You have accessJournal of UrologyCME1 Apr 2023MP80-14 EXTRAPERITONEAL SINGLE-PORT ROBOTIC RADICAL PROSTATECTOMY IN OVER 700 PATIENTS: UPDATED MULTI-INSTITUTIONAL COHORT STUDY FROM THE SPARC COLLABORATION Ethan Ferguson, Jennifer L. Nguyen, Roxana Ramos, Grace Chen, Kennedy Okhawere, Samantha Wilder, Ruth Sanchez De La Rosa, Jaya Chavali, Indu Saini, James Peabody, Ketan K. Badani, Craig Rogers, Jeffrey Nix, Jean Joseph, Michael Stifelman, Simone Crivellaro, Mutahar Ahmed, Moses Kim, and Jihad Kaouk Ethan FergusonEthan Ferguson More articles by this author , Jennifer L. NguyenJennifer L. Nguyen More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Grace ChenGrace Chen More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Jaya ChavaliJaya Chavali More articles by this author , Indu SainiIndu Saini More articles by this author , James PeabodyJames Peabody More articles by this author , Ketan K. BadaniKetan K. Badani More articles by this author , Craig RogersCraig Rogers More articles by this author , Jeffrey NixJeffrey Nix More articles by this author , Jean JosephJean Joseph More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Simone CrivellaroSimone Crivellaro More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , Moses KimMoses Kim More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An extraperitoneal approach to single-port (SP) robot-assisted radical prostatectomy has been demonstrated with proposed benefits in decreased morbidity, single incision, and same-day discharge. We sought to determine the perioperative and early postoperative outcomes in a large, multi-institutional setting. METHODS: SP extraperitoneal radical prostatectomy was performed in 712 patients between February 2019 and October 2022. All procedures were performed by experienced robotic surgeons from eight tertiary medical centers. Data from baseline demographics, perioperative and early postoperative outcomes were collected prospectively and analyzed retrospectively RESULTS: All reported procedures were completed without open conversion, blood transfusions, or intraoperative complications. The median follow-up time was 11.7 months for the entire cohort. The median age, BMI and preoperative PSA were 64 years, 27.9kg/m2, and 6.4 ng/mL, respectively. About 30% of the patients had at least one previous abdominal surgery. On pathology, high risk disease was noted in 12% and lymph node involvement on final pathology was present in 5.8%. Extraprostatic extension was noted in 38% and positive surgical margins were present in 30.2% of cases. Lymphadenectomy was performed in 85% of patients and the median lymph node yield was 5 nodes. There were no intraoperative complications and inadvertent peritoneal entry with insufflation was rare (0.6%) and managed conservatively. Postoperative complications occurred in 11.8%. The median length of stay and foley catheter duration were 8 hours and 7 days, respectively. Postoperative recovery of continence was 69% at 3 months and 88% at 6 months. Recovery of potency was 35.6% at 6 months. CONCLUSIONS: Single-port extraperitoneal robotic radical prostatectomy is safe and feasible for management of clinically localized prostate cancer. Analysis from a large multi-institutional cohort shows promising single incision and short hospital length of stay without compromise in early functional or oncologic outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1157 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Ferguson More articles by this author Jennifer L. Nguyen More articles by this author Roxana Ramos More articles by this author Grace Chen More articles by this author Kennedy Okhawere More articles by this author Samantha Wilder More articles by this author Ruth Sanchez De La Rosa More articles by this author Jaya Chavali More articles by this author Indu Saini More articles by this author James Peabody More articles by this author Ketan K. Badani More articles by this author Craig Rogers More articles by this author Jeffrey Nix More articles by this author Jean Joseph More articles by this author Michael Stifelman More articles by this author Simone Crivellaro More articles by this author Mutahar Ahmed More articles by this author Moses Kim More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023V01-05 ANTERIOR RETROPERITONEAL APPROACH FOR UPPER URINARY TRACT RECONSTRUCTIVE SURGERY USING A SINGLE PORT ROBOTIC PLATFORM Graham Hale, Grace Chen, Alexy Jabbour, and Simone Crivellaro Graham HaleGraham Hale More articles by this author , Grace ChenGrace Chen More articles by this author , Alexy JabbourAlexy Jabbour More articles by this author , and Simone CrivellaroSimone Crivellaro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstruction of the upper urinary tract can be challenging and complex. The introduction of new technology and techniques has had a profound impact on how urologists approach these cases. This video demonstrates a unique anterior retroperitoneal approach using a single port robotic platform to treat a distal ureteral stricture, although this approach can be used for any upper urinary tract reconstructive surgery as well. METHODS: In this video demonstration, we describe an anterior retroperitoneal approach using the da Vinci SP robotic platform to treat a right-sided 3 cm long distal ureteral stricture with a psoas hitch and reimplantation. The patient is a twenty-nine-year-old female with a history of cesarean section, tubal ligation, multiple endoscopic treatments of urolithiasis, and a right ureteral balloon dilation complicated by perforation at an outside institution. The patient is positioned supine with open arms, and McBurney’s point (or its equivalent on the left side) identifies how lateral the incision should be made. The