Implementation and outcomes of HugoTM RAS System in robotic-assisted radical prostatectomy

ABSTRACT Background The results and benefits of Robotic-assisted Radical Prostatectomy (RARP) are already established in the literature. However, new robotic platforms have been released recently in the market and their outcomes are still unknown. In this scenario, our objective is to describe our experience implementing the HugoTM RAS robot and report the clinical data of patients who underwent Robotic-assisted Radical Prostatectomy. Material and Methods We retrospectively analyzed fifteen consecutive patients who underwent RARP with HugoTM RAS System (Medtronic, Minneapolis, USA) from June to October 2021. The patients underwent transperitoneal RARP on lithotomy position, using six trocars (4 robotic trocars and 2 for the assistant). We reported the clinical feasibility and safety of this platform, assessing perioperative data, including complications and early outcomes. Continuous variables were reported as median and interquartile ranges, categorical variables as frequencies and proportions. Results and Limitations All procedures were safe and feasible with no major complications or conversion. Median operative time was 235 minutes (213-271), and median estimated blood loss was 300ml (100-310). Positive surgical margins were reported in 5 patients (33%). The median hospitalization time was 2 days (2-2), and the median time to remove the foley was 7 days (7-7). On the first appointment four weeks after surgery, all patients had undetectable PSA values, and 61% were continent. Conclusions We described preliminary results with safe and feasible procedures performed with HugoTM RAS System robotic platform. The surgeries were successfully executed with acceptable perioperative outcomes, without conversions or major complications. However, as this technology is very recent, further studies with a long-term follow-up are awaited to access postoperative functional and oncological outcomes.

Implementation and outcomes of Hugo(TM) RAS System in robotic-assisted radical prostatectomy.

BACKGROUND: The results and benefits of Robotic-assisted Radical Prostatectomy (RARP) are already established in the literature. However, new robotic platforms have been released recently in the market and their outcomes are still unknown. In this scenario, our objective is to describe our experience implementing the HugoTM RAS robot and report the clinical data of patients who underwent Robotic-assisted Radical Prostatectomy. MATERIAL AND METHODS: We retrospectively analyzed fifteen consecutive patients who underwent RARP with HugoTM RAS System (Medtronic, Minneapolis, USA) from June to October 2021. The patients underwent transperitoneal RARP on lithotomy position, using six trocars (4 robotic trocars and 2 for the assistant). We reported the clinical feasibility and safety of this platform, assessing perioperative data, including complications and early outcomes. Continuous variables were reported as median and interquartile ranges, categorical variables as frequencies and proportions. RESULTS AND LIMITATIONS: All procedures were safe and feasible with no major complications or conversion. Median operative time was 235 minutes (213-271), and median estimated blood loss was 300ml (100-310). Positive surgical margins were reported in 5 patients (33%). The median hospitalization time was 2 days (2-2), and the median time to remove the foley was 7 days (7-7). On the first appointment four weeks after surgery, all patients had undetectable PSA values, and 61% were continent. CONCLUSIONS: We described preliminary results with safe and feasible procedures performed with HugoTM RAS System robotic platform. The surgeries were successfully executed with acceptable perioperative outcomes, without conversions or major complications. However, as this technology is very recent, further studies with a long-term follow-up are awaited to access postoperative functional and oncological outcomes.

Project INSIDE: towards autonomous semi-unstructured human-robot social interaction in autism therapy.

This paper describes the INSIDE system, a networked robot system designed to allow the use of mobile robots as active players in the therapy of children with autism spectrum disorders (ASD). While a significant volume of work has explored the impact of robots in ASD therapy, most such work comprises remotely operated robots and/or well-structured interaction dynamics. In contrast, the INSIDE system allows for complex, semi-unstructured interaction in ASD therapy while featuring a fully autonomous robot. In this paper we describe the hardware and software infrastructure that supports such rich form of interaction, as well as the design methodology that guided the development of the INSIDE system. We also present some results on the use of our system both in pilot and in a long-term study comprising multiple therapy sessions with children at Hospital Garcia de Orta, in Portugal, highlighting the robustness and autonomy of the system as a whole.

Case report: Laparoscopy-assisted urinary undiversion: transforming an ileal conduit into an orthotopic continent neobladder.

