Single Port vs Multiport Robotic Pyeloplasty: Propensity-Score Matched Analysis of Perioperative and Follow-Up Outcomes

Harrison, Robert; Ahmed, Mutahar; Billah, Mubashir; Caviasco, Christina; Cheng, Nathan; Sanders, A. B.; Lovallo, Gregory; Stifelman, Michael

doi:10.1016/j.urology.2021.09.038

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…Consequently, outcomes obtained with the SP approach are readily comparable to those obtained with the MP approach. An extremely low EBL was observed in this series, as it was in previous studies (6,7,9), confirming the safety of this procedure. Moreover, no postoperative complications were registered, and all the patients were discharged on postoperative day one, following an internal protocol, with a median LOS of 31 hours and a median DVPRS score of 4.…”

Section: Commentssupporting

confidence: 90%

“…For what concerns intraoperative outcomes, Bekcsac et al reported an OT of 159 min, with 22.27 mL of EBL, with no significant difference compared to multi-port (MP) approach (7). Interestingly, in a larger series recently published by Harrison et al the OT was significantly longer for SP RAP, compared to MP RAP (128 min vs 88 min, p=.04), with no difference in terms of EBL (6).…”

Section: Commentsmentioning

confidence: 99%

“…With the aim of minimizing skin incision and working in smaller spaces while retaining the advantages of robotic instruments, the Da Vinci Single Port (SP) system (Intuitive Surgical, Sunnyvale, CA™) has gained popularity among surgeons trained in robotic procedures and is currently adopted for many urologic procedures. Preliminary data with this approach reveal encouraging results, demonstrating perioperative and intermediate-term outcomes comparable to standard MP robotic-assisted pyeloplasty (6,7). Nonetheless, up to date, the available literature on SP pyeloplasty in adults is limited to retrospective studies, consisting mainly of initial clinical experiences and small case series.…”

Section: Introductionmentioning

confidence: 99%

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Single Port Robotic Pyeloplasty: early single-center experience

Ditonno,

Franco,

Manfredi

et al. 2023

Int. braz j urol.

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Purpose: Ureteropelvic junction obstruction (UPJO) is a prevalent cause of hydronephrosis, especially in young patients. The treatment paradigm for this condition has shifted from open to minimally invasive pyeloplasty. In the present study we describe our initial single centre experience with single port (SP) robot-assisted pyeloplasty (RAP) via periumbilical incision. Material and methods: With the patient in a 60-degree left flank position, the SP system is docked with the Access port (Intuitive Surgical, Sunnyvale, CA, US) placed in a periumbilical 3 cm incision. Robotic instruments are deployed as follows: camera at 12 o'clock, bipolar grasper at 9 o'clock, scissors at 3 o'clock and Cadiere at 6 o'clock. After isolation and identification of the ureter and the ureteropelvic junction (UPJ), the ureter is transected at this level and then spatulated. Anastomosis is carried out by two hemicontinuous running sutures, over a JJ stent. Results: Between 2021 and 2023, a total of 8 SP RAP have been performed at our institution, with a median (interquartile range, IQR) of 23 years (20.5-36.5). Intraoperative outcomes showed a median (IQR) OT of 210.5 minutes (190-240.5) and a median (IQR) estimated blood loss (EBL) of 50 mL (22.5-50). No postoperative complications were encountered, with a median (IQR) length of stay (LOS) of 31 hours (28.5-34). Conclusion: In the present study we evaluated the feasibility and safety of SP RAP. The observed outcomes and potential benefits, combined with the adaptability of the SP platform, hold promising implications for the application of SP system in pyeloplasty treatment.

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Section: Commentssupporting

confidence: 90%

Section: Commentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Single Port Robotic Pyeloplasty: early single-center experience

Ditonno,

Franco,

Manfredi

et al. 2023

Int. braz j urol.

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“…Not surprisingly, an extremely low EBL was consistently observed in this series, irrespective of the chosen surgical approach for the RAP. Indeed, our results are supported by findings from a previous study, pointing out the similarity between the two techniques in terms of EBL, 9,10,17 and therefore, underscoring the safety of this procedure.…”

Section: Discussionsupporting

confidence: 90%

“…On the contrary, Harrison et al. failed to demonstrate a superiority of SP RAP over MP RAP in terms of postoperative pain and opioid use 10 . Therefore, these hypotheses require further validation through larger‐scale comparative and prospective studies to unequivocally point out the advantages related to the SP system.…”

Section: Discussionmentioning

confidence: 99%

Single port robot‐assisted pyeloplasty: An early comparative outcomes analysis

Ditonno,

Franco,

Manfredi

et al. 2024

Robotics Computer Surgery

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BackgroundThe treatment paradigm for ureteropelvic junction obstruction (UPJO) has shifted towards minimally invasive pyeloplasty. A comparison Single Port (SP) and Multi Port (MP) robot‐assisted pyeloplasty (RAP) was performed.MethodsData from consecutive patients undergoing SP RAP or MP RAP between January 2021 and September 2023 were collected and analysed. Co‐primary outcomes were length of stay (LOS), Defense and Veterans Pain Rating Scale (DVPRS), and narcotic dose. The choice of the robotic system depended on the surgeon's preference and availability of a specific robotic platform.ResultsA total of 10 SP RAPs and 12 MP RAPs were identified. SP RAP patients were significantly younger [23 years (20–34)] than MP RAP [42 years (35.5–47.5), p < 0.01]. No difference in terms of OT (p = 0.6), LOS (p = 0.1), DVPRS (p = 0.2) and narcotic dose (p = 0.1) between the two groups was observed.ConclusionsSP RAP can be implemented without compromising surgical outcomes and potentially offering some clinical advantages.

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