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Robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with daVinci Single-Site® platform. Concept and evolution of the technique following an IDEAL phase 1

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Abstract

To describe the evolution of robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) performed with the daVinci Single-Site Platform® and a home-made multiport aimed to overcome classical drawbacks of LESS, still present with this platform. Between 09/2015 and 06/2017 12 patients underwent R-LESS RP for clinical localized prostate cancer. Following a “phase 1 (development-stage)” innovation, development, exploration, assessment, long-term study (IDEAL) framework, different solutions were drawn to overcome drawbacks of daVinci Single-Site Platform®, included 3 (A, B, and C) multi-ports developed and evaluated in term of advantages/drawbacks concerning ergonomy. The end points of this study were: feasibility, safety, efficacy, by reporting rational description of multiports configuration, demographics, perioperative variables, functional and oncological results. Semi-flexible robotic 5-mm needle-holder instead of Maryland forceps, 30° lenses up and barbed-suture allowed overcoming limits of robotic-platform. Multiport-C (GelPOINT Advanced-Access® and an extra 8-mm robotic trocar outside the multiport) showed the best compromise to ensure both surgeon and bed-side assistant to reproduce a standard robotic procedure. No conversion to either standard robotic or open technique or intraoperative complications occur in any case. Two patients experienced “high-grade” Clavien-Dindo complications. After 12.4 months follow-up, all patients were continent without any sign of biochemical relapse and among 5 preoperative potent patients submitted to nerve-sparing dissection, 4 reported good erectile-function. R-LESS-RP is feasible and safe in the hands of experienced minimally-invasive surgeons. Do date, we recommend a hybrid solution with a home-made multiport and use of an additional standard robotic trocar which allows the use endowrist® technology instruments.

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References

  1. Pini G, Rassweiler J (2012) Minilaparoscopy and laparoendoscopic single-site surgery: mini- and single-scar in urology. Minim Invasive Ther Allied Technol 21:8

    Article  PubMed  Google Scholar 

  2. Gaboardi F, Gregori A, Santoro L et al (2011) ‘LESS’ radical prostatectomy: a pilot feasibility study with a personal original technique. BJU Int 107:460

    Article  PubMed  Google Scholar 

  3. Kaouk JH, Autorino R, Kim FJ et al (2011) Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol 60:998

    Article  PubMed  Google Scholar 

  4. Sorokin I, Canvasser NE, Irwin B et al (2017) The decline of laparoendoscopic single-site surgery: a survey of the endourological society to identify shortcomings and guidance for future directions. J Endourol 31:1049

    Article  Google Scholar 

  5. Haber GP, White MA, Autorino R et al (2010) Novel robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology 76:1279

    Article  PubMed  Google Scholar 

  6. Gaboardi F, Pini G, Suardi N et al (2016) V12 Robotic laparoendoscopic single-site (r-LESS) radical prostatectomy: IDEAL phase 1. Eur Urol Suppl 15(3):eV12

    Article  Google Scholar 

  7. McCulloch P, Altman DG, Campbell WB et al (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105

    Article  PubMed  Google Scholar 

  8. Council for International Organizations of Medical Sciences (2002) International Ethical Guidelines for Biomedical Research Involving Human Subjects. http://www.cioms.ch/images/stories/CIOMS/guidelines/guidelines_nov_2002_blurb.htm. Accessed 13 October 2013

  9. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205

    Article  PubMed  PubMed Central  Google Scholar 

  10. Stolzenburg JU, Schwaibold H, Bhanot SM et al (2005) Modular surgical training for endoscopic extraperitoneal radical prostatectomy. BJU Int 96:1022

    Article  PubMed  Google Scholar 

  11. Wren SM, Curet MJ (2011) Single-port robotic cholecystectomy: results from a first human use clinical study of the new da Vinci single-site surgical platform. Arch Surg 146:1122

    Article  PubMed  Google Scholar 

  12. Kroh M, El-Hayek K, Rosenblatt S et al (2011) First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surg Endosc 25:3566

    Article  PubMed  Google Scholar 

  13. Tewari AK, Srivastava A, Huang MW et al (2011) Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP). BJU Int 108:984

    Article  PubMed  Google Scholar 

  14. Steineck G, Bjartell A, Hugosson J et al (2015) Degree of preservation of the neurovascular bundles during radical prostatectomy and urinary continence 1 year after surgery. Eur Urol 67:559

