Minimizing minimally invasive surgery: Current status of the single-port robotic surgery in Urology.

BACKGROUND: The novel da Vinci Single-Port (SP) robotic platform received the US FDA approval in 2018. The device, specifically conceived for single-site approach, is pushing through the limits of minimally invasive surgery. We sought to provide a comprehensive overview of the current status of the clinical experiences accomplished by the da Vinci SP in urology, and to discuss future perspectives. METHODS: A non-systematic literature review was performed focusing on single port articles in urological surgery using Medline/PubMed and Embase search electronic engines. The authors analyzed findings and a brief report of the clinical experience for surgical procedures completed by the SP platform was described. RESULTS: The current data available from single-port robotic established the safety and feasibility of urologic procedures using this novel platform. However, the results come from single-center case series, small cohorts and retrospective studies that need to be cautiously interpreted. Additional evidence is required to determine the asset of the SP platform in the urological community. CONCLUSIONS: The SP robotic system opens new frontiers on the surgical scenery facilitating the completion of urological surgeries through a single incision. Further comparative studies will be required to assess perioperative and long-term oncological and functional outcomes among SP, multi-arm robotic and open approaches.

Minimizando la cirugía mínimamente invasiva: estado actual de la cirugía robótica de puerto único en Urología / Minimizing minimally invasive surgery: Current status of the single-port robotic surgery in Urology

Antecedentes: La novedosa plataforma robótica da Vinci Single-Port (single port [SP]=puerto único [PU]) recibió la aprobación de la FDA en 2018. El equipo, concebido específicamente para el acceso por un solo puerto, está superando los límites de la cirugía mínimamente invasiva. Buscamos proporcionar una visión global del estado actual de las experiencias clínicas logradas por el PU da Vinci en Urología y discutir las perspectivas futuras.MétodosSe realizó una revisión bibliográfica no sistemática centrada en artículos de cirugía urológica de puerto único utilizando los motores de búsqueda Medline/PubMed y Embase. Los autores analizaron los hallazgos y se describió un breve informe de la experiencia clínica de los procedimientos quirúrgicos llevados a cabo mediante la plataforma PU.ResultadosLos datos actuales disponibles de la cirugía robótica de puerto único han establecido la seguridad y la viabilidad de los procedimientos urológicos que utilizan esta novedosa plataforma. Sin embargo, los resultados provienen de series de casos de un solo centro, cohortes pequeñas y estudios retrospectivos que deben ser interpretados con cautela. Se necesitan estudios adicionales para determinar el valor de la plataforma de PU en la comunidad urológica.ConclusionesEl sistema robótico de PU abre nuevas fronteras en el escenario quirúrgico facilitando la realización de cirugías urológicas a través de una única incisión. Se necesitarán más estudios comparativos para evaluar los resultados oncológicos y funcionales perioperatorios y a largo plazo entre los abordajes de PU, robótico multibrazo y abierto. (AU)

Background: The novel da Vinci Single-Port (SP) robotic platform received the US FDA approval in 2018. The device, specifically conceived for single-site approach, is pushing through the limits of minimally invasive surgery. We sought to provide a comprehensive overview of the current status of the clinical experiences accomplished by the da Vinci SP in urology, and to discuss future perspectives.MethodsA non-systematic literature review was performed focusing on single port articles in urological surgery using Medline/PubMed and Embase search electronic engines. The authors analyzed findings and a brief report of the clinical experience for surgical procedures completed by the SP platform was described.ResultsThe current data available from single-port robotic established the safety and feasibility of urologic procedures using this novel platform. However, the results come from single-center case series, small cohorts and retrospective studies that need to be cautiously interpreted. Additional evidence is required to determine the asset of the SP platform in the urological community.ConclusionsThe SP robotic system opens new frontiers on the surgical scenery facilitating the completion of urological surgeries through a single incision. Further comparative studies will be required to assess perioperative and long-term oncological and functional outcomes among SP, multi-arm robotic and open approaches. (AU)

Single-Port Percutaneous Transvesical Simple Prostatectomy Using the SP Robotic System: Initial Clinical Experience.

