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Objectives We aim to compare the outcomes of a 3-arm versus a 4-arm robotic assisted partial nephrectomy (RAPN) using the da Vinci Si model; as well as, illustrate the deployment of long ports to decrease arm collision during the 4-arm approach. Patients and Methods Results of RAPN in a Middle Eastern tertiary referral center from August 2013 to December 2017 are reported. Comparison between 3 versus 4-arm robotic approaches was done in regards to patient and tumor characteristics, operative parameters, and postoperative outcomes. Statistical analysis was performed with the Student's t-test and chi-squared test. Results Forty consecutive 3-arm RAPNs and 40 consecutive 4-arm RAPNs were retrospectively evaluated. Differences in tumor complexity between the two groups were statistically insignificant. Similarly, surgical margin positivity, mean ischemia time, estimated blood loss, length of hospital stay, and mean change in serum creatinine were statistically insignificant between the two groups. Mean operative time was significantly shorter by 42 minutes in the 4-arm vs 3-arm group (p=0.01). Conclusions The addition of a 4th arm in RAPN can be of benefit in centers that still rely on the da Vinci Si model. The ease of hilar dissection, retraction, and surgeon independence instigated a statistically significant decrease in operative time with 4-arm use.
RESUMO
BACKGROUND: Prostate cancer is the most common cancer among Lebanese men. Management of prostate cancer includes medical, radiological, and surgical intervention. In addition, active surveillance (AS) is proven as a valid option in patients with low-risk prostate cancer. Currently, data from the Middle East about AS are scarce. The aim of this study is to assess the rate of implementation of AS by physicians, determine the selection and follow-up criteria used by physicians, and identify potential barriers to its widespread adoption. METHODS: After receiving ethical approval, a LimeSurvey electronic questionnaire was mailed to 206 eligible urologists, oncologists, and radiation oncologists registered in the order of physicians in Lebanon. The questionnaire included dichotomous, multiple choice questions, and multiple answer questions. The 23 questions tackled sociodemographic information, physician's attitude toward AS, and their current practices. Predictors of AS use were identified using the chi-squared and Fisher's exact test. Then, multivariate logistic regression model for the predictors of AS practice was conducted. RESULTS: The response rate was 25%, and the analysis was run on 52 respondents. Although most of the respondents agreed that AS is a valid modality for low-risk prostate cancer, only 34 (65.4%) of them had patients on active surveillance. The rate of patients on AS was also very low. Urologists, physicians with >15 years of experience, and those who practiced in a university hospital were all predictors of AS usage (p = 0.005; p = 0.002; p = 0.025, respectively). However, physicians with fear of patient noncompliance had the odds of resorting to this modality [odds ratio (OR) = 0.07 (0.01 - 0.76)]. CONCLUSION: The main obstacles to implementing AS were fear of patient noncompliance and lack of national awareness as well as acceptance among the Lebanese uro-oncological body. Efforts to decentralize knowledge and expertize to new health-care practitioners and community hospitals would encourage its implementation.
