Initial experience of laparoendoscopic single-site radical prostatectomy with a novel purpose-built robotic system

Objective This prospective single-arm clinical trial aimed to evaluated the feasibility and safety of the application of the SHURUI system(Beijing Surgerii Technology Co.,Ltd.,Beijing,China),a novel purpose-built robotic system,in single-port robotic radical prostatectomy.Methods Sixteen patients diagnosed with prostate cancer were prospectively enrolled in and underwent robotic radical prostatectomy from October 2021 to August 2022 by the SHURUI single-port robotic surgical system.The demographic and baseline data,surgical,oncological,and functional outcomes as well as follow-up data were recorded.Results The mean operative time was 226.3(standard deviation[SD]52.0)min,and the mean console time was 183.4(SD 48.3)min,with the mean estimated blood loss of 116.3(SD 90.0)mL.The mean length of postoperative hospital stay was 4.50(SD 0.97)days.Two patients had postoperative complications(Clavien-Dindo Grade II),and both patients improved after conservative treatment.All patients’postoperative prostate-specific antigen levels decreased to below 0.2 ng/mL 1 month after discharge.The mean prostate-specific antigen level further decreased to a mean of 0.0219(SD 0.0641)ng/mL 6 months after surgery.Thirty days postoperatively,12 out of 16 patients reported using no more than one urinary pad per day,and all patients reported satisfactory urinary control without the need for pads 6 months after surgery.Conclusion The SHURUI system is safe and feasible in performing radical prostatectomy via both transperitoneal and extraperitoneal approaches.Tumor control and urinary continence were satisfying for patients enrolled in.The next phase involves conducting a large-scale,multicenter randomized controlled trial to thoroughly assess the effectiveness and safety of the new technology in a broader population.

Laparoendoscopic Single-Site Combined Hysterectomy and Nephrectomy in Deep Infiltrating Endometriosis

Within the advance ports and instruments, laparoendoscopic single-site (LESS) surgery has been increasingly used among gynaecologic surgeons. In addition, advanced port systems have enabled to perform concomitant surgical procedures via transumbilical incision. However, combined surgical operations are rarely reported in the literature, particularly in gynaecology. This case report presents a 42-year-old woman who undergo concomitant LESS hysterectomy and nephrectomy due to deep infiltrating endometriosis (DIE) and end stage renal disease. The operation is performed in approximately 3 hours without any complications, and the patient is discharged on postoperative third day. This case demonstrates that complex concomitant operations even in a patient with DIE can be performed using a LESS surgical approach.

Laparoendoscopic single-site distal pancreatectomy in pigs

AIM:To explore the technique for laparoendoscopic single-site distal pancreatectomy.METHODS:Laparoendoscopic single-site spleenpreserving distal pancreatectomy was performed in pigs using a novel flexible multichannel port,a curved laparoscopic multifunctional operative device and a fish hook retractor,which provided a favorable operative field.RESULTS:Six pigs were involved in this study,and five survived the procedure.The first animal died following injury to the superior mesenteric vein and uncontrolledintraoperative bleeding.Except for this failure,the mean operative time was 155 min(range:102-236 min).A steep learning curve was observed in the study,with a mean operative time of 177 min in the first two operations vs 134 min in the last three operations.The mean blood loss was 50 mL,and the postoperative course was uneventful.The animals were sacrificed three weeks after the procedures,and no pancreatic leakage or abdominal infection was found macroscopically.CONCLUSION:Laparoendoscopic single-site distal pancreatectomy is a safe and feasible procedure and can be implemented in humans in selected cases at qualified surgical centers.

Transumbilical laparoendoscopic single-site surgery of simple nephrectomy of nonfunctioning kidney: a two-year experience

