Robotic renal surgery: The future or a passing curiosity?

Warren, James V.; Silva, Vitor da; Caumartin, Yves; Luke, Patrick

doi:10.5489/cuaj.1080

Cited by 11 publications

(5 citation statements)

References 96 publications

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“…The development of laparoscopic procedures correlates in the main with minor technical improvements or general advances in the medical learning curve. This is reflected in the focus of many publications on robotic surgery when discussing future developments in kidney transplantation surgery [ 45 – 48 ].…”

Section: The Development Of Surgical Methodsmentioning

confidence: 99%

Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

Nowacki¹,

Nazarewski²,

Kloskowski³

et al. 2016

aoms

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On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression.

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Section: The Development Of Surgical Methodsmentioning

confidence: 99%

Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

Nowacki¹,

Nazarewski²,

Kloskowski³

et al. 2016

aoms

View full text Add to dashboard Cite

show abstract

“…Particularly when the cost of such technology is high, knowledge of the affect on outcomes would be beneficial. The cost of the standard system in 2003 was approximately $1 million, while the current cost of the S system is approximately $1.5 million with an additional cost for high‐definition optics and other optional components [8]. The price of the most recent system introduced, the da Vinci® Si, is listed as $1.65 million with an optional second instrument‐control console at an additional price, which means the price of the total package with all options is over $2 million.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intraoperative outcomes using the new and old generation da Vinci® robot for robot‐assisted laparoscopic prostatectomy

Shah

Abaza

2011

BJU International

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Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To review and compare intraoperative outcomes for robotic prostatectomy procedures performed on two generations of the da Vinci robotic surgery platform. MATERIAL AND METHODS We reviewed 100 consecutive robotic prostatectomy cases and compared intraoperative outcomes for procedures randomly performed on either the da Vinci S robot or first‐generation standard robot. Baseline demographic data and intra‐operative variables potentially impacting outcomes were reviewed and compared between the two groups. RESULTS Mean total operative time was 191 min using the standard da Vinci robot (range 132–266) versus 169 min with S robot (range 98–230), representing a mean difference of 22 min (P = 0.002). This difference was statistically significant despite no difference in mean patient BMI of 30.6 (range 19–51) for standard versus 29.3 (range 21–37) for S (P = 0.31), no difference in mean prostate size of 54.6 g (range 26–101) for standard versus 57.3 g (range 32–151) for S (P = 0.55), and no difference in frequency of nerve‐sparing (P = 0.99). There was also no difference in the portions of procedues performed by residents, which in some cases was none and some the entire procedure, but the standard was more often used for the surgeon’s first case of the day (P = 0.006). There was no difference in blood loss (P = 0.08), positive margins (P = 0.87), or mean number of lymph nodes removed (10.7 vs 10.6). CONCLUSIONS Both generations of da Vinci robotic technology are equally effective for PALP, but the S robot appears to allow shorter procedure times. Further such evaluations are necessary to guide institutions and public policy decision‐makers on investments in newer generations of robotic technology as incremental advances continue.

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“…19,20 The renal hilum and the vessels were identified and isolated. Intraoperative ultrasound was used to identify the borders of the mass, rule out other renal lesions, and assess renal vascular flow, as previously described by our group.…”

Section: Technical Description Of Ecrmentioning

confidence: 99%

Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function

Campbell

Chan²,

Luke

2017

CUAJ

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Introduction: Intraoperative warm ischemic time (WIT), associated with hilar clamping during partial nephrectomy (PN), is an established modifiable risk factor for renal dysfunction. We assessed early clamp release (ECR) as a strategy to reduce WIT and assess its impact on renal function and bleeding. Methods: We retrospectively assessed patients who underwent minimally invasive PN by a single surgeon at our centre since December 2011. Comparing the standard technique to an ECR modification, WIT, complications, change in estimated glomerular filtration rate (eGFR), and change in differential function as demonstrated by MAG-3 nuclear renography were assessed. Followup blood work and renograms were performed at 6-12 weeks postoperatively and compared to baseline in 70 patients (35 ECR: 35 control). Results: The ECR and control groups were similar in age, sex, and tumour size, with only patient weight being higher in the ECR group (91.6 vs. 81.6 kg; p<0.05). WIT was significantly lower in ECR group compared to control (18.8 vs. 31.5 minutes; p<0.05). Although there was no significant difference in change from baseline eGFR in the early postoperative period (Day 3) or in followup (6-12 weeks), the control group had a significantly greater loss of ipsilateral renal function from baseline compared to the ECR group (9 vs. 4% change; p<0.05). Blood loss and complication rate were similar between groups. Conclusions: The ECR technique offers a safe, reproducible alternative that reduces WIT during laparoscopic PN. ECR demonstrates a reduction in overall ipsilateral renal dysfunction, without increasing complication or intraoperative bleeding risk.

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Robotic renal surgery: The future or a passing curiosity?

Cited by 11 publications

References 96 publications

Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

Comparison of intraoperative outcomes using the new and old generation da Vinci® robot for robot‐assisted laparoscopic prostatectomy

Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function

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