How i do it: Robot-assisted transcerebellar stereotactic approach for brainstem lesion.

BACKGROUND: Stereotactic approaches to diffuse intrinsic pontine gliomas (DIPGs) remain essential due to advances in molecular biology and management, necessitating tissue sampling. Here we present an effective technique with a biopsy by robot-assisted transcerebellar approach. METHOD: Our procedure was performed using the ROSA robotic system and the OARM CT scan, which provided stereotactic conditions for this transcerebellar approach to brainstem lesions. CONCLUSION: The robot-assisted transcerebellar stereotactic approach remains essential to provide complications for biopsy of brainstem lesions.

Comparative analysis of safety and effectiveness between natural orifice specimen extraction and conventional transabdominal specimen extraction in robot-assisted colorectal cancer resection through systematic review and meta-analysis.

The goal of this systematic review and meta-analysis is to evaluate the perioperative and oncologic results of natural orifice specimen extraction (NOSE) compared to conventional transabdominal specimen extraction (TASE) in robotic-assisted surgery for colorectal cancer. A comprehensive electronic search will be performed on PubMed, Embase, and the Cochrane Library to find research articles published from the beginning of the databases to July 2024 that focus on patients who have undergone robotic-assisted surgery for colorectal cancer. Specifically, this review will compare NOSE with conventional TASE. Only studies published in English will be considered. Literature screening will adhere closely to predetermined criteria for inclusion and exclusion, specifically targeting randomized controlled trials and cohort studies. The evaluation of quality will involve the use of the Newcastle-Ottawa Scale (NOS). Meta-analysis of the included studies' data will be performed using Review Manager 5.4.1. In the final analysis, 9 retrospective cohort studies comprising 1571 patients were included. Out of these, 732 patients opted for NOSE, while 839 patients chose conventional TASE in robotic colorectal surgery. Patients who received TASE experienced enhancements in hospital stay duration, time until first gas passage, wound infection rates, and time until the first intake of a liquid diet. Nevertheless, there were no notable distinctions noted between the two methods regarding surgery duration, projected blood loss, intestinal blockage, or frequency of anastomotic leakage. In patients undergoing robotic-assisted colorectal surgery, the safety and feasibility of NOSE are demonstrated. Compared to traditional TASE, it provides clear benefits including shorter hospital stays, earlier first flatus, quicker initiation of a liquid diet, and lower risk of wound infection.

Scheduled intravenous ketorolac is safe and reduces narcotic use after robotic-assisted simple prostatectomy.

We sought to examine whether scheduled intravenous (IV) ketorolac decreased post-operative narcotic utilization and changed peri-operative outcomes (including complications) in patients undergoing robotic-assisted simple prostatectomy (RASP). An IRB-approved, retrospective chart review was performed of all patients undergoing RASP at a single institution from November 2017 to July 2019. Patient demographic, peri-operative, and post-operative data, including morphine equivalent use (MEU), were collected. Scheduled ketorolac use was implemented at the surgeon's discretion for up to 5 days post-operatively. The primary outcome was MEU in the post-operative stay. Two hundred seven men underwent RASP during the study period, of which 143 (69%) received scheduled ketorolac. No differences in patient demographics, prostate size, prior opioid utilization, or operative characteristics were identified between groups. Median MEU was significant less (5 vs 15, p < 0.001) in patients receiving scheduled ketorolac. Significantly more patients receiving scheduled ketorolac did not require the use of any narcotic during hospitalization (30% vs 11%, p = 0.005). On multivariable linear regression adjusted for age, BMI, prior opioid use, and length of stay, ketorolac use independently associated with decreased narcotic use (p = 0.003). No significant difference in transfusion rates were identified (3.5% vs. 1.6%, p = 0.44). Scheduled ketorolac is effective in reducing post-operative, in-hospital opioid utilization without increasing morbidity after RASP. Almost a third of patients on scheduled ketorolac did not require any opioids post-operatively.

Implementation and Utility of the Da Vinci SP (Single Port) in Pediatric Urology.