Background: Laparoendoscopic single-site surgery (LESS) may serve as a potential alternative to conventional laparoscopy and is developing quickly, but still in its infancy. The study is to present our two-year experience in transumbilical LESS simple nephrectomy (LESS-SN) for non-functioning kidney, in an effort to evaluate its feasibility, clinical outcomes and potential advantages. Methods: From December 2008 to December 2010, a total of 11 patients with body mass index (BMI) ≤30 underwent transumbilical TriPort TM LESS-SN by a single experienced urologist at our institution. The indications for nephrectomy included nonfunctioning kidney associated with ureteropelvic junctionstricture (n=1), ureteral calculi (n=6), tuberculosis (n=3), and ureteral stricture (n=1). Patient demographics, perioperative and follow-up data were prospectively collected and analyzed. Results: Ten procedures were successfully completed with one patient converted to open surgery due to uncontrollable bleeding. The mean operative time was 189.2 (ranging 100~320 min) with an estimated blood loss of 204.5 (ranging 50-1 000 ml). There were two complications of bleeding (1- intra-, 1- post-). The mean hospitalization after surgery was 7.9 d (ranging 4-17 d). With a regular follow-up of 1, 6, 12, and 24 months after surgery, all patients remained symptom-free with an intra-umbilical scar. Conclusion: Transumbilical LESS simple nephrectomy for nonfunctioning kidney can be accomplished with favorable surgical outcomes and a superiority of cosmesis. However, cases with chronic inflammation are not suitable for initial up-take and should only be attempted by the very experienced laparoscopist.

Robotic laparoendoscopic single-site surgery(R-LESS) ：current status in urology

Laparoendoscopic single-site surgery(LESS)is technically challenging;it can reduces instrument triangulation and robust retraction and is associated with a steep learning curve.The instruments of the daVinci  surgical system(Intuitive Surgical)are designed with seven degrees of motion mimicing the dexterity of the human hand and wrist.This inherent feature of the robotic arm provides superior ergonomics when performing LESS,especially for complex reconstructive surgery.This review analyzes the evidence supporting current and future application of robotic technology in the field of urologic LESS.

A Comparison between Laparoendoscopic Single-Site and Conventional Laparoscopic Renal Stone Removal Surgery: A Study of Application in Two Cases

Aim: To present our initial experience of applying laparoendoscopic single-site surgery (LESS) nephrolithotomy in the treatment of renal calculi. Methods: In August 2010 and April 2012, the LESS nephrolithotomy technique was applied to treat two patients with a renal calculus. One patient had a calculus measuring 5 × 3 cm, and the second patient's measured 3 × 3 cm. Both patients underwent general anesthesia. The operations were performed through a retroperitoneal approach with a single-port instrument inserted through the retroperitoneal incision. The standard laparoscopic retroperitoneal technique was performed, and the calculi were removed by incising the area of the thin renal cortex and the renal pelvis, respectively. The operating time, estimated blood loss, intraoperative complications, other complications, drainage time, and post-operative hospital stay were recorded. Results: Both procedures were completed successfully. No additional trocars were added. No conversion to standard laparoscopic or open surgery was needed. The operating times were 130 min and 120 min, and the estimated blood losses were 40 mL and 30 mL. There were no intraoperative complications. The wound drainage times were 3 d and 2 d, respectively and the post-operative hospital stays were 8 d and 7 d, respectively. There was no secondary bleeding or wound infection. Follow-up times were 2 years and 3 months, respectively. No incidence of hydronephrosis was recorded. Conclusions: LESS nephrolithotomy is safe and feasible for treating kidney calculi. It can be applied in patients with large renal calculi and regionally thin renal parenchyma.

Transumbilical laparoendoscopic single-site surgery(LESS) partial nephrectomy:a median follow-up of 2 years

Objective:Nephron-sparing surgery(NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis;LESS is developing quickly and its indications have been expanded,but still in its infancy.The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy(LESS-PN),so as to assess its utility, safety and efficacy.Methods:From August 2009 to October 2010,3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution.Patient demographics,perioperative and follow-up data were prospectively collected and analyzed.Results:All the three procedures were successfully completed.A 5-mm ancillary trocar was utilized in all 3 cases.The mean operative duration was 226.3(210-254 min) with an estimated blood loss of 56.7 ml (20-100 ml).Mean warm ischemia time was 35.7 min(19-48 min).One patient was transfused due to postoperative bleeding. The recovery was uneventful and mean length of postoperative stay was 13 days(12-14 days).At the latest follow-up,all patients remained symptom-free and had normal renal function without evidence of recurrence,and they were delighted for a hidden transumbilical scar.Conclusion:Transumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging.Surgical outcomes at a median follow-up of 2 years are promising,while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.