PURPOSE: To describe the technique of laparoscopy-assisted undiversion of an ileal conduit into a continent orthotopic ileal neobladder performed on a patient with a previous radical cystoprostatectomy and ileal conduit. CASE REPORT: A 57-year-old man presented with a prolapsed stoma and a history of a right radical nephroureterectomy for grade 3 ureteral transitional-cell carcinoma and a radical cystoprostatectomy and ileal conduit urinary diversion for in-situ bladder carcinoma, performed 12 and 8 years ago, respectively. After the ileal stoma was resected, five trocars were placed transperitoneally. Partial resection of the distal ileal conduit was performed, leaving in place the proximal segment with its left ureteroileal anastomosis. Flexible urethroscopy revealed a contracting external sphincter, and random urethral frozen-section biopsies ruled out tumor. A 45-cm segment of ileum was isolated and exteriorized through the stoma site, and an ileal neobladder was created extracorporeally, suturing the proximal ileal-conduit segment, with its ureteroileal anastomosis, to it. The ileal neobladder was reintroduced into the abdomen and anastomosed laparoscopically to the urethral stump with six 2-0 polyglactin sutures. The total operative time was 7 hours with a blood loss of 100 mL. There were no intraoperative complications. The hospital stay was 7 days. At a follow-up of 24 months, the patient had total daytime continence and normal renal function, and intravenous urography revealed an unobstructed urinary tract. CONCLUSION: Laparoscopy-assisted ileal-conduit undiversion into an orthotopic ileal neobladder is technically feasible. It can be considered an alternative to open surgery for patients who have undergone urinary diversion.

[Chronic pelvic pain as a complication of cystourethropexy with tension free vaginal tape. Case report]. / Dolor pélvico crónico como complicación de la cistouretropexia con malla libre de tensión. Presentación de un caso.

OBJECTIVE: To report an interesting case of a rare complication of cystourethropexy, as well as its precise diagnosis and results after treatment. METHODS: We reviewed the medical records of the patients as well as their operative report and she underwent outpatient follow-up for the following six months. We descriptively report the findings. RESULTS: It is the case of a female patient presenting a foreign body rejection of a suburethral tension free vaginal tape (TVT). She complained of severe pain in the immediate postoperative period, which led to retrieval of the tape in spite of a good continence result. CONCLUSIONS: Foreign body rejection is a rare complication of vaginal tapes; it is rarely taken into account but it should be present in any exclusion diagnosis because the possibility of tape retrieval is not always associated with recurrence of the incontinence.

Case report: laparoscopic management of massive chylous ascites after salvage laparoscopic retroperitoneal lymph-node dissection.

Chylous ascites is an infrequent complication of retroperitoneal surgery. We describe a patient who suffered massive chylous ascites after simultaneous pneumonectomy and laparoscopic excision of a post-chemotherapy tumor mass. After conservative management failed, exploratory laparoscopy identified the site of the leak, which was clipped and closed with fibrin glue. There has been no recurrence in the ensuing 5 years.

Dolor pélvico crónico como complicación de la cistouretropexia con malla libre de tensión. Presentación de un caso / Chronic pelvic pain as a complication of cystourethropexy with tension free vaginal tape. Case report

OBJETIVO: presentar en la comunidad urológica un caso de interés de una complicación poco común de un procedimiento ya muy extendido como es la cistouretropexia, así como su diagnóstico preciso y resultados al tratamiento. MÉTODO: Se revisó la historia clínica de la paciente así como el protocolo quirúrgico y se le dio seguimiento en la consulta externa por los 6 meses siguientes. Se presentan los hallazgos de manera descriptiva. RESULTADOS: Se trata de una paciente que presenta un rechazo a tejido foráneo por una malla libre de tensión suburetral, quien cursa con dolor intenso en el postoperatorio mediato que lleva al retiro de la misma pese a que el resultado de continencia se había logrado. CONCLUSIONES: El recazo a tejido foráneo es una complicación rara de las malas vaginales por lo cual es poco tomada en cuenta, hay que tener presente que es un diagnóstico de exclusión y que la posibilidad de retiro de la misma no en todos los casos conlleva reaparición de la incontinencia

OBJECTIVE: To report an interesting case of a rare complication of cystourethropexy, as well as its precise diagnosis and results after treatment. METHODS: We reviewed the medical records of the patients as well as their operative report and she underwent outpatient follow-up for the following six months. We descriptively report the findings. RESULTS: It is the case of a female patient presenting a foreign body rejection of a suburethral tension free vaginal tape (TVT). She complained of severe pain in the immediate postoperative period, which led to retrieval of the tape in spite of a good continence result. CONCLUSIONS: Foreign body rejection is a rare complication of vaginal tapes; it is rarely taken into account but it should be present in any exclusion diagnosis because the possibility of tape retrieval is not always associated with recurrence of the incontinence

Case report: laparoscopic repair of saccular renal-artery aneurysm.

We report successful laparoscopic repair of a saccular renal-artery aneurysm in a patient with renovascular hypertension. The repair was performed by clamping the renal hilum, excising the aneurysm, and suturing the vascular defect intracorporeally. Postoperative imaging studies confirmed normal arterial flow in the repaired artery.

