Feasibility study of a novel robotic system for transperitoneal partial nephrectomy: An in vivo experimental animal study
https://doi.org/10.4081/aiua.2023.11852
Accepted: October 23, 2023
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Purpose: To evaluate the safety and feasibility of partial nephrectomy with the use of the novel robotic system in an in vivo animal model. Methods: Right partial nephrectomy was performed in female pigs by a surgical team consisting of one surgeon and one bedside assistant. Both were experienced in laparoscopic surgery and trained in the use of the novel robotic system. The partial nephrectomies were performed using four trocars (three trocars for the robotic arms and one as an assistant trocar). The completion of the operations, set-up time, operation time, warm ischemia time (WIT) and complication events were recorded. The decrease in all variables between the first and last operation was calculated. Results: In total, eight partial nephrectomies were performed in eight female pigs. All operations were successfully completed. The median set-up time was 19.5 (range, 15-30) minutes, while the estimated median operative time was 80.5 minutes (range, 59-114). The median WIT was 23.5 minutes (range, 17-32) and intra- or postoperative complications were not observed. All variables decreased in consecutive operations. More precisely, the decrease in the set-up time was calculated to 15 minutes between the first and third attempts. The operative time was reduced by 55 minutes between the first and last operation, while the WIT was decreased by 15 minutes during the consecutive attempts. No complications were noticed in any operation. Conclusions: Using the newly introduced robotic system, all the advantages of robotic surgery are optimized and incorporated, and partial nephrectomies can be performed in a safe and effective manner.
Ljungberg B, Campbell SC, Choi HY, et al. The epidemiology of renal cell carcinoma. Eur Urol. 2011; 60:615-21. DOI: https://doi.org/10.1016/j.eururo.2011.06.049
Van Poppel H, Becker F, Cadeddu JA, et al. Treatment of localised renal cell carcinoma. Eur Urol. 2011; 60:662-72. DOI: https://doi.org/10.1016/j.eururo.2011.06.040
Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10 year followup. J Urol. 2000; 163:442-5. DOI: https://doi.org/10.1016/S0022-5347(05)67896-2
Tan HJ, Norton EC, Ye Z, et al. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012; 307:1629-35. DOI: https://doi.org/10.1001/jama.2012.475
Hollenbeck BK, Taub DA, Miller DC, et al. National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology. 2006; 67:254-9. DOI: https://doi.org/10.1016/j.urology.2005.08.050
Shiroki R, Fukami N, Fukaya K, et al. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy. IJU. 2016; 23:122-31. DOI: https://doi.org/10.1111/iju.13001
Stifelman MD, Caruso RP, Nieder AM, Taneja SS. Robot-assisted laparoscopic partial nephrectomy. JSLS. 2005; 9:83-6.
Salkowski M, Checcucci E, Chow AK, et al. New multiport robotic surgical systems: a comprehensive literature review of clinical outcomes in urology. Ther Adv Urol. 2023; 15:17562872231177781. DOI: https://doi.org/10.1177/17562872231177781
Avatera. Avatera system. Avatera; 2022 [13/06/2022]; Available from: https://www.avatera.eu/en/avatera-system.
