Best of AUA 2014: Minimally Invasive Surgery

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• Two Surveillance, Epidemiology, and End Results-Medicare-based studies evaluated comparative effectiveness between robot-assisted radical prostatectomy and open radical prostatectomy. In the first, robot-assisted laparoscopic radical prostatectomy was associated with an increased risk of genitourinary complications and medical complications, although the robotic technique did show a lower transfusion rate and a decreased length of stay. Separately, robot-assisted radical prostatectomy was associated with a lower positive surgical margin rate. Patients undergoing robotic surgery also had a lower risk of need for secondary treatment.

• Dual-console robot-assisted laparoscopic prostatectomy was associated with lower operative times and lower intraoperative and postoperative complications compared with a single console.

• Robotic simulation training using the Raven robot compared with the da Vinci system (Intuitive Surgical, Inc., Sunnyvale, CA) resulted in no difference in technical skill acquisition. Importantly, the Raven robot represents an 80% cost savings over the da Vinci console.

• Crowd-sourced assessments of laparoscopic and robotic tasks recorded on video matched expert assessments, with the advantage of being able to retrieve the crowd-sourced assessments in 9 hours compared with 1 month for the expert reviewers.

• A real-time nerve mapping device used during robot-assisted radical prostatectomy accurately identified somatic nerves involved in erectile response.

• Using real-time magnetic resonance imaging, researchers demonstrated the cooling of the periprostatic neurovascular bundle and urethral tissues using a cooling balloon. This will allow for future modeling so that more patient-specific cooling can be performed to further improve outcomes.

• Two studies examined long-term clinical and functional outcomes after minimally invasive partial nephrectomy. One group found no difference in long-term renal function outcomes and excellent preservation of renal function at 5 years when using either on-clamp or off-clamp laparoscopic partial nephrectomy. Another group found that patients with normal preoperative renal function had excellent preservation of their renal function as long as 10 years post surgery.

• A retrospective review of 40 robot-assisted partial nephrectomies and 85 open partial nephrectomies yielded no difference in perioperative and postoperative complications and no difference in short-term estimated glomerular filtration rate preservation. Decreased length of stay was observed with the robotic platform, however.

• At 3-month follow-up, no difference in quality of life measurements was found between patients undergoing robot-assisted laparoscopic radical cystectomy or open radical cystectomy.

• In video sessions, multiple groups tackled reconstructive surgery in the postoperative setting in terms of removal of extruded mesh and urinary fistula repairs. Several groups reported step-by-step procedures for intracorporeal urinary diversion, both ileal conduit and continent orthotopic urinary diversion. Others were advancing the robotic platform to tackle advanced kidney cancers with level 1 and up to level 3 inferior vena cava thrombectomy.

• Phase II results for 25 patients undergoing robotic kidney transplantation compared to 41 patients undergoing open kidney transplantation revealed excellent short-term graft survival and no differences in complications, delayed graft function, and vascular thrombosis. There was some suggestion of decreased risk of certain complications such as pelvic lymphoceles, as well as improved convalescence.UT

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