Comparison of surgical effect and postoperative patient experience between laparoendoscopic single-site and conventional laparoscopic varicocelectomy, a systematic.review and meta-analysis

The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy （LESSV） and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design （RCT and non-RCT）. The odds ratio （OR） or standardized mean difference （SMD） and their 95% confidence intervals （95% CIs） were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work （overall： SMD = -1.454, 95% Ch -2.502m0.405, P= 0.007; non-RCT： SMD = -2.906, 95% Ch -3.796-2.017, P= 0.000; and RCT： SMD = -0.841, 95% Ch -1.393-0.289, P = 0.003） and less pain experience at 3 h or 6 h （SMD = -0.447, 95% Ch -0.754-0.139, P = 0.004）, day 1 （SMD = -0.477, 95% Ch -0.905-0.05, P = 0.029）, and day 2 （SMD = -0.612, 95% Ch -1.099-0.125, P= 0.014） postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect （improvement of semen quality and scrotal pain relief）, and complications （hydrocele and recurrence） yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.

Transurethral assistant transumbilical laparoendoscopic single-site radical prostatectomy

The laparoendoscopic single-site （LESS） technique is the latest technical innovation in laparoscopic surgery to undergo exponential development in urology. This study undertaken to illustrate our initial experience LESS radical prostatectomy （RP） and analyze early outcomes. Nineteen patients diagnosed with prostate cancer underwent LESS-RP in our institute. The patients were divided into two groups： conventional LESS and transurethral assistant LESS. Preoperative, perioperative, postoperative, pathologic, and functional outcomes data were assessed. With the help of a transurethral assistant, the mean operation and anastomosis time were decreased markedly. No focal positive margins were encountered. No prostate-specific antigen recurrence was detected 1 month postoperatively. Complete continence recovery （no pad） was observed in 32% of the patients at 1 month after the operation. No intraoperative and postoperative complications were reported, LESS-RP is a feasible and effective surgical procedure for treatment of prostate cancer. Moreover, transurethral assistant LESS could reduce the difficulty of LESS-RP and shorten the operation time.

Laparoendoscopic single-site radical prostatectomy： technique and initial outcomes

Background Laparoendoscopic single-site surgery radical prostatectomy （LESS-RP） is a challenging urological procedure and needs to be further evaluated. This study was undertaken to illustrate the safety and initial results of pure LESS-RP with conventional available instruments.

Preliminary experience with transperitoneal laparoendoscopic single-site radical nephrectomy using a home-made single-port device in China

Background Laparoendoscopic single-site （LESS） surgery represents a technique to further reduce morbidity and scarring associated with surgery.We present our preliminary experience with transperitoneal LESS radical nephrectomy （RN） using a home-made single-port device in China.Methods From July 2010 to November 2011,eleven patients with renal tumor not greater than T2 underwent LESS-RN by an experienced laparoscopic surgeon.A home-made single-port device was used through a 5-cm umbilical incision.A combination of standard and articulating laparoscopic instruments was used.The sequence of steps of LESS-RN was similar to transperitoneal laparoscopic RN.Patient characteristics,perioperative variables and postoperative outcomes were recorded and analyzed.Results Except for two transperitoneal laparoscopic conversions and one hand-assisted laparoscopic conversion,the other procedures were completed successfully without conversion to open surgery.The mean operative time was 224.5 （155-297） minutes,estimated blood loss was 270.9 （50-900） ml,and hospital stay was 10.4 （5-15） days.The mean visual analog pain scale （VAPS） on the first postoperative day was 4.0/10.Final pathological analysis revealed renal cell carcinoma in all cases with a stage distribution of three T1a,five T1b,and three T2a tumors.With the mean followup period of 21.4 （12-28） months,all patients were alive without evidence of tumor recurrence or metastasis,and were satisfied with the appearance of the scars.Conclusion Transperitoneal LESS-RN using a home-made single-port device is technically feasible and safe in a selected group of patients （low body mass index and stage tumor） and has excellent cosmetic results.Although preliminary oncologic outcome is not compromised,the long-term evaluation of these patients is awaited.

