Laparoendoscopic single‐site (<scp>LESS</scp>) robot‐assisted nephroureterectomy: comparison with conventional multiport technique in the management of upper urinary tract urothelial carcinoma

Lim, Sey Kiat; Shin, Tae Young; Kim, Kwang Hyun; Han, Woong Kyu; Chung, Byung Ha; Hong, Sung Joon; Choi, Young Deuk; Rha, Koon Ho

doi:10.1111/bju.12356

Cited by 13 publications

(7 citation statements)

References 37 publications

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“…This finding is consistent with a recent report assessing a cohort of 422 patients who underwent ONU, LNU, and RNU, demonstrating lower EBL for the robotic group [16]. Lower EBL translated into a lower transfusion rate, whereas ONU showed higher odds of transfusions (20%) [17]. LNU also had higher transfusion rate, but it was not clinically significant compared to RNU (11% vs 9%).…”

Section: Discussionsupporting

confidence: 90%

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

et al. 2019

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Purpose To perform a systematic review and meta-analysis of the literature inherent robotic nephroureterectomy (RNU) and to compare its outcomes with those of other nephroureterectomy (NU) techniques. Methods A systematic literature search was performed up to April 2019 using PubMed, Embase®, and Web of Science. The Preferred Reporting Items for Systematic Review and Meta-analysis Statement was followed for study selection. The following data were extracted for each study: baseline features, surgical outcomes, oncological outcomes, and survival outcomes. Stata® 15.0 was used for statistical analysis. Results Literature search identified 80 studies eligible for the meta-analysis and overall 87,291 patients were included in the analysis: open NU (ONU; n = 45,601), hand-assisted laparoscopic NU (HALNU; n = 442), laparoscopic NU (LNU n = 31,093), and RNU (n = 10,155). RNU was more likely to be performed in those patients with multifocal tumor location (proportion: 0.19; 95% CI 0.14, 0.24) and high-grade disease (proportion: 0.70; 95% CI 0.53, 0.68). The lowest EBL was recorded in the RNU group (weighted mean (WM) 163.31 mL; 95% CI 88.94, 237.68), whereas the highest was in the ONU group (414.99 mL; 95% CI 378.52, 451.46). Operative time was shorter for ONU (224.98 mL; 95% CI 212.26, 237.69). RNU had lower rate of intraoperative complications (0.02; 95% CI 0.01, 0.05). ONU showed higher odds of transfusions (0.20; 95% CI 0.15, 0.25). LOS was statistically significantly shorter for the RNU group (5.35 days; 95% CI 4.97, 5.82). HALNU seemed to present lower risk of PSM (0.02; 95% CI − 0.01, 0.05), and lower risk of recurrence (0.22; 95% CI 0.15, 0.30), metastasis (0.07; 95% CI 0.05, 0.10), and cancer-related death (0.03; 95% CI 0.01, 0.06). ONU showed the lowest 5 years cancer specific survival (proportion: 0.77; 95% CI 0.74, 0.80). No correlation was found between the surgical technique and recurrence-free and cancer-specific survival. Conclusions Evidence regarding RNU for the treatment of UTUC is increasing but it remains quite sparse and of low quality. Despite this, RNU seems to be safe, and to offer the advantages of a minimally invasive approach without impairing the oncological outcomes. Nevertheless, ONU, HALNU, and LNU still represent a valid, and commonly used surgical treatment option. As RNU becomes more popular, and concerns related to its use remain, the best surgical technique for NU remains to be determined. Keywords Open radical nephroureterectomy • Hand-assisted radical nephroureterectomy • Laparoscopic radical nephroureterectomy • Robotic radical nephroureterectomy • Upper tract urothelial carcinoma Electronic supplementary material The online version of this article (

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Section: Discussionsupporting

confidence: 90%

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

et al. 2019

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“…This technique provided good control of the distal ureter, minimized the potential for tumor seeding. Lim 15 made a comparison between laparoendoscopic Single-Site (LESS) nephroureterectomy and conventional multiport technique in the management of UTUC. They concluded that LESS-nephroureterectomy might result in greater intra-operative blood loss.…”

