- nephrectomy
- partial nephrectomy
- pyeloplasty
- adrenalectomy
- ureter reconstruction
Figure 1 – SP robotic platform – Dr. Cadeddu’s lecture from WCET 2022
There are some practical tips for SP robotic partial nephrectomy which can be very useful in surpassing the initial part of the surgeon’s learning curve: patient positioning (lateral decubitus), port placement, insufflation (the GelPoint Mini with Alexis wound protector being very important), docking, assistant ports, preventing the instrument collisions, camera relocation, hilar control (the laparoscopic bulldogs being applied by the assistant), tumor excision (lifting the camera over the kidney, in “cobra” position) and SP cannula extraction.
Dr. Cadeddu presented data from the recent literature revealing similar outcomes for single port vs multi-port robotic platforms for pyeloplasty, with a slightly prolonged operating time for the SP approach (1). Similar results have been reported for SP vs MP partial nephrectomy, as Dr. Cadeddu mentioned in his lecture (2,3). Moreover, for SP vs MP-robot assisted partial nephrectomy, the study published by Harrison in 2022 revealed no differences in operating time, blood loss, ischemia time, intraoperative and postoperative complications, pain score, recurrence rate, and change in the NKF-KDOQI CKD score.
Having this data, why would a patient consent to the SP approach instead of MP robotic platform? Dr. Cadeddu presented the results from a UT Southwestern survey on 112 kidney and prostate patients treated by laparoscopic (80 pts), laparoendoscopic single site surgery (LESS) (17 pts), or open approach (15 pts). The results showed that most valued pre-operative factor was the risk of complications and successful surgery (surgeon’s reputation and complications), the least important being the scar size and number. However, for younger than 50 years female patients or patients with benign pathology, cosmesis was found to be greatly valued (Figure 2 and 3).
Figures 2 &3 – The importance of different factors from the patient’s perspective (overall, by gender, age and surgical indication)
Dr. Cadeddu concluded that the SP platforms’ limitations are related to a longer learning curve (for the robot itself, the limited working space, body habitus, and lots of tissue manipulation) and the extra ports needed for retraction, suction, introduction of sutures (a truly SP should tolerate one assist into the canula). The take-home message is that the SP method for upper urinary tract is feasible and safe, but further studies to determine cost, effectiveness, efficiency, and morbidity reduction are to be determined.
Presented by: Jeffrey Cadeddu, MD, FRCS, Professor, UT Southwestern Medical Center, Dallas, Texas
Written by: Andrei D. Cumpanas, LIFT Research Fellow, Department of Urology, University of California, Irvine. Twitter: @andreicumpanas during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.
References:
- Harrison R, Ahmed M, Billah M, Sheckley F, Lulla T, Caviasco C, Sanders A, Lovallo G, Stifelman M. Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes. J Robot Surg. 2022 Jun 1. doi: 10.1007/s11701-022-01415-8. Epub ahead of print. PMID: 35648289.
- Shukla D, Small A, Mehrazin R, Palese M. Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes. J Robot Surg. 2021 Apr;15(2):293-298. doi: 10.1007/s11701-020-01106-2. Epub 2020 Jun 20. PMID: 32564222.
- Garden EB, Al-Alao O, Razdan S, Mullen GR, Florman S, Palese MA. Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System. JSLS. 2021 Oct-Dec;25(4):e2021.00062. doi: 10.4293/JSLS.2021.00062. PMID: 34949909; PMCID: PMC8692076.