PURPOSE OF REVIEW: Detail the evolution, utility, and future directions of the da Vinci SP® in pediatric urology, focusing on perioperative outcomes and intraoperative details. RECENT FINDINGS: The SP has been safely and successfully utilized in various pediatric urological procedures, from pyeloplasty to nephroureterectomy to appendicovesicostomy. Reports indicate mixed operative times but similar hospital stays and postoperative outcomes compared to multiport (MP) robotic surgery. The learning curve for transitioning from MP to SP systems in pediatric patients appears manageable, though the smaller abdominal circumference in children poses a notable challenge. This review assumes that SP systems will primarily be acquired for adult services, not considering initial and ongoing costs to hospital systems. The SP serves as a complementary option, rather than a replacement, for MP robotic surgery in pediatric urology, offering potential advantages in specific scenarios. Cosmetic outcomes with the SP appear at least as favorable as MP surgery, but further research is needed. Future research should focus on patient-centered outcomes to optimize SP robotic surgery use in pediatric patients.

Tubeless ureteroenteric anastomosis in robot-assisted radical cystectomy with intracorporeal urinary diversion does not increase the risk of anastomotic stenosis or postoperative complications.

The objective is to demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis, and in the second cohort, stenting was omitted. Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regard to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference, and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between the cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion does not appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted.

Intraoperative Navigation in Reverse Shoulder Arthroplasty: Advantages and Future Prospects.

Intraoperative navigation is a novel technology that can provide real-time feedback to the surgeon during implantation and enhance the accuracy and precision of glenoid component positioning. Applications of intraoperative navigation systems have demonstrated increased precision in baseplate version and inclination, as well as improved baseplate screw placement, with fewer screws used and greater purchase length achieved when compared to standard instrumentation. Early clinical studies have shown favorable results, with significantly improved patient-reported and clinical outcomes and decreased complications. The implementation of intraoperative navigation is associated with a short learning curve and a minimal increase in operative time. Nevertheless, further research is necessary to substantiate the clinical benefit of navigation and evaluate its economic cost-effectiveness and impact on implant survival. Augmented reality and robotic-assisted surgery are additional emerging technologies that, while novel, hold the potential to further advance the field of shoulder arthroplasty.

Are all robotic technologies created equal? Comparing one of the latest image-free robotic technologies to all other robotic systems for total knee arthroplasty.

BACKGROUND: Robotic-assisted technologies have been developed to increase surgical precision and reduce surgical variability in total knee arthroplasty (TKA). Several different robotic systems have been introduced in the last decade for TKA. The DePuy Synthes VELYS™ Robotic-Assisted Solution (VRAS) is an imageless system designed to eliminate the need for preoperative CT scans and is one of the latest entrants in the rapidly evolving field of robotic technology in TKA. This study compared the clinical and economic outcomes associated with VRAS and other robotic-assisted technologies for primary TKA. METHODS: A retrospective cohort study using the Premier Healthcare Database included patients who underwent primary TKA with VRAS or other robotic-assisted technologies from January 1, 2022, to April 30, 2023. The primary outcome for the study was hospital follow-up visits (revisits) within 90 days post-TKA. Secondary outcomes included readmission and revision rates within 90 days post-TKA, operating room time, length of stay, discharge status and hospital costs. Cohorts were balanced using propensity score fine stratification, and generalized linear models were constructed to evaluate outcomes. RESULTS: This study included 827 VRAS TKA patients and 16,428 TKA patients treated with other robotic-assisted technologies. The 90-day all-cause and knee-related revisit rates were significantly lower for VRAS than for other robotic-assisted technologies (all-cause 13.9% vs. 22.8% and knee-related 2.8% vs. 5.4%, respectively; p value < 0.01). The all-cause and knee-related 90-day readmission rates were also lower for VRAS, although the differences were not statistically significant. The 90-day revision rates were similar for VRAS and other robotic-assisted technologies (0.48% vs. 0.45%), as was the operating room time (138 vs. 137 min). The 90-day knee-related cost for the VRAS cohort was $15,048 compared to $16,867 for other robotic technologies. CONCLUSIONS: This database study demonstrated that early postoperative revisit rates and total cost of care are lower for VRAS than for all other robotic-assisted technologies for TKA, while operating room time and discharge status were similar. These are important findings in ever-evolving healthcare systems that are increasingly cost conscious and cognizant of principles associated with value-based care.

