OLV Vattikuti Robotic Surgery Institute

Aalst, Belgium

OLV Vattikuti Robotic Surgery Institute

Aalst, Belgium
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Lovegrove C.E.,King's College London | Elhage O.,King's College London | Khan M.S.,Guys & St Thomas Hospital | Novara G.,University of Padua | And 3 more authors.
European Urology Focus | Year: 2017

Context Novel surgical techniques demand that surgical training adapts to the need for technical and nontechnical skills. Objective To identify training methods available for robot-assisted surgical (RAS) training in urology, evaluate their effectiveness in terms of validation, educational impact, acceptability, and cost effectiveness, and assess their effect on learning curves (LCs). Evidence acquisition A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines searched Ovid Medline, Embase, PsycINFO, and the Cochrane Library. Results were screened to include appropriate studies. Quality was evaluated. Each method was evaluated, and conclusions were drawn regarding LCs. Evidence synthesis Of 359 records, 24 were included (521 participants). Training methods included dry-lab training (n = 7), wet-lab training (n = 7), mentored training (n = 7), and nonstructured pathways (n = 5). Dry-lab training demonstrated educational impact by reducing console time and was acceptable in a study; 100% of participants confirmed face validity. Wet-lab training principally uses human cadaveric material; effectiveness is well rated, although dry-lab training and observation were rated as equally useful. Mentored programmes combine lectures, tutorials, observation, simulation, and proctoring. Minifellowships were linked to greater practice of RAS 1 yr later. LCs vary according to experience. One study found that surgeons from robot-related fellowships demonstrated fewer positive surgical margins than surgeons from laparoscopic-related fellowships (24% vs 34.6%; p = 0.05) and reduced time (132 vs 152 min; p = 0.0003). Five studies examined nonstructured training pathways (clinical practice). Experience correlated with fewer complications (p = 0.007), improved continence (p = 0.049), and reduced time (p = 0.002). Conclusions RAS training methods include dry and wet lab, mentored training, and nonstructured pathways. Limited available evidence suggests that they affect LCs differently and are rarely used alone. The different methods of training appear effective when combined. Their benefits must be explored to facilitate validated acceptable training with educational impact. Patient summary Robot-assisted training encompasses several methods used in combination, but more evidence is required to gain the greatest benefit and formulate future training pathways. © 2016 European Association of Urology

Pokorny M.,Onze Lieve Vrouw Hospital | Novara G.,University of Padua | Novara G.,OLV Vattikuti Robotic Surgery Institute | Geurts N.,Onze Lieve Vrouw Hospital | And 7 more authors.
European Urology | Year: 2015

Background Robot-assisted simple prostatectomy (RASP) is a minimally invasive procedure for treatment of patients with lower urinary tract symptoms (LUTS) due to large benign prostatic enlargement (BPE). Objective To present the perioperative and short-term functional outcomes of RASP in a large series of patients with LUTS due to BPE treated in a high-volume referral center. Design, setting, and participants We retrospectively collected data for 67 consecutive patients who underwent RASP from October 2008 to August 2014. Surgical procedure RASP was performed using a Da Vinci S or Si system with a transvesical approach. Measurements Complications were graded according to the Clavien-Dindo system. Continuous variables are reported as median and interquartile range (IQR). Comparison of preoperative and postoperative outcomes was assessed by Wilcoxon test. A two-sided value of p < 0.05 was considered statistically significant. Results and limitations The median preoperative prostate volume was 129 ml (IQR 104-180). For the 45 patients who did not have an indwelling catheter, the median preoperative International Prostate Symptom Score (IPSS) was 25 (20.5-28), the median maximum flow rate (Qmax) was 7 ml/s (IQR 5-11), and the median post-void residual volume (PVRV) was 73 ml (IQR 40-116). The median operative time was 97 min (IQR 80-127) and the median estimated blood loss was 200 ml (IQR 115-360). The postoperative complication rate was 30%, including three cases (4.5%) with grade 3b complications (major bleeding requiring cystoscopy and coagulation). The median catheterization time was 3 d (IQR 2-4) and the median length of stay was 4 d (IQR 3-5). The median follow-up was 6 mo (IQR 2-12). At follow-up, the median IPSS was 3 (IQR 0-8), the median Qmax was 23 ml/s (IQR 16-35), and the median PVRV was 0 ml (IQR 0-36) (all p < 0.001 vs baseline values). The retrospective design is the major study limitation. Conclusions Our data indicate good perioperative outcomes, an acceptable risk profile, and excellent improvements in patient symptoms and flow scores at short-term follow-up following RASP. Patient summary We analyzed the perioperative and functional outcomes of robot-assisted simple prostatectomy in the treatment of male patients with lower urinary tract symptoms due to large prostatic adenoma. The procedure was associated with a relatively low risk of complications and excellent functional outcomes, including considerable improvements in symptoms and flow performance. We can conclude that the procedure is a valuable option in the treatment of such patients. However, comparative studies evaluating the efficacy of the procedure in comparison with endoscopic treatment of large prostatic adenomas are needed. © 2015 European Association of Urology.