Section: Discussionmentioning

confidence: 99%

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

Song¹,

Wang²,

Zhao³

et al. 2020

CMAR

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Background: The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and here report our early outcomes. Methods: From January 2017 to December 2019, a total of 106 patients underwent LNU by a single surgeon at our department, of whom 50 patients underwent standard technique and 56 patients underwent CRT technique. Relevant clinical data were collected including each patient's characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed. Results: LNU was performed successfully on all 106 patients. There was no significant difference in patients' characteristics. Compared to the standard group, patients in the CRT group had shorter operative time (P=0.001), less estimated blood loss (EBL) (P<0.001), lower visual analogue scale (VAS) pain score (P=0.020) and less scarring (P=0.013). The median time of surgical drain stay decreased from 5 to 2 days (P=0.004) and median hospital stay after surgery decreased from 5 to 3 days (P=0.001). The complication rates did not show statistical differences between the two groups within the first 30 days postoperatively (P=0.263). For the long-term complications, the incidence of abdomen bulge or incisional hernia in the CRT group was less than that in the standard group (P<0.001). Conclusion: The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.

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“…In this paper by Lim et al [1], patients were relatively homogenous between the two non-randomised arms. However, patients in LESS-RALNU cohort were significantly older (71 vs 62 years).…”

Section: Ralnu Was First Reported In 2006 and Since Then Multiple Gromentioning

confidence: 91%

“…In this small non-randomised prospective single-surgeon series, Lim et al [1] compare laparoendoscopic single-site robot-assisted nephrouretectomy (LESS-RALNU) with multiport RALNU (M-RALNU) for operative technique and oncological outcomes. The authors should be congratulated on reporting in an area of urology where there is paucity of data and techniques are constantly evolving.…”

Section: Robot-assisted Nephrouretectomy: Is Less More?mentioning

confidence: 99%

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Robot‐assisted nephrouretectomy: is LESS more?

Zargar

Kaouk

2014

BJU International

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An exciting article in this edition describes a paradigm shift in the management of Peyronie's disease (PD) [1]. Reconstructive surgery for PD has been mostly palliative and fraught with unsatisfactory outcomes either in terms of penile length, function or both. This article [1] describes the use of collagenase to effectively dissolve the offending plaque without the side-effects associated with surgery. The results are impressive albeit not entirely curative. The advantage of this strategy is that men can be treated irrespective of the phase of the condition. This means that men can be referred on to a specialist as soon as the diagnosis of PD is made rather than awaiting stabilisation. This will also facilitate disease modifying drugs, such as potassium para-aminobenzoate (Potaba, which has level 1 evidence supporting its use) [2] or pentoxifylline, to be used during the acute phase. These drugs do not appear to be popular among andrologic surgeons, perhaps due to their gastrointestinal side-effects. However, Potaba capsules seem better tolerated than in the sachet form.Collagenase has already been used in Dupuytren's contracture, which has strong correlations with PD. The studies described in this article have led to its acceptance by licensing bodies in several countries. It would appear to have better results when combined with penile modelling, such as with a vacuum erectile device. The treatment is quite intensive with several outpatient visits required. The side-effects are rare but can be serious. It would appear that corporal rupture occurs when sexual intercourse is attempted too early, which emphasises the need for clear instructions and management of expectations. It will be interesting to see if there is a limit to the amount/extent of repeat treatments, as we strive to restore length and contour fully. Many patients are eager to undergo this novel therapy. It should be introduced in a controlled and audited system.

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Laparoendoscopic single‐site (LESS) robot‐assisted nephroureterectomy: comparison with conventional multiport technique in the management of upper urinary tract urothelial carcinoma

Cited by 13 publications

References 37 publications

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

Robotic versus other nephroureterectomy techniques: a systematic review and meta-analysis of over 87,000 cases

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

Robot‐assisted nephrouretectomy: is LESS more?

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