Robotic assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomised controlled trials.

The aim of this study is To compare robotic-assisted and conventional total knee arthroplasty (TKA) on both short- and long-term outcomes A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, Scopus, and Web of Science databases were searched for relevant studies. The studies included were randomised controlled trials directly comparing robotic-assisted versus conventional TKA. The outcomes were pooled as mean difference (MD) or risk ratio (RR), with 95% confidence interval. RevMan software version 5.4 was used for performing the statistical analysis. Nine studies deemed eligible for inclusion. The data showed a significant favouring of robotic-assisted than the conventional TKA in mechanical alignment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and femoral coronal plane outliers (MD = - 1.10, 95% CI [- 1.51, - 0.69], p < 0.00001), (MD = - 1.19, 95% CI [- 2.35, - 0.03], p = 0.04), and (RR = 0.49, 95% CI [0.30, 0.80], p = 0.004), respectively. On the other hand, conventional TKA was better in range of motion-flexion (long-term) than the robotic-assisted one (MD = - 3.02, 95% CI [- 3.68, - 2.37], p < 0.00001). There were no significant differences between them in knee society score-knee score, knee society score-function score, change in hospital for special surgery (HSS) knee rating scale, and change in range of motion-extension (MD = - 0.36, 95% CI [- 2.43, 1.70], p = 0.73), (MD = - 0.34, 95% CI [- 2.36, 1.68], p = 0.74), (MD = 0.78, 95% CI [- 0.84, 2.40], p = 0.34), and (MD = 0.16, 95% [- 1.32, 1.64], p = 0.83), respectively. Robotic-assisted TKA demonstrated better outcomes than conventional TKA in terms of mechanical alignment and WOMAC scores. However, the conventional TKA showed a better range of motion-flexion in the long term. More data are needed to assess long-term outcomes comprehensively.

Closed-chest robotic mitral repair using a semi-rigid ring inserted through a trocar.

There are several types of annuloplasty devices for mitral repair. We present a totally-thoracoscopic robotic mitral repair using a new semi-rigid ring with a nitinol core that makes it malleable so that it can be inserted through a trocar. This technique combines the advantages of semi-rigid rings and a totally-thoracoscopic approach, which may further expand this approach to other aetiologies.

Robotic Partial Nephrectomy for Treating Renal Masses: Outcomes and Complications.

INTRODUCTION: Partial nephrectomy is the preferred treatment for renal tumors <7 cm. Robot-assisted laparoscopic approach is a minimally invasive method that offers advantages for resecting complex tumors. Here, we conducted a descriptive retrospective analysis of the first robotic partial nephrectomies (RPNs) performed at our center. MATERIALS AND METHODS: A retrospective cohort of 94 patients who consecutively underwent RPN at our center between November 2012 and December 2022 was investigated. Baseline patient data, tumor characteristics, intraoperative variables, pathological tumor analysis, and postoperative complications at 30 days were analyzed. RESULTS: The patients were followed up for a median of 25.3 months. Baseline values included a median age of 63 years and a median body mass index (BMI) of 28.1. Intraoperative variables comprised a median surgical time of 150 min and a median warm ischemia time of 16 min. The mean postoperative creatinine level was 1 mg/dL. The median tumor size was 41.9 mm, with a median PADUA score of 8 and a median RENAL score of 8. Resected tumors were predominantly cT1a (58.5%) and cT1b (39.3%), while the positive margin rate was 21.3%. A total of 19.2% of the patients experienced Clavien-Dindo complications, of which 11% were Clavien-Dindo I; 66.7%, Clavien-Dindo II; And 22.2%, Clavien-Dindo IIIb. However, no Clavien-Dindo IIIa or IV complications were reported. CONCLUSIONS: RPN is an effective and safe technique for treating solid renal masses, demonstrating a low complication rate and adequate oncologic control locally and distally.

[Transoral robotic surgery in pharyngolaryngeal surgery].

