristics varied greatly amongst patients and across studies. One patient (0.7%) required conversion to a multi-port approach and there were no conversions to an open technique. No intraoperative complications were reported, and no Clavien grade III or greater postoperative complications have been described in the initial 81 radical prostatectomies performed with the SP platform. Single Port techniques appear to represent a safe and feasible approach for performing the minimally invasive radical prostatectomy. The current available literature on the single port radical prostatectomy is weak and consists of single center studies with small sample sizes, short-term follow up and limited functional data. More rigorous multi-center trials with standardized metrics for reporting functional outcomes as well as long-term cancer specific survival are necessary to validate these initial studies.

Single-port robotic surgery: the next generation of minimally invasive urology.

INTRODUCTION: The da Vinci Single-Port (SP) platform (Intuitive Surgical Inc, Sunnyvale CA) is a recently approved robotic surgical platform which features several novel modifications from previously available single trocar models including a flexible camera, articulating instruments, and navigator guidance for real-time monitoring of instrument position. We sought to describe our clinical experience with this device as well as to review the current literature related to the use of the SP platform. METHODS: We provide a narrative review of clinical data related to single-port robotic surgery within the field of urology. In addition, we report our initial clinical experience for surgical procedures performed with the SP platform between December 2018 and April 2019 following installation of the system at our institution. RESULTS: Currently, the presently available literature for single-port robotic urological surgery consists of single-center case reports and series. Most major robotic urologic operations appear technically feasible using the da Vinci SP platform; however, additional multi-center studies and randomized trials are needed to determine what role the SP platform will play. CONCLUSIONS: Rather than an iterative step or a niche system, the SP platform provides for a new approach to single-site laparoscopic or robotic techniques and is demonstrated as a feasible approach for several major robotic urological operations. While comparative studies will be required to evaluate perioperative and long-term outcomes between SP and multi-port platforms, further technological advances will continue to push surgeons towards less morbid and more minimally invasive approaches for surgery.

Single-port robot-assisted laparoscopic radical prostatectomy: initial experience and technique with the da Vinci® SP platform.

OBJECTIVES: To assess the safety and feasibility of the da Vinci® SP (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform for a consecutive series of patients who underwent single-port robot-assisted laparoscopic radical prostatectomy (SP-RALP). PATIENTS AND METHODS: In all, 10 consecutive patients with biopsy confirmed prostate cancer underwent SP-RALP at our institution. Pre-, peri-, and postoperative data were prospectively collected for key outcomes including: estimated blood loss (EBL), operative time, postoperative pain requirements, duration of hospital stay, and complications. RESULTS: The patients were aged 52-77 years with a body mass index of 24.4-36.7 kg/m2 . Prostate volumes ranged from 26 to 136 mL, with a mean (sd) PSA (prostate specific antigen) level of 11.0 (10.6) ng/mL. Lymph node dissection was performed in four patients and nerve sparing in five. No intraoperative complications occurred, and no patients required conversion to an open approach. Total EBL was 20-150 mL, with a median (interquartile range [IQR]) console time of 189 (171-207) min and operative time of 234 (216-247) min. No patients were readmitted or required intervention. Urethral catheters were removed at a median (IQR) of 10 (8-11) days after surgery. CONCLUSION: SP-RALP appears to be a safe and feasible approach to performing robotic radical prostatectomy. Long-term follow-up will be necessary to assess initial oncological and functional results.

HMBPP-deficient Listeria mutant immunization alters pulmonary/systemic responses, effector functions, and memory polarization of Vγ2Vδ2 T cells.

Whereas infection or immunization of humans/primates with microbes coproducing HMBPP/IPP can remarkably activate Vγ2Vδ2 T cells, in vivo studies have not been done to dissect HMBPP- and IPP-driven expansion, pulmonary trafficking, effector functions, and memory polarization of Vγ2Vδ2 T cells. We define these phosphoantigen-host interplays by comparative immunizations of macaques with the HMBPP/IPP-coproducing Listeria ΔactA prfA* and HMBPP-deficient Listeria ΔactA ΔGCPE: prfA* mutant. The HMBPP-deficient ΔGCPE: mutant shows lower ability to expand Vγ2Vδ2 T cells in vitro than the parental HMBPP-producing strain but displays comparably attenuated infectivity or immunogenicity. Respiratory immunization of macaques with the HMBPP-deficient mutant elicits lower pulmonary and systemic responses of Vγ2Vδ2 T cells compared with the HMBPP-producing vaccine strain. Interestingly, HMBPP-deficient mutant reimmunization or boosting elicits enhanced responses of Vγ2Vδ2 T cells, but the magnitude is lower than that by HMBPP-producing listeria. HMBPP-deficient listeria differentiated fewer Vγ2Vδ2 T effector cells capable of coproducing IFN-γ and TNF-α and inhibiting intracellular listeria than HMBPP-producing listeria. Furthermore, HMBPP deficiency in listerial immunization influences memory polarization of Vγ2Vδ2 T cells. Thus, both HMBPP and IPP production in listerial immunization or infection elicit systemic/pulmonary responses and differentiation of Vγ2Vδ2 T cells, but a role for HMBPP is more dominant. Findings may help devise immune intervention.

Chronic 17beta-estradiol or cholesterol prevents stress-induced hippocampal CA3 dendritic retraction in ovariectomized female rats: possible correspondence between CA1 spine properties and spatial acquisition.

Chronic stress may have different effects on hippocampal CA3 and CA1 neuronal morphology and function depending upon hormonal status, but rarely are manipulations of stress and gonadal steroids combined. Experiment 1 investigated the effects of chronic restraint and 17beta-estradiol replacement on CA3 and CA1 dendritic morphology and spatial learning in ovariectomized (OVX) female Sprague-Dawley rats. OVX rats were implanted with 25% 17beta-estradiol, 100% cholesterol, or blank silastic capsules and then chronically restrained (6h/d/21d) or kept in home cages. 17beta-Estradiol or cholesterol prevented stress-induced CA3 dendritic retraction, increased CA1 apical spine density, and altered CA1 spine shape. The combination of chronic stress and 17beta-estradiol facilitated water maze acquisition compared to chronic stress + blank implants and nonstressed controls + 17beta-estradiol. To further investigate the interaction between 17beta-estradiol and stress on hippocampal morphology, experiment 2 was conducted on gonadally intact, cycling female rats that were chronically restrained (6h/d/21d), and then euthanized at proestrus (high ovarian hormones) or estrus (low ovarian hormones). Cycling female rats failed to show chronic stress-induced CA3 dendritic retraction at either estrous phase. Chronic stress enhanced the ratio of CA1 basal spine heads to headless spines as found in experiment 1. In addition, proestrous rats displayed increased CA1 spine density regardless of stress history. These results show that 17beta-estradiol or cholesterol protect against chronic stress-induced CA3 dendritic retraction in females. These stress- and 17beta-estradiol-induced morphological changes may provide insight into how dendritic complexity and spine properties contribute to spatial ability.