Robotic Transperitoneal Infrarenal Para-Aortic Lymphadenectomy With Double Docking: Technique, Learning Curve, and Perioperative Outcomes

Ponce, Jordi; Barahona, Marc; Jesús, María; Rovira, Jordi; García‐Tejedor, Amparo; Gil-Ibáñez, Blanca; Gaspar, Hugo Manuel; Sabrià, Enric; Bartolomé, Carlos; Martí, Lola

doi:10.1016/j.jmig.2016.02.005

Cited by 15 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With increased BMI, transperitoneal lymphadenectomy may not have been sufficient to adequately collect the lymph nodes of the renal vessels because of poor visualization, due to increased intraabdominal adipose tissue. Ponce et al 11 suggested that a learning curve of 20 cases was necessary to manage properly the surgical technique. In our study, mainly two centers performed this procedure routinely.…”

Section: Discussionmentioning

confidence: 99%

Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy?

et al. 2020

View full text Add to dashboard Cite

Background. The outcomes of paraaortic lymphadenectomy were compared for the treatment of gynecological malignancies to identify the most appropriate surgical approach. Methods. Our retrospective, multicentric study included 1304 patients who underwent paraaortic lymphadenectomy for gynecological malignancies. The patients were categorized into the following five groups based on treatment type: transperitoneal laparoscopy (group A, n = 198), extraperitoneal laparoscopy (group B, n = 681), robot-assisted transperitoneal laparoscopy (group C, n = 135), robot-assisted extraperitoneal laparoscopy (group D, n = 44), and laparotomy (group E, n = 246). Results. The prevalence of cancer types differed according to the surgical approach: there were more ovarian cancers in group E and more cervical cancers in groups B and D (p \ 0.001). Estimated blood loss was higher in group E (844.2 mL) than in groups treated with minimally invasive interventions (115.8-141.5 mL, p \ 0.005). For infrarenal dissection, fewer nodes were removed in group C compared with the other approaches (16 vs. 21 nodes, respectively, p \ 0.05). The average operative time ranged from 169 min for group A to 247 min for group E (p \ 0.001). Length of hospital stay was 14 days for group E versus 3.5 days for minimally invasive procedures (p \ 0.05). The early postoperative grade 3 and superior Dindo-Clavien complications occurred in 9-10% of the patients in groups B-D, 15% of the patients in group E, and only 3% and 4% for groups A and C, respectively. The most common complication was lymphocele. Conclusions. Laparotomy increases preoperative and postoperative morbidity. The robot-assisted transperitoneal approach demonstrated a poorer lymph node yield than laparotomy and extraperitoneal approaches.

show abstract

Section: Discussionmentioning

confidence: 99%

Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy?

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The main characteristics of robotic technology that facilitate surgical performances also help to shorten the learning curve, including three‐dimensional visualization, articulated instrumentation, and stability of the camera . In addition, further technological improvements have improved the versatility of its use, and robotic‐assisted laparoscopy is now a valid and diffused surgical method for treatment of gynecological cancers, even when para‐aortic lymphadenectomy is required …”

Section: Introductionmentioning

confidence: 99%

“…19 In addition, further technological improvements have improved the versatility of its use, and robotic-assisted laparoscopy is now a valid and diffused surgical method for treatment of gynecological cancers, even when para-aortic lymphadenectomy is required. [20][21][22][23][24][25][26][27][28][29][30] In this context, we investigated the surgical outcome of the robotic approach in gynecological cancer patients undergoing pelvic surgery and aortic lymphadenectomy. All patients provided a written informed consent for their data to be collected and analyzed for scientific purpose, according to our institutional policy.…”

mentioning

confidence: 99%

The role of robotic aortic lymphadenectomy in gynecological cancer: surgical and oncological outcome in a single institution experience

Gallotta

Federico

Gaballa

et al. 2018

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and Objective This study aims to investigate the surgical outcomes observed in robotic transperitoneal aortic lymphadenectomy (AL) in gynecological cancer patients. Methods Retrospective data were collected and analyzed on 71 patients undergoing robotic surgical procedures for gynecological cancers, including transperitoneal AL, between December 2014 and February 2018 at the Catholic University of the Sacred Heart, Rome, Italy. Results Median age of the sample population was 50 years (range, 26‐76 years). The median operative time was 210 minutes (range, 75‐480 minutes), the median estimated blood loss was 50 ml (range, 20‐300 ml). The number of para‐aortic nodes removed was 12 (range, 7‐43). In the whole series, 13 patients (18.3%) had at least one metastatic node. Overall, 10 patients (14.1%) experienced any grade early postoperative complications. Three patients experienced more than one complication. Three intraoperative complications occurred with two cases of vascular injury. Conversion to laparotomy was necessary for one patient (1.4%). Conclusions The present study shows the safety and adequacy of robotic transperitoneal AL as surgical staging step for gynecological cancers in terms of perioperative and postoperative outcomes.

show abstract

“…Others have reported no learning curve associated with LNY in robotic-assisted laparoscopic para-aortic lymphadenectomy combined with oncologic pelvic surgery. 18 This suggests that LNY is probably not impacted in the early adoption of this procedure by an experienced robotic surgeon. There remains debate regarding the oncologic efficacy of robotic approaches for oncologic procedures when compared with the standard open technique.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve for Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection

Schermerhorn

Christman

Rocco

et al. 2021

Journal of Endourology

View full text Add to dashboard Cite

Introduction: Robotic retroperitoneal lymph node dissection (R-RPLND) is a challenging procedure. We hypothesized that surgical times and operative complications would decrease as surgeons became more facile with R-RPLND. Materials and Methods: We retrospectively reviewed 121 consecutive R-RPLNDs performed at Naval Medical Center San Diego and Mayo Clinic Arizona by 4 fellowship trained robotic surgeons between 2008 and 2018. Linear regression was used to analyze independent predictors of setup time, operative time, and lymph node counts. Logistic regression was used to analyze open conversions, overall complications, and high-grade complications. Variables included as independent predictors were: sequential case number, surgeon, clinical stage, chemotherapy status, RPLND template, and body mass index. Univariate and multivariate analyses were conducted. Statistical significance was established at a = 0.05. Results: There was no change in setup time with case number ( p = 0.317), but differences were noted between surgeons. Operative times decreased with increasing case number ( p < 0.001) but were negatively affected by clinical stage III testis cancer ( p = 0.029) and history of chemotherapy exposure ( p = 0.050). Surgical times are predicted to decrease by 1 hour after 44 cases. Lymph node counts were dependent only on the surgeon. No factors were predictive of open conversions. Fewer overall complications occurred as experience was gained ( p = 0.001), but high-grade complications could not be predicted. Conclusions: Consistent with the learning curves shown for other technologically advanced surgical techniques, experience appears to improve surgical times and lower complication rates for R-RPLND.

show abstract

Robotic Transperitoneal Infrarenal Para-Aortic Lymphadenectomy With Double Docking: Technique, Learning Curve, and Perioperative Outcomes

Cited by 15 publications

References 20 publications

Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy?

Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy?

The role of robotic aortic lymphadenectomy in gynecological cancer: surgical and oncological outcome in a single institution experience

Learning Curve for Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection

Contact Info

Product

Resources

About