https://www.europeanurology.com/article/S0302-2838(10)00603-2/pdf/robotic-laparoendoscopic-single-site-radical-prostatectomy-technique-and-early-outcomes

Robotic Laparoendoscopic Single-Site Radical Prostatectomy: Technique and Early Outcomes

Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been succesfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

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Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery

Effect of prior radiotherapy and ablative therapy on surgical outcomes for the treatment of rectourethral fistulas.

PURPOSE
We documented thoracic related complications during urological laparoscopic surgery.


MATERIALS AND METHODS
A total of 1129 patients underwent major urological laparoscopic procedures in a 5-year period. Operative reports and postoperative radiographic reports were retrospectively reviewed to identify patients with thoracic related medical and surgical sequelae. Of the patients 619 (55%) underwent at least 1 chest x-ray in the immediate or early postoperative period. In the remaining 510 patients (45%) there was no clinical indication to perform chest x-ray.


RESULTS
Of 619 patients undergoing chest x-ray 438 (71%) were completely normal. Medical pulmonary complications, surgical thoracic complications and subclinical, incidentally detected gas collections in the chest were identified in 12.6%, 0.5% and 5.5% of patients, respectively. Medical complications in 12.6% of cases included pulmonary infiltrate/atelectasis in 9.7%, pleural effusion in 4.8% and pulmonary embolus in 0.3%. Surgical complications included symptomatic pneumothorax in 4 patients (0.35%), hemothorax in 1 (0.08%) and chylothorax in 1 (0.08%). Subclinical abnormal thoracic gas collections were radiographically noted in 34 of the 619 patients (5.5%) on chest x-ray, including pneumomediastinum in 19 (3.1%), pneumothorax in 10 (1.6%) and pneumopericardium in 5 (0.8%). Overall 36 of 40 (90%) thoracic surgical complications (3) and subclinical, incidentally detected gas collections (33) occurred during retroperitoneal laparoscopy. Re-intervention was necessary in 6 patients (0.5%), namely pulmonary embolus requiring vena caval filter placement in 3 (0.3%), pneumothorax requiring a chest tube in 2 (0.17%) and hemothorax requiring emergency open thoracotomy in 1 (0.08%). No patient underwent open conversion to complete the initial proposed operation.


CONCLUSIONS
Due to its high solubility the expectant management of incidental CO2 pneumothorax, pneumopericardium and pneumomediastinum is recommended initially in the clinically stable patient. Inadvertent diaphragmatic entry can be satisfactorily repaired laparoscopically without open conversion. Although it is rare, surgical thoracic complications are potentially life threatening, requiring prompt identification and management.

Thoracic complications during urologic laparoscopy

Purpose of reviewMinimally invasive urology is rapidly advancing, and single-site laparoscopic surgery is being explored clinically. Such laparoscopic procedures are technically challenging and require an experienced laparoscopic surgeon due to the lack of port placement triangulation and instrument

Robotic single-site surgery.

Laparoscopic augmentation enterocystoplasty through a single trocar.

Laparoscopic Repair of Rectourethral Fistulas After Prostate Surgery

Urologic laparoscopy has entered the mainstream in the modern urologist’s armamentarium. Minimally invasive techniques aim to reproduce the results of open surgery with lower morbidity, less postoperative pain, and shorter convalescence.1 Laparoscopic surgery has many advantages, but its somewhat more restricted environment requires a specialized skill set, specific troubleshooting, and unique potential complications. The degree of complexity of the surgical procedure and the experience of the surgeon significantly influence complication rates.

Difficulties in Urologic Laparoscopy Complications

Olympus laparoscopic video tower (21-in. monitor, EXERA II image processor with light source) (Olympus Medical Systems, Tokyo, Japan) High-definition laparoscopic EndoEye 30° “chip-on-a-stick” laparoscope (Olympus Medical Systems, Tokyo, Japan)

Difficulties in Laparoscopic Radical Prostatectomy

New operating procedures that spare the important neural structures of the urogenital tract have led to improved functional results in terms of bladder function, urinary continence and erectile potency. Well-described examples are nerve-sparing radical prostatectomy [1–3] and cystectomy (continence, potency) [3, 4], ureteric antireflux surgery (bladder function) [5], extended radical hysterectomy with total mesometrial resection (bladder function) [6] and rectal resection (continence, bladder function, potency) [7].

Rene J. Sotelo Noguera

Papers

Laparoscopic augmentation enterocystoplasty through a single trocar.

Laparoscopic Repair of Rectourethral Fistulas After Prostate Surgery

Difficulties in Urologic Laparoscopy Complications

Difficulties in Laparoscopic Radical Prostatectomy

Urinary Bladder and Prostate