A Single-Site Positioning Method Based on TOA and DOA Estimation Using Virtual Stations in NLOS Environment

This paper presents a single-site positioning method based on the joint estimation of propagation time-of-arrival(TOA) and direction-of-arrival(DOA), with the assist of virtual stations in the typical non-line-of-sight(NLOS) environment. Consider the influence of multipath noise on the positioning performance, the proposed method firstly presents a modified high-resolution estimation technique called Multipath noise Limiting Matrix Pencil(MLMP) algorithm to achieve the TOA/DOA estimations, in which the matrix pencil and matrix enhancement process are implemented to deal with the measurements from the uniform linear array(ULA) receiver. Meanwhile, the subspace dimension estimation is improved via an adaptive threshold, for enhancing the performance of high-resolution techniques in low signal-noise-ration(SNR) situation. Next the proposed method generates virtual stations utilizing the known floor plan of surrounding reflectors, and adopts a weighted Least Square(WLS) position estimator to calculate the required position, combining the TOA/DOA estimations with the location of virtual stations. Simulations are conducted to evaluate the proposed method under NLOSconditions, and the results show that comparing with the multipath fingerprinting scheme, the proposed method has better performance in various simulation scenarios.

Current status of laparoendoscopic rendezvous in the treatment of cholelithiasis with concomitant choledocholithiasis

The current evidence in favor of the laparoendoscopic rendezvous is promising and demonstrates the main advantages of this technique in regard to shorter hospital stay and selective cannulation of the commonbile duct(CBD), avoiding thus the inadvertent cannulation of the pancreatic duct. In addition, in the rendezvous technique the contrast medium is not injected retrogradely as during the traditional endoscopic retrograde cholangiopancreatography(ERCP), when the medium accidentally could be injected under pressure into the pancreatic duct. The RV technique minimizes that risk. Both these main advantages of the RV technique over the classic ERCP, are related with a significant lower incidence of hyperamylasemia and post-ERCP pancreatitis, compared with the traditional two stage procedure. Choledocholithiasis is present in 10% to 15% of patients undergoing cholecystectomy. To date, the ideal management of CBD stones remains controversial. Prospective randomized trials have shown that laparoscopic management of the CBD stones, as a single stage procedure, is the most efficient and cost effective method of treatment. Laparoendoscopic rendezvous has been proposed as an alternative single stage approach. Several studies have shown the effective use of this technique in the treatment of CBD stones by improving patient compliance and clinical results including shorter hospital stay, higher success rate and less cost. The current evidence about the use of this technique presented in this review article is promising and demonstrates the main advantages of the procedure.

Robotic single-site supracervical hysterectomy with manual morcellation:Preliminary experience

AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016.We evaluated the feasibility,safety and outcomes among these patients.RESULTS The mean surgical time was 244 min and the estimated blood loss was 216 mL,with no blood transfusion necessitated.The docking time was shortened gradually from 30 to 10 min.We spent 148 min on console operation.Manual morcel ation time was also short,ranging from 5 to 10 min.The mean hospital stay was 5 d.Lower VAS pain score was also noted.There is no complication during or after surgery.CONCLUSION RSSSH is feasible and safe,incurs less postoperative pain and gives good cosmetic appearance.The technique of inbag,manual morcellation can avoid tumor dissemination.

Laparoendoscopic single site,laparoscopic or open surgery for adrenal tumors:Selecting the optimal approach

Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy(OS-A), minimally-invasive adrenalectomy(MI-A), and laparoendoscopic single-site adrenalectomy(LESS-A) remain unclear. A comprehensive Englishlanguage literature review was performed using MEDLINE/Pub MED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors(> 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors(< 4-5 cm), including pheochromocytoma and isolated adrenal metastases.

Single-site laparoscopic partial nephrectomy: Where are we going?

AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.