The rise of minimally invasive surgery and the concept of rapid recovery have led to transoral surgery becoming increasingly vital in pharyngolaryngeal surgery. In 2009, the U. S. Food and Drug Administration approved the use of the da Vinci Surgical Robot for transoral robotic surgery（TORS）. Due to its high-definition lens and flexible, precise operation, TORS is rapidly gaining popularity worldwide and expanding its indications. Although some experts in China have attempted to apply TORS to treat pharyngolaryngeal diseases, compared to European and American countries, TORS in China is still in its exploratory stage. This paper briefly reviews the application of TORS in pharyngolaryngeal surgery.

Intravenous indocyanine green to evaluate distal ureteral vascularity during robot-assisted radical cystectomy with intracorporeal urinary diversion.

PURPOSE: The aim of the present study is to assess the role of indocyanine green (ICG) to evaluate distal ureteral vascularity during robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion and its impact on the incidence of benign ureteroenteric strictures (UES). METHODS: The study included patients who underwent RARC for bladder cancer between 2018 and 2023. All patients included underwent intracorporeal urinary diversion with ileal conduit or neobladder. Bricker technique was performed in all ureteroenteric anastomosis. ICG was employed during the study period to evaluate ureteral vascularity. We divided patients into 2 groups depending on the utilization of ICG during surgery and compared demographic, clinicopathological and perioperative outcomes, including benign UES rates. RESULTS: We identified 221 patients that underwent RARC with intracorporeal urinary diversion. Ileal conduit was performed in 173 (78.3%) patients and neobladder in 48 (21.7%) cases. A total of 142 (64.3%) and 79 (35.7%) patients were in the non-ICG and ICG group, respectively. With a median follow-up of the entire cohort of 21.1 months, there were no differences in the rate of benign UES after RARC between the non-ICG and the ICG group (p = 0.901). In the non-ICG group, 26 (18.3%) patients developed benign UES and in the ICG group 15 (19.0%) patients. Most of the strictures appeared in the left ureter in both groups (80.8% non-ICG vs. 66.7% ICG, p = 0.599). Median time to stricture diagnosis was 4 months (IQR 3-7.25) for the non-ICG and 3 months (IQR 2-5) for the ICG group (p = 0.091). The ICG group had a slightly greater length of ureter resected compared with the non-ICG group (1.5 vs. 1.3 cm, p = 0.007). CONCLUSION: In our experience, choosing to use ICG intraoperatively to evaluate distal ureteral vascularity may not reduce the rate of benign UES after robot-assisted radical cystectomy with intracorporeal urinary diversion and Bricker ureteroileal anastomosis.

A systematic review of robot-assisted simple prostatectomy outcomes by prostate volume.

PURPOSE: The aim of our study is to assess the differences in functional outcomes during the perioperative and postoperative period after RASP depending on BPH volume. METHODS: We searched 2 databases: MEDLINE (PubMed) and Google Scholar using the following search query: robot* AND "simple prostatectomy". The search strategy and review protocol are available at Prospero (CRD42024508071). RESULTS: We included 25 articles published between 2008 and 2023. Preoperatively, patients with prostate size < 100 cm3 had more severe symptoms while postoperatively all of them had only mild lower urinary tract symptoms (LUTS). In larger BPH, two authors reported moderate LUTS after RASP: Fuschi [1] (mean IPSS 8.09 ± 2.41) and Stolzenburg [2] (mean IPSS 8 ± 2.7). Postoperative Qmax was also noticeably higher in smaller BPH (mean value range 28.5-55.5 ml/s) compared to larger BPH (mean Qmax 18-29.6 ml/s), although in both groups it was within the normal range. Postoperative post-void residual (PVR) was normal as well except in one study by Stolzenburg et al. [2]. Blood loss was comparable between the groups. The complications rate in general was low. CONCLUSION: RASP is effective in terms of subjective and objective urination indicators, and a safe procedure for BPH. In the lack of data on implementation of RASP in small prostate volumes, this procedure can be seen as an upper size «limitless¼ treatment alternative. Currently, comparative data regarding prostate volume is lacking, and future trials with subgroups analysis related to BPH volume might help to address this issue.