incision can be adjusted in the cranial or caudal direction depending on which part of the upper urinary tract the surgery will be performed. After incising the fascia, the peritoneum is bluntly dissected away from the transversalis fascia until the psoas is palpated and there is adequate room to place the SP access port and continue the surgery. RESULTS: We successfully performed a salvage right sided ureteral reimplant with psoas hitch using this approach to treat the distal ureteral stricture. One small hole was inadvertently created in the peritoneum, and we briefly discuss strategies to manage this. The patient was discharged day of surgery with a foley catheter and ureteral stent and followed an unremarkable post-operative course. The ureteral stent was removed in clinic 4 weeks later and she is scheduled for imaging follow up per protocol. CONCLUSIONS: An anterior retroperitoneal approach using a single port robotic platform can be performed during upper urinary tract reconstructive surgeries and offers several advantages. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e80 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Graham Hale More articles by this author Grace Chen More articles by this author Alexy Jabbour More articles by this author Simone Crivellaro More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023V05-12 ANTERIOR RETROPERITONEAL APPROACH TO THE SINGLE PORT PARTIAL NEPHRECTOMY Grace Chen and Simone Crivellaro Grace ChenGrace Chen More articles by this author and Simone CrivellaroSimone Crivellaro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the Food and Drug Administration’s (FDA) approval of the da Vinci Single-Port (SP) robotic platform in 2018, a wealth of new surgical techniques have been described that capitalize on the SP platform’s proficiency in small spaces. A rarely described technique even among robotic surgeons is the anterior retroperitoneal approach. To our knowledge, this is the first description of this approach utilizing the SP platform in the literature. Our objective is to describe the technique used at our institution for the anterior retroperitoneal single port partial nephrectomy. METHODS: This video abstract uses intraoperative recordings from one patient who underwent a SP partial nephrectomy at our institution. The clinical techniques are described in detail following detailed discussion with an experience robotic surgeon (SC). No pathologic or short-term outcomes were available. RESULTS: Retroperitoneal access was successfully obtained via an anterior incision for a 3.7 cm interpolar mass. The mass was successfully treated without need for conversion to multi-port or open approaches. Total operative time was 192 minutes. Total estimated blood loss (EBL) was 20 cc. The total hospital length of stay (LOS) was 8 hours. The patient was successfully discharged home with a non-narcotic pain control plan. CONCLUSIONS: The anterior retroperitoneal approach to SP robotic partial nephrectomy is safe and feasible. Theoretical advantages of this approach include increased efficiency and decreased positional injuries due to the ability to perform surgery in the supine position, less bowel manipulation, and potentially decreased opioid requirements. Further outcomes data is anticipated. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e428 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grace Chen More articles by this author Simone Crivellaro More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Multiport robotic surgery in the retroperitoneum is limited by the bulky robotic frame and clashing of instruments. Moreover, patients are placed in the lateral decubitus position, which has been linked to complications. Objective: To assess the feasibility and safety of a supine anterior retroperitoneal access (SARA) technique with the da Vinci Single-Port (SP) robotic platform. Design, setting, and participants: Between October 2022 and January 2023, 18 patients underwent surgery using the SARA technique for renal cancer, urothelial cancer, or uret-eral stenosis. Perioperative variables were prospectively collected and outcomes were assessed. Surgical procedure: With the patient in a supine position, a 3-cm incision is made at the McBurney point and the abdominal muscles are dissected. Finger dissection is used to develop the retroperitoneal space for the da Vinci SP access port. After docking, the first step is to dissect retroperitoneal tissue to reveal the psoas muscle. This allows identifi-cation of the ureter, the inferior renal pole, and the hilum. Measurements: A descriptive statistical analysis was performed. Data collected included demographics, operative time, warm ischemia time (WIT), surgical margin status, com-plications, length of hospital stay, 30-d Clavien-Dindo complications, and postoperative narcotic use. Results and limitations: Twelve patients underwent partial nephrectomy (PN) and two each underwent pyeloplasty, radical nephroureterectomy, and radical nephrectomy. In the PN group, mean age was 57 yr (interquartile range [IQR] 30-73), median body mass index was 32 kg/m2 (IQR 17-58), and 25% had stage & GE;3 chronic kidney disease. The med-ian Charlson comorbidity index was 3 (IQR 0-7) and 75% of PN patients had an American Society of Anesthesiologists score & GE;3. The median RENAL score was 5 (IQR 4-7). The median WIT was 25 min (IQR 16-48) and the median tumor size was 35 mm (IQR 16-50). The median estimated blood loss was 105 ml (IQR 20-400) and the median operative time was 160 min (IQR 110-200). Positive surgical margins were found in one patient. In the overall cohort, one patient was readmitted and managed conserva-tively; 83% of the PN group were discharged on the same day as their surgery, with