Abstract
Minimally invasive radical prostatectomy has rapidly been adopted as the primary means of surgical intervention for prostate cancer. Intraoperative tissue retraction relies on either gravity (via positioning) or use of additional ports and instrumentation. We report the use of a novel trocar-less magnetic retractor system to aid with tissue retraction. Three patients underwent robotic-assisted radical prostatectomy in the treatment of prostatic adenocarcinoma at a single tertiary care institution. All surgeries utilized the Levita™ Magnetic Surgical System (San Mateo, CA) without the use of a fourth robotic arm. The magnetic grasper was used to manipulate the bowel, peritoneum, seminal vesicles, and prostatic capsule. Demographic, pre-operative, and perioperative information were collected. No cases required placement of any additional ports. No intraoperative or immediate post-operative complications occurred. No tissue tearing or subjective tissue damage was noted by placement or removal of the magnetic retractor. Mean operative time was 216 ± 17 min and mean blood loss was 333 ± 57 mL. All patients were discharged to home on post-operative day 1. Robotic prostatectomy utilizing a magnetically anchored tissue grasper appears to be safe and effective while reducing the number of ports (fourth robotic arm) needed. Further investigation is warranted.
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References
Trinh Q-D, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, Jeong W, Shariat SF, Hansen J, Schmitges J (2012) Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 61(4):679–685
Sorokin I, Sundaram V, Singla N, Walker J, Margulis V, Roehrborn C, Gahan JC (2017) Robot-assisted versus open simple prostatectomy for benign prostatic hyperplasia in large glands: a propensity score–matched comparison of perioperative and short-term outcomes. J Endourol 31(11):1164–1169
Cadeddu J, Fernandez R, Desai M, Bergs R, Tracy C, Tang S-J, Rao P, Desai M, Scott D (2009) Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience. Surg Endosc 23(8):1894–1899
Best SL, Bergs R, Scott DJ, Fernandez R, Mashaud LB, Cadeddu JA (2012) Solo surgeon laparo-endoscopic single site nephrectomy facilitated by new generation magnetically anchored and guided systems camera. J Endourol 26(3):214–218
Park S, Bergs RA, Eberhart R, Baker L, Fernandez R, Cadeddu JA (2007) Trocar-less instrumentation for laparoscopy: magnetic positioning of intra-abdominal camera and retractor. Ann Surg 245(3):379
Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA (2009) Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc 23(7):1660–1666
Haskins IN, Strong AT, Allemang MT, Bencsath KP, Rodriguez JH, Kroh MD (2018) Magnetic surgery: first US experience with a novel device. Surg Endosc 32(2):895–899
Rivas H, Robles I, Riquelme F, Vivanco M, Jiménez J, Marinkovic B, Uribe M (2018) Magnetic surgery: results from first prospective clinical trial in 50 patients. Ann Surg 267(1):88
Johnson B, Crivelli J, Sorokin I, Gahan J, Cadeddu JA (2018) Surgical outcomes of three vs four arm robotic partial nephrectomy: is the fourth arm necessary? Urology [accepted]
Golkar FC, Ross SB, Sperry S, Vice M, Luberice K, Donn N, Morton C, Hernandez JM, Rosemurgy AS (2012) Patients’ perceptions of laparoendoscopic single-site surgery: the cosmetic effect. Am J Surg 204(5):751–761
Kudsi OY, Castellanos A, Kaza S, McCarty J, Dickens E, Martin D, Tiesenga FM, Konstantinidis K, Hirides P, Mehendale S, Gonzalez A (2017) Cosmesis, patient satisfaction, and quality of life after da Vinci Single-Site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial. Surg Endosc 31(8):3242–3250. https://doi.org/10.1007/s00464-016-5353-4
Park SK, Olweny EO, Best SL, Tracy CR, Mir SA, Cadeddu JA (2011) Patient-reported body image and cosmesis outcomes following kidney surgery: comparison of laparoendoscopic single-site, laparoscopic, and open surgery. Eur Urol 60(5):1097–1104
Zeltser IS, Bergs R, Fernandez R, Baker L, Eberhart R, Cadeddu JA (2007) Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model. J Urol 178(1):288–291. https://doi.org/10.1016/j.juro.2007.03.001
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J. Cadeddu is a member of the advisory board and an investor in Levita Magnetics, Inc. R. Steinberg and B. Johnson declare they have no conflict of interest.
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Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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Steinberg, R.L., Johnson, B.A. & Cadeddu, J.A. Magnetic-assisted robotic surgery: initial case series of reduced-port robotic prostatectomy. J Robotic Surg 13, 599–603 (2019). https://doi.org/10.1007/s11701-018-0889-z
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DOI: https://doi.org/10.1007/s11701-018-0889-z