Robotic-assisted total hip arthroplasty outperforms manual technique in obese and overweight patients: a prospective comparative study.

BACKGROUND: With the increasing prevalence of obesity, there is growing awareness of the impact of overweight and obesity on total hip arthroplasty (THA). Research exploring the accuracy of acetabular component orientation in THA between robotic-assisted and manual techniques across different BMI categories is insufficient. METHODS: This prospective study evaluated 221 patients who underwent THA with a Robotic Interactive Orthopaedic Arm system and 252 patients who underwent manual THA between March 2022 and January 2024. The patients were divided into four groups according to their BMI. We analysed whether there were differences in the accuracy of acetabular component positioning between robotic-assisted THA and manual THA across different BMI categories. RESULTS: In the overweight group, robotic-assisted THA achieved a significantly higher rate of abductions within the target range (73/6) than manual THA (62/28) (p = 0.000). Both abductions and anteversions within the target range were also significantly more frequent in the robotic-assisted THA group (69/10) than in the manual THA group (56/34) (p = 0.000). Among the obese patients, robotic-assisted THA showed a perfect record for anteversions within the target range (29/0), markedly outperforming manual THA (39/6) (p = 0.040). CONCLUSION: In the overweight (24 kg/m² ≤ BMI < 28 kg/m²) and obese (BMI ≥ 28 kg/m²) groups, robotic-assisted THA demonstrates significantly greater accuracy in acetabular component positioning compared to manual THA. This indicates that robotic-assisted technology may provide a more precise positioning of the acetabular component in overweight and obese patients.

Open thoracotomy versus VATS versus RATS for segmentectomy: a systematic review & Bayesian network meta-analysis.

BACKGROUND: Recent trials suggest that more conservative resections such as segmentectomy are non-inferior to more radical approaches. Most segmentectomy can be safely performed using video-assisted thoracoscopic surgery (VATS). The clinical benefits of robotic-assisted thoracoscopic surgery (RATS) remain unclear. We aimed to perform a systematic review evaluating the outcome of open thoracotomy, VATS, and RATS for segmentectomy. METHODS: A systematic database search was conducted of original articles exploring the outcome of open versus VATS versus RATS segmentectomy in PubMed, EMBASE and SCOPUS. The primary outcome was 30-day mortality. Secondary outcomes were hospital readmission, air leak, and post-operative pneumonia respectively. RESULTS: 11 studies were included with a total patient sample size of 7280. There were no differences between the three approaches in terms of 30-day mortality, hospital readmission, air leak, and post-operative pneumonia. CONCLUSION: There are no significant differences between the three approaches in the clinical outcomes measured. While our analysis demonstrates the potential benefits of RATS, it is important to note that the steep learning curve associated with this technique may impact its wider adoption and efficacy in the community. Further randomised control studies are required to compare the short and long terms results of VATS and RATS approaches.

A clinical study on robot navigationassisted intramedullary nail treatment for humeral shaft fractures.

BACKGROUND: The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it's efficacy with that of traditional surgical intramedullary nail treatment. MATERIALS AND METHODS: This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant-Murley score) between the two groups of patients. RESULTS: There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001). CONCLUSION: Robot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes.

Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single center experience.

PURPOSE: The aim of the study was to compare the perioperative outcomes of patients affected by inflammatory bowel disease (IBD) who underwent surgery performed through laparoscopy or using the Medtronic Hugo™ RAS. METHODS: This is a retrospective study from a prospectively maintained database comparing laparoscopic vs. robotic-assisted surgery for IBD from 01/11/2017 to 15/04/2024. All procedures were performed by a single surgeon robotic-naïve with a large experience in laparoscopic surgery for IBD. The robotic procedures were performed using the Medtronic Hugo™ RAS platform. Outcomes were 30-day postoperative complications, operative time, conversion rate, intraoperative complications, length of hospital stay, and readmission rate. RESULTS: Among 121 consecutive patients, 80 underwent laparoscopic (LG) and 41 robotic-assisted surgery (RG). Baseline, preoperative and disease-specific characteristics were comparable except for older age (50 [38-56] vs. 38 [28-54] years; p = 0.05) and higher albumin level (42 [40-44] vs. 40 [38-42] g/L, p = 0.006) in the RG. The intracorporeal anastomosis was more frequent in the RG (80% vs. 6%; p < 0.001) with longer operative time (240 vs. 205 min; p = 0.006), while the conversion rate was not different (5% vs. 10%, p = 0.49). Surgical procedure types were equally distributed between the two groups, and the rate of intra-abdominal septic complication (IASC) was comparable across the different procedures. Postoperative complications were similar, including the rate of IASC (5% vs. 5%, p = 1), postoperative ileus (5% vs. 7.5%, p = 0.71), bleeding (2% vs. 5%, p = 0.66), and Clavien-Dindo > 2 complications (7% vs. 6%; p = 1). CONCLUSION: IBD surgery performed using the Medtronic Hugo™ RAS is safe and feasible, with similar postoperative outcomes when compared to the laparoscopic approach.