Simone G.,Regina Elena Cancer Institute | Simone G.,San Giovanni Bosco Hospital | Gill I.S.,University of Southern California | Mottrie A.,OLV Vattikuti Robotic Surgery Institute | And 4 more authors.
European Urology | Year: 2015

Context On-clamp partial nephrectomy (PN) has been considered the standard approach to minimize intraoperative bleeding and thus achieve adequate control of tumor margins. The potential negative impact of ischemia on renal function (RF) led to the development of techniques to minimize or avoid renal ischemia, such as off-clamp PN and minimally ischemic PN techniques. Objective To review current evidence on the indications and techniques for and outcomes of minimally ischemic and off-clamp PN. Evidence acquisition A systematic review of English-language publications on PN without a main renal artery clamp from January 2005 to July 2014 was performed using the Medline, Embase, and Web of Science databases. Evidence synthesis The searches retrieved 52 papers. Off-clamp PN has been more commonly applied to small and peripheral renal tumors, while minimally ischemic PN is best suited for hilar and medially located renal tumors. These approaches are associated with increased intraoperative blood loss and perioperative transfusion rates compared to on-clamp PN. Minimally ischemic and off-clamp PN have potential functional benefits when longer ischemia time is anticipated, particularly for patients with lower baseline RF. Limitations include the lack of prospective randomized trials comparing minimally ischemic and off-clamp to on-clamp techniques, and the small sample size and short follow-up of most published series. The impact of different resection and renorrhaphy techniques on postoperative RF and its assessment via renal scintigraphy requires further investigations. Conclusions Minimally ischemic and off-clamp PN are established procedures that may be particularly applicable for patients with decreased baseline RF. However, these techniques are technically demanding, with potential for increased blood loss, and require considerable experience with PN surgery. The role of ischemia in patients with a contralateral healthy kidney and consequently an indication for elective minimally ischemic or off-clamp PN remains a debatable issue. Patient summary In this review we analyzed available evidence on minimally ischemic and off-clamp partial nephrectomy. These techniques, although technically demanding, may be particularly applicable for patients with decreased baseline renal function. © 2015 European Association of Urology.

Brunckhorst O.,King's College London | Volpe A.,University of Piemonte Orientale | van der Poel H.,Netherlands Cancer Institute | Mottrie A.,OLV Vattikuti Robotic Surgery Institute | Ahmed K.,King's College London
European Urology Focus | Year: 2016

Context Urology is at the forefront of minimally invasive surgery to a great extent. These procedures produce additional learning challenges and possess a steep initial learning curve. Training and assessment methods in surgical specialties such as urology are known to lack clear structure and often rely on differing operative flow experienced by individuals and institutions. Objective This article aims to assess current urology training modalities, to identify the role of simulation within urology, to define and identify the learning curves for various urologic procedures, and to discuss ways to decrease complications in the context of training. Evidence acquisition A narrative review of the literature was conducted through December 2015 using the PubMed/Medline, Embase, and Cochrane Library databases. Evidence synthesis Evidence of the validity of training methods in urology includes observation of a procedure, mentorship and fellowship, e-learning, and simulation-based training. Learning curves for various urologic procedures have been recommended based on the available literature. The importance of structured training pathways is highlighted, with integration of modular training to ensure patient safety. Conclusions Valid training pathways are available in urology. The aim in urology training should be to combine all of the available evidence to produce procedure-specific curricula that utilise the vast array of training methods available to ensure that we continue to improve patient outcomes and reduce complications. Patient summary The current evidence for different training methods available in urology, including simulation-based training, was reviewed, and the learning curves for various urologic procedures were critically analysed. Based on the evidence, future pathways for urology curricula have been suggested to ensure that patient safety is improved. © 2016 European Association of Urology

Fisher R.A.,King's College London | Dasgupta P.,King's College London | Mottrie A.,King's College London | Mottrie A.,OLV Vattikuti Robotic Surgery Institute | And 5 more authors.
International Journal of Surgery | Year: 2015

