ABSTRACT Introduction Robot‐assisted pyeloplasty has become a standard minimally invasive procedure for ureteropelvic junction obstruction; however, factors associated with a prolonged operation remain incompletely understood. In this study, we aimed to identify risk factors for a prolonged operation at a single institution. Methods We retrospectively reviewed the data of 100 consecutive patients who underwent robot‐assisted pyeloplasty at our institution between April 2016 and January 2026. Patients were divided into two groups based on the operative time: the prolonged group (≥ 75th percentile) and the non‐prolonged group (< 75th percentile). Clinical and anatomical variables were analyzed, and a multivariable logistic regression model was constructed to identify independent predictors of a prolonged operation. Results In the multivariable analysis, high ureteral insertion (odds ratio: 5.6; 95% confidence interval: 1.8–18.3; p = 0.0047), male sex (3.3; 1.2–9.9; p = 0.024), and preoperative ureteral stenting (3.7; 1.32–11.2; p = 0.015) were identified as significant independent predictors of a prolonged operation. Neither postoperative complication rates ( p = 0.33) nor surgical success rates ( p = 0.25) differed between the groups. Conclusion High ureteral insertion, male sex, and preoperative ureteral stenting were significant independent predictors of prolonged robot‐assisted pyeloplasty. Nonetheless, these factors were not associated with surgical success or complication rates, confirming the safety and effectiveness of robot‐assisted pyeloplasty even in challenging cases.
ABSTRACT Introduction Tumor proximity to the left brachiocephalic vein (LBCV) may affect vascular exposure and dissection during the subxiphoid approach (SXA). We investigated the association between tumor–LBCV distance and operative time in patients undergoing subxiphoid robot‐assisted or video‐assisted thoracoscopic surgery for thymoma. Methods Consecutive patients who underwent minimally invasive SXA for thymoma between 2019 and 2024 were retrospectively reviewed. The shortest tumor–LBCV distance (d‐LBCV) was measured on preoperative computed tomography. Associations of d‐LBCV and tumor size with operative time were evaluated using correlation, interaction, and multivariable linear regression analyses. Results Among 64 patients with clinical Stage I thymoma without radiological evidence of vascular invasion, 45 and 19 underwent robot‐ and video‐assisted thoracoscopic surgery, respectively. Overall, shorter d‐LBCV ( r = −0.357, p = 0.0037) and larger tumor size ( r = 0.328, p = 0.0082) were correlated with longer operative time. In multivariable analysis adjusting for tumor size, surgical platform, and surgical procedure, shorter d‐LBCV remained significantly associated with longer operative time (regression coefficient, −7.62 min per 10‐mm increase; 95% CI, −13.21 to −2.03; p = 0.008). Surgical procedure was also significantly associated with operative time, whereas tumor size and surgical platform were not. Although platform‐specific analyses showed different association patterns, interaction analyses showed no significant differences between RATS and VATS for tumor size or d‐LBCV. Conclusion Shorter d‐LBCV was independently associated with longer operative time during minimally invasive SXA for thymoma, despite adjustment for tumor size, surgical platform, and surgical procedure. d‐LBCV may provide useful anatomical information for preoperative planning; although further validation is required.
ABSTRACT Introduction Evidence on multiplatform implementation of robotic posterior retroperitoneoscopic adrenalectomy remains limited. We assessed first‐year operative performance in a high‐volume endocrine referral center experienced in laparoscopic posterior retroperitoneoscopic and robotic adrenal surgery. Methods All consecutive adults undergoing unilateral total robotic posterior retroperitoneoscopic adrenalectomy between July 2025 and July 2026 were retrospectively analyzed. Operative times, perioperative outcomes, chronological trends, cumulative sum curves, and multivariable Gamma generalized linear models were assessed. Results Thirty‐four procedures were performed: 7 with Toumai, 25 with da Vinci Xi, and 2 with da Vinci SP. Median total operative, docking, console, and procedure times were 59.0, 6.0, 19.0, and 54.0 min, respectively. One conversion to laparoscopic posterior retroperitoneoscopic adrenalectomy occurred (2.9%). Two intraoperative complications (5.9%) and two 30‐day postoperative complications (5.9%) were recorded, including one death after postdischarge acute myocardial infarction. Across the cohort, docking time decreased with consecutive case number (Spearman ρ = −0.623; p < 0.001), whereas total operative and console times did not. After adjustment for platform, body mass index, and lesion size in 32 multiport procedures, only docking time remained associated with case number (time ratio 0.980, 95% confidence interval 0.963–0.997; p = 0.021). Cumulative sum inflections occurred around Cases 7–8 but coincided with platform transition. Conclusion In this limited first‐year experience in an expert adrenal surgery program, robotic posterior retroperitoneoscopic adrenalectomy implementation was feasible across three platforms, with adaptation reflected mainly by docking optimization. Platform‐specific time differences were descriptive and cannot establish comparative efficiency because platform use was sequential and instrumentation differed across systems.
ABSTRACT Urinary bladder paraganglioma is a rare tumor associated with a risk of catecholamine‐induced hypertensive crisis during tumor manipulation. The optimal surgical approach remains uncertain, particularly for larger tumors or those with suspected local invasion. We report four cases managed at our institution. All tumors were diagnosed preoperatively by magnetic resonance imaging and 123 I‐metaiodobenzylguanidine scintigraphy, and all patients received preoperative α‐blockade. Three tumors (1.0–1.5 cm) without extravesical extension were treated with laparoscopic partial cystectomy without conversion. One larger tumor (4.3 cm) with suspected local invasion was managed using a planned open procedure and was associated with marked intraoperative hypertension and technical difficulty. These findings suggest that laparoscopic partial cystectomy is technically feasible in selected patients with small, localized bladder paragangliomas, whereas tumor size and suspected local invasion may influence surgical planning. The technical requirements for complete resection and catecholamine‐related hemodynamic risk should be assessed separately.
