EAU Guidelines on Robotic and Single-site Surgery in Urology

Merseburger, Axel S.; Herrmann, Thomas; Shariat, Shahrokh F.; Kyriazis, Iason; Nagele, Udo; Traxer, Olivier; Liatsikos, Evangelos

doi:10.1016/j.eururo.2013.05.034

Cited by 154 publications

(79 citation statements)

References 155 publications

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“…Well-described advantages of robot-assisted over conventional laparoscopy include stereoscopic vision, filtration of tremor, and 7 degrees of freedom [6]. Our institution reported its initial experience with robotic adrenalectomy in the porcine model in 2000 [23] and 2 yr later in the clinical setting [2].…”

Section: Critical Analysismentioning

confidence: 99%

See 1 more Smart Citation

Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis

Brandão¹,

Autorino²,

Laydner³

et al. 2014

European Urology

173

101

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Section: Critical Analysismentioning

confidence: 99%

“…Robotic surgery in urology has been mainly used to date for procedures involving reconstruction such as radical prostatectomy and partial nephrectomy, whereas its use for extirpative procedures such as nephrectomy and adrenalectomy has been limited, mainly because of cost issues [6].…”

Section: Introductionmentioning

confidence: 99%

Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis

Brandão¹,

Autorino²,

Laydner³

et al. 2014

European Urology

173

101

View full text Add to dashboard Cite

“…4 That being said, there is little data evaluating the safety and feasibility of RANU. 5 To date, only few retrospective studies have been published, with limited sample size (ranging from 11 to 43), originating from tertiary referral centres, where results may not be representative of the American population at large. [6][7][8][9][10][11] In the face of such little data, we wanted to examine short-term outcomes of RANU compared with LNU using a large contemporary cohort of patients representative of the United States population.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Trudeau

Gandaglia

Shiffmann

et al. 2014

CUAJ

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Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large populationbased cohort of patients with upper-tract urothelial carcinoma (UTUC). Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures. Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade. Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU. IntroductionUpper-tract urothelial carcinoma (UTUC) accounts for about 5% of all urothelial carcinomas.1 According to treatment guidelines, radical nephroureterectomy (RNU) represents the treatment of choice for localized disease.2 Based on equal efficacy and easier convalescence compared to the open procedure, many urologists have advocated minimally invasive approaches as the standard of care. 2,3 In this context, laparoscopic nephroureterectomy (LNU) and robotic-assisted nephroureterectomy (RANU) are available; the robotic approach is being increasingly adopted for several other urologic malignancies.4 That being said, there is little data evaluating the safety and feasibility of RANU.5 To date, only few retrospective studies have been published, with limited sample size (ranging from 11 to 43), originating from tertiary referral centres, where results may not be representative of the American population at large. [6][7][8][9][10][11] In the face of such little data, we wanted to examine short-term outcomes of RANU compared with LNU using a large contemporary cohort of patients representative of the United States population. Specifically, we focused on perioperative complications, blood transfusions, prolonged length of stay, in-hospital mortality and hospitalization costs. (NIS) database were abstracted. The NIS is a 20% stratified probability sample that encompasses about 8 million ...

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“…13 Laparoscopic adrenalectomy usually requires three to four ports for the introduction of the instruments, but a single-port transumbilical approach is possible. 14,15 Robot-assisted laparoscopic adrenalectomy is feasible and safe but more expensive, and its advantages over conventional laparoscopy have yet to be definitively demonstrated. [15][16][17] The mean operating time for laparoscopic adrenalectomy performed by experienced surgeons in major series is between one and two hours, and mean hospital stay is about three days.…”

Section: Unilateral Adrenalectomymentioning

confidence: 99%

“…14,15 Robot-assisted laparoscopic adrenalectomy is feasible and safe but more expensive, and its advantages over conventional laparoscopy have yet to be definitively demonstrated. [15][16][17] The mean operating time for laparoscopic adrenalectomy performed by experienced surgeons in major series is between one and two hours, and mean hospital stay is about three days. 18,19 Conversion to open surgery is required in less than 5% of cases.…”

Section: Unilateral Adrenalectomymentioning

confidence: 99%

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure and medications in most cases, and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control blood pressure. Dietary sodium restriction should be implemented in all cases, because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of blood pressure, serum potassium concentration or cardiovascular and renal outcomes, although the benefits of treatment tend to be observed sooner with surgery.PA patients display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing chronic kidney disease in 30% of patients. However, further kidney damage is prevented by the treatment of PA. Clinical summary-The goals of treatment are the normalization of serum potassium concentration, blood pressure control and prevention of the direct effects of excess aldosterone on target organs. 3-The non-surgical treatment of PA is based on mineralocorticoid receptor antagonists and dietary sodium restriction.-Epithelial sodium channel blockers are used when mineralocorticoid receptor antagonists are not well tolerated; thiazide diuretics and calcium channel blockers are used when blood pressure control is insufficient with the first-line treatment.-Laparoscopic adrenalectomy is safe and decreases BP and medication requirements in patients with unilateral PA; drug-based treatments are appropriate in cases in which surgery is inappropriate or not desired.

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EAU Guidelines on Robotic and Single-site Surgery in Urology

Cited by 154 publications

References 155 publications

Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis

Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

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