Introduction: Robotic surgery is a rapidly expanding field. Thus far training for robotic techniques has been unstructured and the requirements are variable across various regions. Several projects are currently underway to develop a robotic surgery curriculum and are in various stages of validation. We aimed to outline the structures of available curricula, their process of development, validation status and current utilization. Methods: We undertook a literature review of papers including the MeSH terms "Robotics" and "Education". When we had an overview of curricula in development, we searched recent conference abstracts to gain up to date information. Results: The main curricula are the FRS, the FSRS, the Canadian BSTC and the ERUS initiative. They are in various stages of validation and offer a mixture of theoretical and practical training, using both physical and simulated models. Discussion: Whilst the FSRS is based on tasks on the RoSS virtual reality simulator, FRS and BSTC are designed for use on simulators and the robot itself. The ERUS curricula benefits from a combination of dry lab, wet lab and virtual reality components, which may allow skills to be more transferable to the OR as tasks are completed in several formats. Finally, the ERUS curricula includes the OR modular training programme as table assistant and console surgeon. Conclusion: Curricula are a crucial step in global standardisation of training and certification of surgeons for robotic surgical procedures. Many curricula are in early stages of development and more work is needed in development and validation of these programmes before training can be standardised. © 2014 Surgical Associates Ltd.

Bjurlin M.A.,New York University | Gan M.,Olv Vattikuti Robotic Surgery Institute | McClintock T.R.,New York University | Volpe A.,Olv Vattikuti Robotic Surgery Institute | And 5 more authors.
European Urology | Year: 2014

Background Near-infrared fluorescence (NIRF) imaging is a technology with emerging applications in urologic surgery. Objective To describe surgical techniques and provide clinical outcomes for robotic partial nephrectomy (RPN) with selective clamping and robotic upper urinary tract reconstruction featuring novel applications of NIRF imaging. Design, setting, and participants Data from 90 patients who underwent successful RPN with selective clamping or upper urinary tract reconstruction utilizing NIRF imaging between April 2011 and October 2012 were reviewed. Surgical procedure We performed RPN utilizing NIRF imaging to aid with selective clamping and upper tract reconstruction with NIRF imaging, the details of which are outlined in this paper and the accompanying video. Outcome measurements and statistical analysis Patient characteristics, perioperative outcomes, and complications were analyzed. Results and limitations Of the 48 RPN patients for whom selective clamping was attempted successfully, median estimated blood loss was 200.0 ml, warm ischemia time was 17.0 min, and median change in estimated glomerular filtration rate was -6.3%. There was a 12.5% complication rate, and all complications were Clavien grade 1-3 (14.3%). The upper urinary tract reconstruction utilizing NIRF imaging was performed in 42 patients and included pyelopasty (n = 20), ureteral reimplant (n = 13), ureterolysis (n = 7), and ureteroureterostomy (n = 2). Radiographic and symptomatic improvement was observed in 100% of the pyeloplasty, ureteral reimplant, and ureteroureterostomy patients and 71.4% of ureterolysis patients, for an overall success rate of 95.2%. This study is limited by the small sample size, the short follow-up period, and the lack of a comparative cohort. Conclusions Our technique of RPN with selective arterial clamping and robotic upper urinary tract reconstruction utilizing NIRF imaging is presented. This technology provides real-time intraoperative angiogram to confirm selective ischemia and may be an adjunct technology to confirm well-perfused tissue within a reconstruction anastomosis. Further investigation is needed to evaluate long-term outcomes of NIRF imaging in robotic upper urinary tract surgery and to delineate its indications. © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Autorino R.,Cleveland Clinic | Autorino R.,The Second University of Naples | Zargar H.,Cleveland Clinic | White W.M.,Urologic | And 7 more authors.
Urology | Year: 2014

Herein, we provide a systematic review and critical analysis of the current evidence on the applications of near-infrared fluorescence in robotic urologic surgery. Article selection proceeded according to Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Overall, 14 studies were identified and included. Indocyanine green fluorescence imaging system has been tested for several applications, robotic partial nephrectomy representing the most studied one. Available evidence suggests this technology can be of aid in visually defining the surgical anatomy, thus ultimately facilitating the task of the console surgeon. Whether the added cost is justified by better outcomes remains to be determined. © 2014 Elsevier Inc. All rights reserved.

Lee R.K.,Cornell University | Mottrie A.,O.L.V. Clinic | Mottrie A.,Olv Vattikuti Robotic Surgery Institute | Payne C.K.,Stanford University | Waltregny D.,University of Liège
European Urology | Year: 2014