Does prolonged pneumoperitoneum affect oxidative stress compared with open surgical procedures?

BACKGROUND AND PURPOSE: As laparoscopic surgery has evolved, it has become part of the urologic surgical armamentarium and is now used to perform more complex procedures. Carbon dioxide, used to create pneumoperitoneum, produces physiologic changes in various organs, including the kidneys. Such changes are associated with altered redox status because of the release of free radicals and changes in oxidative stress signals. It is unknown whether prolonged pneumoperitoneum is associated with an increase in oxidative stress compared with open surgery. The objective of this study was to compare oxidative stress in patients undergoing urologic laparoscopic and open operations. PATIENTS AND METHODS: Urine samples were obtained immediately preoperatively, immediately postoperatively, and at 6 and 18 hours after surgery from 10 patients who underwent urologic laparoscopic surgery and 10 patients who underwent open surgery. Concentrations of the oxidative stress marker isoprostane (8- iso-prostaglandin F2a) were measured, and the results were analyzed with respect to clinical factors associated with the type of surgery. RESULTS: Urinary isoprostane concentrations (mean +/- SEM) in the laparoscopic and open groups showed an increase immediately after surgery to 189.0 +/- 64.2% and 141.1 +/- 45.8% of the preoperative values, respectively. A decrease in isoprostane was subsequently observed in both groups at 6 hours postoperatively, with preoperative values restored at 18 hours postoperatively (126.3 +/- 19.7% and 89.5 +/- 55.9% at 6 and 18 hours, respectively, in the laparoscopic group and 130.7 +/- 41.6% and 88.7 +/- 20.4% at 6 and 18 hours, respectively, in the open-surgery group). Although in both groups the peak PGF 2a concentration was observed immediately (0 hours) postoperatively, no significant differences were observed between the groups at 0, 6, and 18 hours. In the laparoscopic-surgery group, the mean increase tended to be higher and the decrease to be less prolonged than in the open-surgery group. CONCLUSION: Oxidative stress, as measured by urinary 8-iso-prostaglandin F2a, is produced by both laparoscopic and open urologic surgery. The findings of our nonrandomized study suggest a pattern of increased oxidative stress postoperatively with either type of surgery, with subsequent return almost to preoperative levels. Prolonged laparoscopic operative time did not affect oxidative stress levels.

Early experience with the laparoscopic boari flap at a single institution.

PURPOSE: We present our initial experience with the laparoscopic Boari flap for long ureteral strictures. MATERIALS AND METHODS: Nine patients underwent a laparoscopic Boari flap procedure at our institution. Eight patients had 4 to 7 cm distal ureteral strictures on excretory urogram and retrograde pyelogram, and 1 had transitional cell carcinoma in the distal right ureter. We analyzed our intraoperative parameters with regard to operative time and intraoperative complications. The operative results assessed were hospital stay, renal function, symptomatic improvement and radiological studies. The patient with ureteral transitional cell carcinoma was excluded from analysis because ureteral stricture etiology differed from that in the other 8. RESULTS: Mean operative time was 156.6 minutes. Mean estimated blood loss was 124 cc. There were no intraoperative complications. Mean hospital stay was 3 days. At a mean followup of 17.6 months all patients were symptom-free and had an unobstructed ureterovesical anastomosis on followup excretory urogram. One surgical postoperative complication resolved laparoscopically. CONCLUSIONS: The laparoscopic Boari flap is a feasible alternative surgical technique in patients with long distal ureteral strictures. Larger series with longer followup are needed to validate these results vs the standard open technique.

Laparoscopic management of symptomatic and large adrenal cysts.

PURPOSE: We present the feasibility and results of the laparoscopic management of symptomatic and large adrenal cysts. MATERIALS AND METHODS: From June 1993 to April 2004 we performed 149 laparoscopic adrenalectomies. In this series 8 patients with symptomatic adrenal cysts or pseudocysts were treated laparoscopically. Surgical indications for laparoscopic management of adrenal cysts were abdominal pain in 5 cases and cyst size 5 cm or greater in 3. RESULTS: The incidence of adrenal cyst was 5.4% (8 of 149 cases). Six patients underwent laparoscopic adrenal cyst decortication and marsupialization, 1 underwent laparoscopic partial adrenalectomy and 1 underwent laparoscopic adrenalectomy. Mean operative time was 77.5 minutes. There were no intraoperative or postoperative complications. Mean hospital stay was 1.7 days. At a mean followup of 18.5 months all patients were asymptomatic and without radiographic evidence of cyst recurrence. CONCLUSIONS: Laparoscopic conservative management of adrenal cysts is safe and feasible. Laparoscopic decortication and marsupialization should be the preferred treatment option for symptomatic adrenal cysts. Laparoscopic partial adrenalectomy or a total adrenalectomy can be performed in cases of larger cysts which compromise most of the adrenal gland. To our knowledge, this represents the largest series of symptomatic adrenal cysts managed laparoscopically.