    Article  PubMed  Google Scholar 

  15. Cornford P, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate Cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71:630

    Article  Google Scholar 

  16. Mattevi D, Luciani LG, Vattovani V, et al. (2017) First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform. J Robot Surg. https://doi.org/10.1007/s11701-017-0724-y

    Article  PubMed  Google Scholar 

  17. Cestari A, Buffi NM, Lista G, et al (2012) Feasibility and preliminary clinical outcomes of robotic laparoendoscopic single-site (R-LESS) pyeloplasty using a new single-port platform. Eur Urol 62:175

    Article  PubMed  Google Scholar 

  18. Kaouk JH, Palmer JS (2008) Single-port laparoscopic surgery: initial experience in children for varicocelectomy. BJU Int 102:97

    Article  PubMed  Google Scholar 

  19. Martin OD, Azhar RA, Clavijo R, et al (2016) Single port radical prostatectomy: current status. J Robot Surg 10:87

    Article  PubMed  Google Scholar 

  20. Leewansangtong S, Vorrakitkatorn P, Amornvesukit T et al (2010) Laparo-endoscopic single site (LESS) robotic radical prostatectomy in an Asian man with prostate cancer: an initial case report. J Med Assoc Thai 93(3):383–387

    PubMed  Google Scholar 

  21. Desai MM, Aron M, Berger A et al (2008) Transvesical robotic radical prostatectomy. BJU Int 102:1666

    Article  PubMed  Google Scholar 

  22. White MA, Haber GP, Autorino R et al. (2010) Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes. Eur Urol 58(4):544–550. https://doi.org/10.1016/j.eururo.2010.06.040 (epub 2010 Jul 14)

    Article  PubMed  Google Scholar 

  23. Barret E, Sanchez-Salas R, Cathelineau X et al (2009) Re: Initial complete laparoendoscopic single-site surgery robotic assisted radical prostatectomy(LESS-RARP). Int Braz J Urol 35:92

    Article  PubMed  Google Scholar 

  24. Akca O, Zargar H, Kaouk JH (2015) Robotic surgery revives radical perineal prostatectomy. Eur Urol 68:340

    Article  PubMed  Google Scholar 

  25. Silberstein JL, Power NE, Touijer KA (2011) Laparoendoscopic single site (LESS) radical prostatectomy: a review of the initial experience. Minerva Urol Nefrol 63:123

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Kaouk JH, Haber GP, Autorino R et al (2014) A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 66:1033

    Article  PubMed  Google Scholar 

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Author notes

  1. Franco Gaboardi and Giovannalberto Pini contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, IRCCS San Raffaele Turro Hospital, Via Stamira d’Ancona 20, 20127, Milan, Italy

    Franco Gaboardi, Giovannalberto Pini, Nazareno Suardi, Giovanni Passaretti & Salvatore Smelzo

  2. Scientific Working Group, EAU Section of Uro-Technology (ESUT), Arnhem, The Netherlands

    Giovannalberto Pini

  3. Robotic Group, EAU Section of Young Academic Urologist (YAU), Arnhem, The Netherlands

    Giovannalberto Pini & Nazareno Suardi

  4. Department of Urology, University “Vita Salute” San Raffaele, Milan, Italy

    Nazareno Suardi & Francesco Montorsi

Authors
  1. Franco Gaboardi
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  2. Giovannalberto Pini
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  3. Nazareno Suardi
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  4. Francesco Montorsi
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  5. Giovanni Passaretti
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  6. Salvatore Smelzo
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Correspondence to Franco Gaboardi.

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Conflict of interest

All authors involved in the article had nothing to disclose about commercial associations that might create a conflict of interest in connection with submitted manuscripts. Franco Gaboardi, Giovannalberto Pini, Nazareno Suardi, Francesco Montorsi, Giovanni Passaretti, Salvatore Smelzo declare that they have no conflict of interest.

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Gaboardi, F., Pini, G., Suardi, N. et al. Robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with daVinci Single-Site® platform. Concept and evolution of the technique following an IDEAL phase 1. J Robotic Surg 13, 215–226 (2019). https://doi.org/10.1007/s11701-018-0839-9

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  • DOI: https://doi.org/10.1007/s11701-018-0839-9

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