1126 Robot-assisted surgery: Applications in urology

1126

Robot-assisted surgery: Applications in urology Eur Urol Suppl 2014;13;e1126          

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Lin C-Y., Ou Y-C., Yang C-K., Chiu K-Y., Wang S-S., Su C-K., Ho H-C., Cheng C-L., Chen C-S., Li J-R., Chen W-M. Taichung Veterans General Hospital, Dept. of Surgery, Div. Urology, Taichung, Taiwan INTRODUCTION & OBJECTIVES: The da Vinci robot system has became the main fashion of minimal invasive surgery and has been used in numerous complex reconstructive procedures. Beginning from the robotic assisted laparoscopic radical prostatectomy in 2005, we tried to expand our practical model and application of da Vinci robot system into other urologic surgeries.  MATERIAL & METHODS: Since Dec 2005, we established a urologic robotic team and adopted conventional 4-arm da Vinci robotic system. (Intuitive surgical Inc., Sunnyvale, CA, USA) We performed a retrospective study about the application and of robotic urologic surgery in a single institute. There were total 683 cases with 14 procedures from Dec 2005 to Dec 2012. Surgeries were performed by 9 operators, but one of them performed 582 cases. RESULTS: Total 683 cases of robotic urologic surgeries were divided into three time intervals. We performed the first robotic assisted laparoscopic radical prostatectomy in Dec 2005, and then we started other kinds of procedure.(Table 1). 

 

total number

performed by single surgeon

2005 2008

2009 2010

2011 2012

 

683

582

159

195

329

Radical prostatectomy

586

500

136

170

280

Partial nephrectomy

27

21

8

8

11

bil LN dissection

14

9

6

4

4

Dismembered pyeloplasty

9

7

3

1

5

Heminephrectomy

1

1

0

0

1

Nephroureterectomy and Radical cystectomy

6

6

3

2

1

Nephroureterectomy and Radical cystectoprostatectomy

3

3

0

3

0

Nephroureterectomy with bladder cuff excision

11

11

0

4

7

Partial cystectomy

2

1

0

0

2

Radical cystoprostatectomy or cystectomy with ileal conduit

5

4

0

0

5

Ureteral reconstruction

1

1

1

0

0

Pyelolithotomy/ ureterolithotomy

2

2

1

0

1

Nephropexy

2

2

0

0

2

Simple prostatectomy

12

12

1

3

8

   We also analyzed the operation time, blood loss and transfusion rate of the major operation and the procedure with larger number size.The initial outcomes of different robotic procedures are represented in Table 2.

Procedure

case number

operation time (range)

blood loss (range)

transfusion rate

conversion

Radical prostatectomy

586

144

137±165

2%

10/586

Partial nephrectomy

27

258

430

11%

3/21

bil LN dissection

14

90 (70 -120)

35(20-200)

0

0

Dismembered pyeloplasty

9

138 (80 - 270)

<10

0

0

Nephroureterectomy and radical cystectomy/cystectoprostatectomy

9

295 (210 - 390)

470 (270 - 850)

33%

0

Nephroureterectomy with bladder cuff excision

11

129 (110 - 150)

63.3 (20 - 100)

0

0

Partial cystectomy

2

150

50

0

0

Radical cystoprostatectomy or cystectomy with ileal conduit

5

230 (230 - 320)

310 (100 - 700)

20%

0

Simple prostatectomy

12

150 (130 - 180)

208.3 (50 - 850)

8%

0

10 cases of radical prostatectomy and 3 cases of partial nephrectomy were reported of conversion.

Robotic assisted laparoscopic radical prostatectomy (RARP) Case number Reason

Result

3

da Vinci surgical system malfunction

laparoscopy

1

L't external iliac vein injury

Convert to laparotomy

1

Software incompatibility before operation Reschedule (delayed 6 hours)

2

Severe adhesion

Laparotomy

1

Urethral injury

Minimal laparotomy

1

Bleeding

Minimal laparotomy

1

da Vinci surgical system malfunction

3 arm system with laparoscopic assistance

Robotic assisted partial nephrectomy (RAPN) Case number Reason

Result

2

Tumour margin involvement

robotic assisted radical nephrectomy

1

Renal vein injury

Laparotomy radical nephrectomy

CONCLUSIONS: Based on our experience, robotic system can be applied to many kinds of urologic surgeries both safely and efficiently.