Uréter ileal revisitado / Ileal ureter revisited

Introducción: El reemplazo del uréter por un asa desfuncionalizada de íleon fue reportado por primera vez hace más de cien años. En las últimas décadas sus indicaciones y el conocimiento de las técnicas para su utilización se han ampliado enormemente. Material y Método: Se efectúa una revisión de las indicaciones, técnica quirúrgica complicaciones del uréter ileal, a partir del reporte de tres casos clínicos de uso de un segmento de íleon como reemplazo ureteral. Resultados: Entre el año 2001 y 2003, tres pacientes (promedio 28 años de edad) recibieron un segmento de íleon como subtitulo de un uréter severamente dañado. Durante el período de seguimiento (promedio 22 meses) no se objetivaron complicaciones graves derivadas del procedimiento, la necesidad de realizar una nueva diversión urinaria, evidencia de deterioro renal o mortalidad. Conclusiones: El intestino constituye un recurso indiscutible al que puede recurrir el urólogo en su práctica quirúrgica reconstructiva. El uso de un segmento desfuncionalizado de íleon como reemplazo de un uréter dañado, proporciona una alternativa terapéutica segura y reproducible, de proveer el riñón de un drenaje a baja presión, no obstructivo, que preserve la función renal.

Donor nephrectomy in the era of hand-assisted laparoscopic urologic surgery.

Living-donor nephrectomy has traditionally been performed through a flank incision with or without rib resection or by an anterior extraperitoneal incision, both of which reduce the willingness of potential donors to undergo the procedure. The first successful human laparoscopic donor nephrectomy was reported in 1995. In order to reduce warm ischemia and operative time and to make the operation safer and easier, some laparoscopic surgeons have used hand assistance. The authors describe their technique for this operation and review the results.

Retrograde ureteroscopic endopyelotomy.

Several different procedures can be used to treat UPJ obstruction. Retrograde ureteroscopic endopyelotomy provides a safe and adequate first line of treatment for this condition. With the advent of smaller ureteroscopes and ancillary devices, this technique has evolved to include children. Adherence to strict endourologic principles and direct visualization make retrograde ureteroscopic endopyelotomy a safe and effective treatment modality. This procedure represents an extension of the basic endoscopic skills of the urologist, creating a short learning curve and wide margin of safety.

Laparoscopic partial nephrectomy of solid renal masses without hilar clamping using a monopolar radio frequency device.

PURPOSE: Partial nephrectomy is currently recommended for most amenable solid renal tumors, especially if they are exophytic and less than 4 cm. We reviewed our initial experience with laparoscopic partial nephrectomy for solid renal masses without clamping the renal vasculature using a monopolar device that uses radio frequency energy with low volume saline irrigation for simultaneous blunt dissection, hemostatic sealing and coagulation of the renal parenchyma (TissueLink, TissueLink Medical, Inc., Dover, New Hampshire). MATERIALS AND METHODS: From September 2002 to April 2003, 10 patients underwent transperitoneal laparoscopic partial nephrectomy, including 9 with solid renal masses and 1 with a complex cyst. In all cases the renal hilum was dissected and the renal vessels were isolated but none had renal vascular clamping. The TissueLink DS dissecting sealer or Floating Ball (TissueLink Medical, Inc.) was used to dissect the tumor free bluntly, while simultaneously sealing and coagulating bleeders. RESULTS: Mean patient age was 54.6 years (range 42 to 72). Mean American Society of Anesthesiologists score was 2.3 (range 2 to 4). Mean tumor size was 3.9 cm (range 2.1 to 8). The mass had a peripheral location in 7 cases and a central location in 3. Mean operative time was 232 minutes (range 144 to 280) and mean blood loss was 352 ml (range 20 to 1000). One patient received blood transfusion and all tumor margins were negative. Mean hospital stay was 1.7 days (range 1 to 5) and pain medication use was minimal. One patient had a brief period of urine leakage from the lower pole calix, which was managed successfully by ureteral stenting and Foley catheter drainage of the bladder. CONCLUSIONS: Laparoscopic partial nephrectomy can be performed without renal vascular clamping. TissueLink technology allows complete tumor resection and provides adequate parenchymal hemostasis of the tumor bed. Its scant tissue charring production does not interfere with the pathological assessment of the tumor margin status.