Kaouk JH, Khalifeh A, Hillyer S, et al. Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur Urol. 2012; 62:553-61. DOI: https://doi.org/10.1016/j.eururo.2012.05.021
Aboumarzouk OM, Stein RJ, Eyraud R, et al. Robotic versus laparoscopic partial nephrectomy: a systematic review and metaanalysis. Eur Urol. 2012; 62:1023-33. DOI: https://doi.org/10.1016/j.eururo.2012.06.038
Dulabon LM, Kaouk JH, Haber GP, et al. Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases. Eur Urol. 2011; 59:325-30. DOI: https://doi.org/10.1016/j.eururo.2010.11.017
Komninos C, Shin TY, Tuliao P, et al. Robotic partial nephrectomy for completely endophytic renal tumors: complications and functional and oncologic outcomes during a 4-year median period of follow- up. Urology. 2014; 84:1367-73. DOI: https://doi.org/10.1016/j.urology.2014.08.012
Ricciardulli S, Ding Q, Zhang X, et al. Evaluation of laparoscopic vs robotic partial nephrectomy using the margin, ischemia and complications score system: a retrospective single center analysis. Arch Ital Urol Androl. 2015; 87:49-55. DOI: https://doi.org/10.4081/aiua.2015.1.49
Simsek A, Yavuzsan AH, Colakoglu Y, et al. Comparison of robotic and laparoscopic partial nephrectomy for small renal tumours. Arch Ital Urol Androl. 2017; 89:93-6. DOI: https://doi.org/10.4081/aiua.2017.2.93
Choi JE, You JH, Kim DK, et al. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol. 2015; 67:891-901. DOI: https://doi.org/10.1016/j.eururo.2014.12.028
Lee CU, Alabbasi M, Chung JH, et al. How far has robot-assisted partial nephrectomy reached? Investig Clin Urol. 2023; 64:435-47. DOI: https://doi.org/10.4111/icu.20230121
Pierorazio PM, Patel HD, Feng T, et al. Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology. 2011; 78:813-9. DOI: https://doi.org/10.1016/j.urology.2011.04.065
Mottrie A, De Naeyer G, Schatteman P, et al. Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol. 2010; 58:127-32. DOI: https://doi.org/10.1016/j.eururo.2010.03.045
Bourgi A, Ayoub E, Merhej S, et al. A comparison of perioperative outcomes of transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review. J Robot Surg. 2023. DOI: https://doi.org/10.1007/s11701-023-01685-w
Becker F, Van Poppel H, Hakenberg OW, et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol. 2009; 56:625-34. DOI: https://doi.org/10.1016/j.eururo.2009.07.016
Porpiglia F, Renard J, Billia M, et al. Is renal warm ischemia over 30 minutes during laparoscopic partial nephrectomy possible? Oneyear results of a prospective study. Eur Urol. 2007; 52:1170-8. DOI: https://doi.org/10.1016/j.eururo.2007.04.024
Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol. 2010; 58:340-5. DOI: https://doi.org/10.1016/j.eururo.2010.05.047
Wang L, Lee BR. Robotic partial nephrectomy: current technique and outcomes. IJU. 2013; 20:848-59. DOI: https://doi.org/10.1111/iju.12177
Benway BM, Bhayani SB, Rogers CG, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol. 2009; 182:866-72. DOI: https://doi.org/10.1016/j.juro.2009.05.037
Kowalewski KF, Neuberger M, Sidoti Abate MA, et al. Randomized Controlled Feasibility Trial of Robot-assisted Versus Conventional Open Partial Nephrectomy: The ROBOCOP II Study. Eur Urol Oncol. 2023; S2588-9311(23)00112-8. DOI: https://doi.org/10.1016/j.euo.2023.05.011
Fan S, Xu W, Diao Y, et al. Feasibility and Safety of Dual-console Telesurgery with the KangDuo Surgical Robot-01 System Using Fifth-generation and Wired Networks: An Animal Experiment and Clinical Study. Eur Urol Open Sci. 2023; 49:6-9. DOI: https://doi.org/10.1016/j.euros.2022.12.010
Xu W, Dong J, Xie Y, et al. Robot-Assisted Partial Nephrectomy with a New Robotic Surgical System: Feasibility and Perioperative Outcomes. J Endourol. 2022; 36:1436-43. DOI: https://doi.org/10.1089/end.2022.0140
Hussein AA, Mohsin R, Qureshi H, et al. Transition from da Vinci to Versius robotic surgical system: initial experience and outcomes of over 100 consecutive procedures. J Robot Surg. 2023; 17:419-26. DOI: https://doi.org/10.1007/s11701-022-01422-9
Prata F, Ragusa A, Tempesta C, et al. State of the Art in Robotic Surgery with Hugo RAS System: Feasibility, Safety and Clinical Applications. J Pers Med. 2023; 13:1233. DOI: https://doi.org/10.3390/jpm13081233
Gallioli A, Uleri A, Gaya JM, et al. Initial experience of robotassisted partial nephrectomy with Hugo RAS system: implications for surgical setting. World J Urol. 2023; 41:1085-91. DOI: https://doi.org/10.1007/s00345-023-04336-9
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
