Robotic-assisted laparoscopy living donor nephrectomy: Technique and results of a monocentric retrospective series.

INTRODUCTION: Robot-assisted nephrectomy for living kidney donation (LKD) has been described in the literature as a safe and reproducible technique in high volume centers with extensive robotic surgery experience. Any surgical procedure in a healthy individual ought to be safe in regards to complications. The objective of this study was to evaluate the Robotic-assisted Living Donor Nephrectomy (RLDN) experience in a robotic surgery expert center. METHODS: This is a retrospective study from 11/2011 and 12/2019. In total, 118 consecutive Living Donor (LD) kidney transplants were performed at our institution. All the procedures were performed by robotic-assisted laparoscopic approach. Extraction was performed by iliac (IE), vaginal (VE) or umbilical extraction (UE). The left kidney was preferred even if the vascular anatomy was not modal. RESULTS: For donors: the median operative time was 120min with 50mL of blood loss. The median warm ischemia time was 4min, with a non-significant shorter duration with the UE (4min) in comparison with IE or VE (5min). Nine patients had postoperative complications including 1 grade II (blood transfusion) and 1 grade IIIb (vaginal bleeding after VE). None of our procedures were converted to open surgeries and no deaths were reported. For the recipients: 1.7% presented delayed graft function; their median GFR at 1 year was 61mL/min/1.73m2. CONCLUSION: RLDN in an expert center appears to be a safe technique. The advantages of the robot device in terms of ergonomy don't hamper the surgical outcomes. Donor, recipient and graft survivals seem comparable to the reported laparoscopic outcomes in the literature.

[Robotic-assisted laparoscopic implantation of artificial urinary sphincter AMS 800® in woman: Single center experience]. / Implantation du sphincter artificiel AMS 800® chez la femme par cœlioscopie robot-assistée : expérience monocentrique.

INTRODUCTION: Artificial urinary sphincter (AUS) is the treatment of last resort of stress urinary incontinence (UI) due to intrinsic sphincter deficiency (IS). The implantation procedure has been described by open surgery and laparoscopy with a significative rate of complication by Lucas et al. (2012) and Costa et al. (2001). We report our experience of implantation of SUA by robotic-assisted laparoscopy (R-SUA) in 17 patients among 3 revisions. MATERIAL AND METHODS: Between 2012 and 2017, 17 patients have been consecutively included. The surgical technique was described by Fournier et al. The continence was defined by the absence of urine leakage. RESULTS: The median age at implantation was 66,8±7 years, in the primo-implantation (PI) group, one patient had a neurological acontractile bladder, and bladder was open in 11 patients (78,6%) to ensure the bladder neck dissection. In the revision group (R) 3 patients had a complete replacement of SUA for mechanical failure. One vaginal bound was reported, but did not compromise the implantation, and the survival of SUA. Duration of intervention, size of cuff, postoperative catheterization and hospitalization time were respectively 205±34 and 112±8min; 7,7±0.9 and 5.2±0.8cm; 5.9±2.1 and 4.3±4 days; 6.6±1.5 and 7±3.6 days for PI and R groups. At the end of a mean follow-up of 24.6±18.4 and 59±5 months, continence was respectively 86% and 100%, for the PI and R groups. CONCLUSION: The implantation of R-SUA was feasible and safe with encouraging results. Other studies must evaluate the place of R-SUA among the different enabled surgical techniques. LEVEL OF EVIDENCE: 4.

[Robotic surgery in endometrial cancer: Feasibility in obese patients]. / Chirurgie robotique du cancer de l'endomètre chez la patiente obèse.

OBJECTIVE: Minimally invasive surgery is a technique frequently used in gynecologic surgery. The robot-assisted surgery is a recent approach, and the benefits are not yet proven. The objective of this study was to evaluate the feasibility to use robot-assisted surgery for obese patient with endometrial cancer. METHODS: All patients undergoing a robotic surgery for uterus malignant indication between March 2013 and May 2016 in our center were retrospectively included. Patients were divided in two groups, according to their body mass index (BMI). The group with BMI<30kg/m2 was the reference for this comparative study. The main criteria was the robot operative time. The other criteria were total operating time, hospital stay and intraoperative and postoperative complications. RESULTS: Seventy-seven patients met inclusion criteria for analysis. The median robot operative time was 110minutes for all patients [21-341], without difference between the five groups (P=0.60). There was no difference for the total operative time (P=0.50). The median hospital stay was 3 days (P=0.92). There were ten intraoperative complications. One patient had a conversion (1.3%). There was no statistical difference for postoperative complications (P=1). CONCLUSION: Our study found few differences in the surgical management by laparoscopic robot-assisted between obese and non obese women. Robot-assisted surgery seems to be feasible for uterine cancer treatment of obese patients. Prospective and randomized studies are needed to assess the benefit of the robotic surgery.

[Robotic-assisted laparoscopy for deep infiltrating endometriosis: the Register of the Society of European Robotic Gynaecological Surgery]. / Place de la robotique dans l'endométriose pelvienne profonde : à propos du registre de la SERGS.

OBJECTIVES: To assess the interest of robotic-assisted laparoscopy in the context of deep infiltrating endometriosis and to investigate perioperative results. PATIENTS AND METHODS: From November 2008 to April 2012, 164 women with stage IV endometriosis who underwent robotic-assisted laparoscopy (DA VINCI Intuitive Surgical System(®)) were included by eight international participating clinical centers. Patients were divided in 4 groups according to the localization of the nodule(s): rectum (n=88), bladder (n=23), ureter and uterosacral ligaments (n=115) et hysterectomy (n=28). We evaluated the procedures performed, the duration of intervention, the complications, the recurrence and the impact on fertility. RESULTS: In the rectum group, there was a laparotomy conversion, 2 sutured rectal injuries and a red cells blood transfusion. In the bladder group, there was a vesicovaginal hematoma and a prolongated intermittent self-catheterization. In the ureter and uterosacral ligaments group, there was 2 ureteral fistulas and there was no complication in the hysterectomy group. DISCUSSION AND CONCLUSION: This study is the largest series published in the literature on robotic-assisted laparoscopy for deep infiltrating endometriosis. The interest of robotic-assisted laparoscopy in deep infiltrating endometriosis seems to be promising while no increase in surgical time, blood loss, and intra- and postoperative complications were observed.