OBJECTIVE: To present our initial experience with single-port percutaneous transvesical simple prostatectomy using the novel SP robotic surgical system. METHODS: Ten patients underwent single-port transvesical simple prostatectomy between February and November 2019. Percutaneous access to the bladder dome was made and all SP instruments were inserted through the SP multichannel cannula directly into the bladder. Prostate adenoma enucleation, hemostasis and trigonization were done according to the principles of open simple prostatectomy technique. Demographics and perioperative outcomes were prospectively collected and analyzed. RESULTS: All procedures were performed successfully without the need for conversion to open surgery. Median preoperative estimated prostate size was 159 (Interquartile range (IQR) 108-223) grams. No intraoperative complications occurred. Median operative time and estimated blood loss were 190 (IQR 146-203) minutes and 100 (IQR 68-175) ml, respectively. Mean postoperative specimen weight was 84.3 ± 34 grams. Median length of hospital stay was 19 (IQR 17-28) hours. All patients were satisfied with their urinary flow after catheter removal without any episode of acute urinary retention 1-6 months, postoperatively. CONCLUSION: Single-port transvesical simple prostatectomy can be offered as an alternative treatment option for surgical management of lower urinary tract symptoms associated with large prostate adenoma. Sparing the peritoneal cavity, minimum dissection of the bladder, excellent visualization of the prostate fossa can be some of the potential advantages of this minimally invasive approach. Comparative studies with standard techniques are advisable to evaluate the surgical outcome and postoperative morbidity of each treatment modality.

Cirugía robótica multicuadrante concomitante para prostatectomía radical y nefrectomía parcial izquierda. Dos procedimientos mediante un solo abordaje / Multiquadrant combined robotic radical prostatectomy and left partial nephrectomy: a combined procedure by a single approach

INTRODUCCIÓN: Presentar el primer caso de cirugía multicuadrante concomitante-prostatectomía radical robótica y nefrectomía parcial robótica izquierda- realizadas con técnica de puerto único utilizando el sistema quirúrgico da Vinci SP(R) (Intuitive Surgical, Sunnyvale CA, EE. UU.). PACIENTE Y METODOLOGÍA: Varón de 66 años con diagnóstico de cáncer de próstata localizado y lesión sospechosa en riñón izquierdo encontrada en tomografía axial computarizada (TAC) durante la evaluación del cáncer de próstata. Ambos procedimientos se realizaron usando una sola incisión de 3cm, y un puerto laparoscópico adicional; utilizando un Gelpoint(R) estándar (Applied Medical, Rancho Santa Margarita, CA, EE. UU.) y replicando la técnica previamente descrita de puerto único para prostatectomía radical robótica y nefrectomía parcial con el uso de la plataforma robótica puerto único prostatectomía SP(R). RESULTADOS: Tiempo operatorio total fue 256 min, con un tiempo de consola de 108min para la prostatectomía radical, y 101 min para la nefrectomía parcial, respectivamente, incluyendo un tiempo de isquemia de 26 min. La pérdida sanguínea estimada fue de 250 cc. No sé necesito transfusión. La enfermedad final de próstata fue adenocarcinoma Gleason 7 (4+3) y para la lesión renal fue carcinoma de células renales. Después de 2 meses de seguimiento, PSA fue indetectable, sin recurrencia o complicaciones. CONCLUSIONES: La técnica de puerto único presenta ventajas como: más fácil planificación quirúrgica y transición para cirugías combinadas y multicuadrantes, recuperación más rápida, dolor postoperatorio mínimo y menor uso de opioides, además de excelentes resultados cosméticos. Sugerimos que procedimientos combinados deberían ser realizados solo en instituciones con un alto volumen de pacientes, por cirujanos con amplia experiencia en cirugía robótica y con pacientes seleccionados