郑氏4C悬吊法经脐单孔腹腔镜手术治疗宫颈癌的疗效及预后分析

目的探讨郑氏4C悬吊法经脐单孔腹腔镜手术(TU-LSSS)治疗宫颈癌的疗效,并分析其预后。方法选取我院收治的宫颈癌患者92例,并随机分为对照组(传统腹腔镜术)和观察组(郑氏4C悬吊法TU-LSSS),每组46例。比较2组患者围术期相关指标。随访3年,记录患者无进展生存期(PFS)和总生存期(OS),并分析预后的影响因素。结果与对照组比较,观察组患者手术时间更长(P<0.05),术中出血量更少(P<0.05),术后肠鸣音恢复时间、住院时间更短(P<0.05),术后3年PFS率、3年OS率更高(P<0.05)。随访3年,疾病进展或死亡共11例。经单因素分析,预后良好组与预后不良组患者肿瘤直径、临床分期、淋巴结转移、脉管浸润、治疗方法比较,差异有统计学意义(P<0.05);二元Logistic回归分析显示,肿瘤直径(≥4 cm)、临床分期(≥ⅠB2期)、淋巴结转移、脉管浸润是宫颈癌预后的危险因素(P<0.05),郑氏4C悬吊法TU-LSSS是保护因素(P<0.05)。结论郑氏4C悬吊法TU-LSSS治疗宫颈癌可有效促进患者恢复,提高3年PFS率和OS率。预后与多种因素有关,需根据不同危险因素给予针对性处理。

机器人辅助经腹膜后入路单孔腹腔镜下活体供肾切取术:全球首例报道(附视频)

南京医科大学第二附属医院泌尿外科于2023年5月收治1例“左侧供肾”患者,完成了首例机器人辅助经腹膜后入路单孔腹腔镜下活体供肾切取术,该术式国内外尚无相关报道。手术顺利完成,未增加额外切口,术前机器人定位时间8 min,手术时间83 min,术中出血20 ml,热缺血时间3 min,冷缺血时间131 min。供肾动脉长3.5 cm,静脉长5.1 cm,输尿管长15 cm。皮肤切口长度为6 cm。供者术后复查肾功能正常,无任何围手术期并发症,术后3 d出院。肾移植术中再通血流后,移植肾色泽良好,张力正常,30 s后即有尿液流出,受者术后2 d血肌酐降至正常,未出现移植肾功能延迟恢复。结果表明,机器人辅助经腹膜后入路单孔腹腔镜下活体供肾切取术具有安全、可靠、创伤小、恢复快、体表切口美观等优势,具有良好的临床应用前景。

三种腹腔镜手术在异位妊娠治疗的临床对比研究

目的比较经阴道自然腔道内镜手术(transvaginal natural orifice transluminal endoscopic surgery,v-NOTES)、经脐单孔腹腔镜手术(transumbilical laparoendoscopic single site surgery,TU-LESS)及传统腹腔镜手术治疗异位妊娠的疗效与差异。方法回顾性选取2019年6月至2022年6月扬州大学医学院附属扬州市妇幼保健院收治的异位妊娠患者121例,根据手术方式不同将纳入患者分为传统腹腔镜组(49例)、TU-LESS组(43例)和v-NOTES组(29例)。观察各组患者的年龄、体质量指数(body mass index,BMI)、血红蛋白(hemoglobin,Hb)、手术时间、术中出血、术后排气时间、术后24h视觉模拟评分法(visual analogue scale,VAS)评分、术后住院时间和满意度。结果v-NOTES组患者的排气时间、术后住院时间均显著短于传统腹腔镜组和TU-LESS组,术后24h VAS评分显著低于传统腹腔镜组和TU-LESS组(P<0.05);三组患者的术后满意度比较差异有统计学意义(H=57.364,P<0.001),且v-NOTES组>TU-LESS组>传统腹腔镜组。结论与TU-LESS和传统腹腔镜手术比较,v-NOTES治疗异位妊娠术后恢复快,疼痛轻,更加美观,但需要手术者熟练掌握。

机器人辅助单孔腹腔镜前列腺根治性切除术在中高危前列腺癌患者中的应用(附视频)

目的:探讨机器人辅助单孔腹腔镜前列腺根治性切除术在中高危前列腺癌患者中的临床疗效。方法:回顾性收集南京医科大学第二附属医院2022年9月—2023年9月收治的56例中高危前列腺癌患者临床资料,根据手术方法不同将患者分为对照组和观察组,对照组应用传统单孔腹腔镜前列腺根治性切除术,观察组采用机器人辅助单孔腹腔镜前列腺根治性切除术,收集并分析两组患者的围手术期资料。结果:观察组的手术时间、术中出血量、术后住院时间均低于对照组(P<0.05);两组患者在术后并发症发生率、切缘阳性率以及病理分级比较差异均不显著(P>0.05)。结论:机器人辅助单孔腹腔镜前列腺根治性切除术具有手术创伤小、术后恢复快等优点,其用于治疗中高危前列腺癌患者是安全可行的。