Robot-assisted laparoscopic adrenalectomy: preliminary UK results

OBJECTIVE: To describe the results of our first two cases of laparoscopic adrenalectomy using the da Vinci surgical system (Intuitive Surgical, Inc., Mountain View, CA, USA). PATIENTS AND METHODS: Amongst 75 robot-assisted procedures performed at our institution, two patients underwent robot-assisted laparoscopic adrenalectomy. The set-up time, procedure time, hospital stay, complications and outcomes were recorded. RESULTS: Both operations were completed successfully using the robot; the mean (range) set-up time was 31 (25-37) min and mean procedure time 118.5 (107-130) min. One patient had a postoperative pulmonary embolus and was discharged 5 days after surgery; the second patient was discharged after 3 days. There were no intraoperative complications; both patients were well at the 1-year follow-up. CONCLUSIONS: Robot-assisted laparoscopic adrenalectomy is technically feasible and can be conducted efficiently and safely with the da Vinci surgical system.     

Robot‐assisted radical prostatectomy in men aged ≥70 years

OBJECTIVES

To assess the outcomes of elderly men with prostate cancer treated with robot‐assisted radical prostatectomy (RARP), because more healthy elderly men will present with localized prostate cancer and many will seek surgical treatment as the population ages.

PATIENTS AND METHODS

Between 2005 and 2008, 203 men had RARP performed by one surgeon; patients were categorized into two groups based on their age (≥70 vs <70 years). All data were recorded prospectively in an institutional approved database.

RESULTS

Of the 203 men, 23 (11%) were aged ≥70 years; the older men had similar baseline characteristics as younger men, and had characteristics during and after surgery comparable to those in younger men. The pathological RARP Gleason grade was significantly greater in older men. Surgical complications were not significantly different between the groups. Continence rates were significantly lower in older men at 6 months after surgery, but returned to levels equivalent to those in younger men within 12 months after surgery. Older patients took significantly longer to be capable of driving after surgery.

CONCLUSIONS

The outcomes of RARP in elderly men are largely comparable to those in younger men, with the exception of higher pathological Gleason grade, a transient delay in return of continence, and taking longer to return to driving after surgery. Advanced chronological age should not be a contraindication for RARP in patients with clinically localized prostate cancer, but expectations should be managed preoperatively.     

Techniques in laparoscopic donor nephrectomy

What's known on the subject? and What does the study add? Innovations in laparoscopic surgery have provided transplant surgeons with a range of techniques as well as a vast array of minimally invasive instruments. Whilst randomized control trials have compared open and laparoscopic donor nephrectomy, there is a paucity of high quality data comparing different laparoscopic approaches. This article summarizes the main techniques of laparoscopic donor nephrectomy currently in use and reviews the evidence available for each. In addition, controversial aspects of donor nephrectomy are examined, including the technological advances applicable to this operation. Increasing numbers of living donor kidney transplants are being performed worldwide, and the majority of donor operations are now laparoscopic. Transperitoneal ‘pure’ and hand‐assisted laparoscopic donor nephrectomy are the two most commonly performed procedures, although retroperitoneal approaches are advocated by some centres. Controversy persists with respect to the technical aspects of donor nephrectomy, including both the approach and the method of ligation of the hilar vessels. More recently, robot‐assisted, laparo‐endoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) ‐assisted donor nephrectomy have also been performed, further increasing the number of options available, but creating uncertainty as to the ideal approach.     

Does the presence of significant risk factors affect perioperative outcomes after robot‐assisted radical cystectomy?

OBJECTIVE

To evaluate the effect of preoperative risk factors on perioperative outcomes up to 3 months after robot‐assisted radical cystectomy (RARC), as RC continues to be associated with a high rate of morbidity and mortality.

PATIENTS AND METHODS

From 2005 to 2007, 66 consecutive patients had RARC at Roswell Park Cancer Institute. Patient demographics, preoperative risk factors and complications up to 3 months after RARC were reviewed from a prospective quality‐assurance database. Patients were stratified into high‐ and low risk groups based on age, previous abdominal surgery, chronic obstructive pulmonary disease (COPD), body mass index (BMI), Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiologists (ASA) score.

RESULTS

Age, previous abdominal surgery, COPD, BMI, RCRI score and ASA score did not significantly influence complications during or up to 3 months following RARC (P > 0.05). Advanced age was associated with a higher RCRI score (P = 0.014) and an increased likelihood of admission to the Intensive Care Unit (P = 0.007). A higher ASA score was associated with an increased overall hospital stay (P = 0.039). Previous abdominal surgery was associated with more frequent unscheduled postoperative clinic visits (P = 0.014). Operative duration did not significantly influence complication rates (P > 0.05). Fifteen of 62 patients (24%) had a major complication, while 15 (24%) had minor complications within 3 months of surgery. The reoperation rate was 11% and the overall mortality rate was 1.6%.

CONCLUSIONS

RARC appears to be well tolerated, independent of comorbid risk factors such as age, BMI, RCRI and ASA score.