Context Abdominal sacrocolpopexy (ASC) represents the superior treatment for apical pelvic organ prolapse (POP) but is associated with increased length of stay, analgesic requirement, and cost compared with transvaginal procedures. Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) may offer shorter postoperative recovery while maintaining equivalent rates of cure. Objective This review evaluates the literature on LSC and RSC for clinical outcomes and complications. Evidence acquisition A PubMed search of the available literature from 1966 to 2013 on LSC and RSC with a follow-up of at least 12 mo was performed. A total of 256 articles were screened, 69 articles selected, and outcomes from 26 presented. A review, not meta-analysis, was conducted due to the quality of the articles. Evidence synthesis LSC has become a mature technique with results from 11 patient series encompassing 1221 patients with a mean follow-up of 26 mo. Mean operative time was 124 min (range: 55-185) with a 3% (range: 0-11%) conversion rate. Objective cure was achieved in 91% of patients, with similar satisfaction rates (92%). Six patient series encompassing 363 patients treated with RSC with a mean follow-up of 28 mo have been reported. Mean operative time was 202 min (range: 161-288) with a 1% (range: 0-4%) conversion rate. Objective cure rate was 94%, with a 95% subjective success rate. Overall, early outcomes and complication rates for both LSC and RSC appeared comparable with open ASC. Conclusions LSC and RSC provide excellent short- to medium-term reconstructive outcomes for patients with POP. RSC is more expensive than LSC. Further studies are required to better understand the clinical performance of RSC versus LSC and confirm long-term efficacy. Patient summary Laparoscopic and robot-assisted sacrocolpopexy represent attractive minimally invasive alternatives to abdominal sacrocolpopexy. They may offer reduced patient morbidity but are associated with higher costs. © 2014 European Association of Urology.

Lista G.,Vita-Salute San Raffaele University | Buffi N.M.,Vita-Salute San Raffaele University | Lughezzani G.,Vita-Salute San Raffaele University | Lazzeri M.,Vita-Salute San Raffaele University | And 9 more authors.
Urology | Year: 2015

Objective To explore the margin, ischemia, and complications (MIC) system achievement rate within a population of patients who were treated with robotic partial nephrectomy (RAPN), at 3 different tertiary care centers, and to determine the factors predicting MIC achievement. Methods The study population consisted of 339 patients who underwent RAPN for cT1 renal tumors at 3 centers. Cancer control was defined as the absence of positive surgical margin. Ideal threshold of warm ischemia time (WIT) was considered ≤20 minutes. Safety was defined as the absence of major complications. The achievement of MIC was considered as the fulfillment of all these 3 outcomes. The primary endpoint was to determine the MIC rate in our study population; the secondary endpoint was to detect factors affecting its achievement. Results The overall MIC rate was 67%. Median WIT was 17 minutes (range, 7-51 minutes). In 88 cases (26%), WIT was 20 minutes. Positive surgical margins were found in 22 patients (6.5%). Overall postoperative and major complication rates were 14.5% (n = 49) and 3.8% (n = 13). In multivariate logistic regression analysis, continuously coded and categorically coded preoperative aspects and dimensions used for an anatomical scores were an independent predictor of MIC achievement (odds ratio, 0.636; confidence interval, 0.436-0.928; P =.019 and odds ratio, 0.098; confidence interval, 0.030-0.326; P .001). Conclusion The MIC binary system may represent a useful tool to summarize the achievement of optimal perioperative outcomes of RAPN. In the current population, tumor complexity was significantly associated with MIC achievement. © 2015 Elsevier Inc.

Volpe A.,University of Piemonte Orientale | Volpe A.,Olv Vattikuti Robotic Surgery Institute | Amparore D.,University of Turin | Amparore D.,Olv Vattikuti Robotic Surgery Institute | Mottrie A.,Olv Vattikuti Robotic Surgery Institute
Current Opinion in Urology | Year: 2013

PURPOSE OF REVIEW: Nephron-sparing surgery is the standard of care for the treatment of localized renal tumours and is increasingly performed for larger and more challenging lesions. Aim of this review is to analyse the outcomes of partial nephrectomy for the treatment of T1b renal tumours greater than 4 cm in size. RECENT FINDINGS: No randomized trial has compared the outcomes of partial nephrectomy compared to radical nephrectomy for T1b renal tumours. However, several single, multi-institutional and population-based studies consistently showed similar cancer-specific survival rates for open partial nephrectomy (OPN) and radical nephrectomy for tumours greater than 4 cm in size. A decreased loss in renal function was observed with partial nephrectomy compared to radical nephrectomy for T1b tumours. Laparoscopic partial nephrectomy (LPN) for tumours greater than 4 cm in size was shown to obtain similar short-to-intermediate-term oncological outcomes of laparoscopic radical nephrectomy and OPN in experienced centres, but is associated with longer warm ischaemia time and higher complication rates. The initial series of robot-assisted partial nephrectomy show similar perioperative results and decreased warm ischaemia time compared to LPN, whereas the oncological outcomes are still immature. SUMMARY: Partial nephrectomy for T1b renal tumours achieves comparable oncological outcomes and better preservation of renal function compared to radical nephrectomy and should be performed whenever technically possible. OPN remains at present the gold standard technique. LPN represents an alternative to OPN in centres with advanced laparoscopic expertise. Robot-assisted partial nephrectomy has the potential to overcome the drawbacks of pure laparoscopic surgery, but larger series and longer follow-up are needed to further define its role in the management of T1b tumours. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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