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.

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 TriPortTM LESS-SN by a single experienced urologist at our institution. The indications for nephrectomy included nonfunctioning kidney associated with ureteropelvic junction stricture （n=l）, ureteral calculi （n=6）, tuberculosis （n=3）, and ureteral stricture （n=l）. 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.

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.

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.

Synchronous bilateral laparoendoscopic single-site urological surgeries via the umbilicus:a report of 2 cases

Objective： To describe two cases of bilateral transumbilical laparoendoscopic single-site（LESS） surgeries in a single operative session and assess the safety, feasibility and efficacy. Methods： One patient underwent right ureterolithotomy and left varicocelectomy, and the patient was performed with right simple nephrectomy for nonfunctioning kidney due to ureteral calculus and left ureterolithotomy using a novel multichannel TriPortTM via a single 2-3 cm transumbilical incision Results： The right-side ureterolithotomy and left-side varicocelectomy were finished in 229 minutes, with a total estimated blood loss of 50 hal. The right-side simple nephrectomy and left-side ureterolithotomy in the other patient were finished in 340 minutes, with a total estimated blood loss of 100 ml. There were no major complications. At the latest follow-up, both patients remained symptom-free and there were no evidences of recurrence. Both of them were delighted for the single scarConclusion： Synchronous LESS urologic procedure via a single umbilical incision is technically feasible, safe and efficacious with a promising potential

Laparoendoscopic single-site distal pancreatectomy in pigs

AIM: To explore the technique for laparoendoscopic single-site distal pancreatectomy.

Duplicated inferior vena cava in a patient undergoing right transumbilical laparoendoscopic single-site (LESS) radical nephrectomy

LaparoEndoscopic Single-site(LESS) renal surgery emerging as a potential alternative to conventional laparoscopy,is technically challenging and the major vascular anomaly may increase the risk of intraoperative haemorrhage.Herein,we present a case of right transumbilical LESS radical nephrectomy which was successfully performed in the presence of double inferior vena cava and duplicated the standard laparoscopic techniques.Most importantly,to bring such an aberrant vascular anatomy to the attention of laparoscopic,especially LESS surgeons with high resolution pictorial illustrations.

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,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.

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.

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。

达芬奇机器人SP系统在泌尿外科的应用与发展

达芬奇机器人SP系统是一种智能化微创手术系统,其立体化、精准化的优势将有助于完成高难度、复杂手术。达芬奇机器人SP系统是单孔领域的一大助力,并已广泛应用于泌尿外科。与传统开腹手术相比,微创手术具有缩短住院时间和加速患者术后恢复等优势。为了减少手术切口,并在一定程度上满足现代美学要求,单孔腹腔镜手术(LESS)在临床应用甚广,但LESS在一定程度上存在器械间相互干扰,影响手术操作,进而限制了LESS在临床的进一步应用,这就要求符合美学概念和对器械三维关系影响小的新器械出现。因此更符合人体构造学及更具三维立体感的达芬奇机器人SP系统应运而生。达芬奇机器人SP系统规避了LESS的一些风险,并结合了达芬奇机器人系统与单切口的优势,近年来被广用于泌尿外科领域,本文就达芬奇机器人SP系统在泌尿外科领域的发展和应用进行综述。

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。

达芬奇Xi手术机器人辅助单孔腹腔镜治疗早产低体重儿十二指肠梗阻:全球首例报道(附手术视频)

本文报道了2023年4月武汉大学中南医院小儿外科应用达芬奇Xi手术机器人辅助单孔腹腔镜治疗新生儿十二指肠梗阻1例,术中同时完成两处异位胰腺病灶切除。患儿胎龄35-1w,剖宫产,出生体重2090 g,出生后50 h进行手术。手术机器人操作时间76 min,术中出血量约5 ml,术后6 d试进水,术后8 d开奶,并逐步恢复至母乳喂养,间断复查腹部彩超3次,未见明显异常,术后16 d痊愈出院。

妇科经自然腔道单孔手术发展现状与未来方向

经自然腔道单孔内镜手术创伤小,美容效果好,术后康复快,并发症发生率低,符合现代无瘢痕、无痛的微创理念,是妇科微创外科的发展方向。妇科经自然腔道单孔内镜手术主要分为经脐入路与经阴道入路。经阴道入路腹部无瘢痕,切口愈合快,术后疼痛程度低,并发症发生率低,是目前妇科微创手术的研究热点。近年来,机器人手术系统快速发展,与经自然腔道单孔内镜手术结合可实现三维成像放大术野,灵活的机械臂实现复杂手术操作,拓宽了手术适应证,提高了手术精准度,被认为是微创手术的革命性突破。该文就妇科经自然腔道单孔手术发展现状与未来方向进行阐述。

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。

不同时机超声引导腹直肌鞘阻滞对术后镇痛的影响

目的探讨单孔腹腔镜妇科手术超声引导腹直肌鞘阻滞的最佳时机。方法选取2021年8月至2022年1月温州医科大学附属第二医院妇科病房63例择期行单孔腹腔镜下妇科良性肿物切除手术的患者为研究对象,根据随机数字表法将其分为E组(32例)和O组(31例),剔除3例,最终纳入60例,每组各30例。E组患者采用术前超声引导腹直肌鞘阻滞,O组患者采用术后超声引导腹直肌鞘阻滞。比较两组患者拔管后即刻(T_(1))、术后12h(T_(2))、术后24h(T_(3))静息、活动状态的数字疼痛量表(numerical rating scale,NRS)评分;比较两组患者术中切皮前后的平均动脉压及心率;比较两组患者术中瑞芬太尼使用量、术后羟考酮使用量、术后镇痛补救率;比较两组患者入室时长及手术时长;记录两组患者神经阻滞并发症的发生情况。结果整体分析发现:两组患者静息NRS评分时间点比较及交互作用差异均有统计学意义(P<0.05),活动NRS评分时间点比较差异有统计学意义(P<0.05)。进一步两两比较,组内比较:O组患者T_(2)、T_(3)时点静息NRS和活动NRS评分均显著低于T_(1)时点(P<0.05);E组患者T_(3)时点静息NRS评分显著低于T_(1)时点,T_(2)、T_(3)时点活动NRS评分均显著低于T_(1)时点(P<0.05)。组间比较:E组患者T_(1)时点静息NRS和活动NRS评分均显著低于O组(P<0.05)。切皮后,O组患者的平均动脉压显著高于本组切皮前,心率显著快于本组切皮前(P<0.05)。两组均无腹腔穿刺、穿刺点感染、局部麻醉药中毒等情况发生。结论单孔腹腔镜妇科手术中,术前超声引导下腹直肌鞘神经阻滞,在术后早期可为患者提供更佳的镇痛效果,且患者术中切皮前后心率和平均动脉压变化更小,值得推荐。