INTRODUCTION: To present the first case of a concomitant robotic radical prostatectomy and a left robotic partial nephrectomy performed by a single-port approach using the SP(R) da Vinci surgical system (Intuitive Surgical, Sunnyvale CA, EE. UU. ). PATIENT AND METHODS: A 66-year-old male diagnosed with localized prostate cancer and a left kidney renal mass incidentally found on computed tomography (CT) scan during prostate cancer evaluation. Procedures were performed using a single supra-umbilical 3cm incision, plus one additional laparoscopic port, utilizing a standard Gelpoint(R) (Applied Medical, Rancho Santa Margarita, CA, EE. UU. ) and replicating the technique previously described for single-port transperitoneal radical prostatectomy and partial nephrectomy with the use of the SP(R) robotic platform. RESULTS: Total operative time was 256 minutes (min) with a console time of 108min for radical prostatectomy, and 101 min for the partial nephrectomy respectively, including a warm ischemia time of 26 min. Estimated blood loss was 250 cc. Blood transfusion was not needed. Final pathology for prostate was adenocarcinoma Gleason 7 (4+3) and for the kidney lesion was renal cell carcinoma. After two months of follow-up, PSA was undetectable and no complications or recurrence were detected. CONCLUSIONS: The single-port approach has advantages as easier surgical planning and transition for combined and multi-quadrants surgeries: faster recovery, minimal postoperative pain and need for opioids, and excellent cosmetic outcome. We suggest that combined procedures should be performed only in high volume institutions by surgeons with vast experience in robotic surgery in selected patients

Multiquadrant Combined Robotic Radical Prostatectomy And Left Partial Nephrectomy: A Combined procedure by A Single Approach. / Cirugía robótica multicuadrante concomitante para prostatectomía radical y nefrectomía parcial izquierda. Dos procedimientos mediante un solo abordaje.

INTRODUCTION: To present the first case of a concomitant robotic radical prostatectomy and a left robotic partial nephrectomy performed by a single-port approach using the SP® da Vinci surgical system (Intuitive Surgical, Sunnyvale CA, EE.UU.). PATIENT AND METHODS: A 66-year-old male diagnosed with localized prostate cancer and a left kidney renal mass incidentally found on computed tomography (CT) scan during prostate cancer evaluation. Procedures were performed using a single supra-umbilical 3cm incision, plus one additional laparoscopic port, utilizing a standard Gelpoint® (Applied Medical, Rancho Santa Margarita, CA, EE.UU.) and replicating the technique previously described for single-port transperitoneal radical prostatectomy and partial nephrectomy with the use of the SP® robotic platform. RESULTS: Total operative time was 256minutes (min) with a console time of 108min for radical prostatectomy, and 101min for the partial nephrectomy respectively, including a warm ischemia time of 26min. Estimated blood loss was 250cc. Blood transfusion was not needed. Final pathology for prostate was adenocarcinoma Gleason 7 (4+3) and for the kidney lesion was renal cell carcinoma. After two months of follow-up, PSA was undetectable and no complications or recurrence were detected. CONCLUSIONS: The single-port approach has advantages as easier surgical planning and transition for combined and multi-quadrants surgeries: faster recovery, minimal postoperative pain and need for opioids, and excellent cosmetic outcome. We suggest that combined procedures should be performed only in high volume institutions by surgeons with vast experience in robotic surgery in selected patients.

Arteriovenous dialysis access-associated transvenous pacemaker infection.

Pacemaker (PM), implantable cardioverter defibrillator and cardiac resynchronization therapy devices also provide support to chronic hemodialysis patients with cardiac rhythm abnormalities. However, these devices can get infected. In general, device infection is either primary or metastatic spread from a distant source. Arteriovenous grafts are commonly used to provide dialysis therapy. Compared to a fistula an arteriovenous graft runs a higher risk of infection. In this analysis, we report 2 chronic hemodialysis patients who have been successfully receiving dialysis through an arteriovenous graft for approximately 2 years. Both had had a PM device for about the same duration. Access infection necessitated surgical removal of the arteriovenous graft in these patients. However, due to bacteremia (methicillin-resistant Staphylococcal aureus (MRSA)), infection spread to involve the transvenous PM leads in both patients. In 1 patient the infection also involved the PM pocket. Lead and wound culture confirmed MRSA in both patients. PM device and leads were removed in both patients. After the resolution of bacteremia, both patients received an epicardial pacemaker. None of the patients had valvular endocarditis. While dialysis was provided with a catheter, an arteriovenous fistula was planned. In conclusion, contamination of the transvenous PM device can occur due to hematogenous spread of infection from an infected arteriovenous graft. Epicardial instead of a transvenous PM might be the better option for such patients to provide long-term cardiac rhythm support.