Robotic assisted simple prostatectomy mitigates perioperative morbidity compared to open simple prostatectomy - a single institution report.

BACKGROUND: According to the guidelines of the European Association of Urology, open simple prostatectomy should be offered to men with a prostate size exceeding 80 mL suffering from moderate to severe LUTS in the absence of a transurethral enucleation technique. However, open simple prostatectomy is associated with complications such as bleeding, blood transfusions and increased length of stay compared to minimally invasive procedures. The aim of the study was to compare perioperative data from the first cases of robotic assisted simple prostatectomy (RASP) to that of patients subjected to open simple prostatectomy (OSP) at our department. METHODS: The patients were identified by a search for the respective procedure codes. In the OSP group enucleation of the adenoma was performed through the prostatic capsule (Millin procedure), while access to the adenoma was gained through the bladder in the RASP group. Complications were scored according to the Clavien-Dindo classification system. RESULTS: 27 patients who underwent OSP were retrospectively identified and compared to the first 26 patients who were subjected to RASP. The groups were similar with respect to age, body mass index and ASA score. Operative time was significantly shorter in the OSP group compared to the RASP group. Bleeding volume, drop in postoperative hemoglobin and the number of blood transfusions were all significantly higher in the OSP group compared to the RASP group. Average length of stay was 5.5 (2-18) days in the OSP group compared to 1.6 (1-5) days in the RASP group (p < 0.001). The number of postoperative complications, Clavien-Dindo ≥ 2, were significantly higher in the OSP group (11) compared to the RASP group (none, p < 0.001). CONCLUSIONS: The introduction of robotic assisted simple prostatectomy reduced perioperative morbidity at our department.

Robotic-assisted laparoscopic modified ureteroplasty using lingual mucosa grafts or appendiceal flaps for the management of complex ureteral strictures: a retrospective cohort study.

OBJECTIVE: To evaluate the feasibility, safety and efficacy of robot-assisted laparoscopic modified ureteroplasty using a lingual mucosa graft (LMG) or an appendiceal flap (AF) for complex ureteral strictures and summarize our experience. METHODS: A total of 16 patients with complex ureteral strictures (range: 1.5-5 cm) who underwent robotic-assisted laparoscopic-modified ureteroplasty and were admitted to our hospital from May 2022-October 2023 were retrospectively analyzed. We used modified presuture methods in patients who needed the posteriorly augmented anastomotic technique to reduce anastomotic tension. Perioperative variables and outcomes were recorded for each patient. RESULTS: The operation under robot-assisted laparoscopy was successfully performed in all sixteen patients (12 with LMG ureteroplasty and 4 with AF ureteroplasty) without conversion to open surgery. The mean length of the ureteral structure was 2.90 ± 0.90 cm (range: 1.5-5 cm), the mean operation duration was 209.69 ± 26.74 min (range: 170-255 min), the median estimated blood loss was 75 (62.5) ml (range: 50-200 ml), and the duration of postoperative hospitalization was 10.44 ± 2.10 d (range: 7-14 d). The follow-up time in this group was 6 ~ 21 months. The success rate of the surgery was 100%. CONCLUSION: Robot-assisted laparoscopic modified ureteroplasty using AF or LMG is a safe and feasible operation for complex ureteral strictures and deserves to be popularized.