Search

Purpose: Surgeons' adaptability to robotic manipulation remains underexplored. This study evaluated the participants' first-touch robotic training skills using the hinotori surgical robot system and its simulator (hi-Sim) to assess adaptability. Methods: We enrolled 11 robotic surgeons (RS), 13 laparoscopic surgeons (LS), and 15 novices (N). After tutorial and training, participants performed pegboard tasks, camera and clutch operations, energizing operations, and suture sponge tasks on hi-Sim. They also completed a suture ligation task using the hinotori surgical robot system on a suture simulator. Median scores and task completion times were compared. Results: Pegboard task scores were 95.0%, 92.0%, and 91.5% for the RS, LS, and N groups, respectively, with differences between the RS group and LS and N groups. Camera and clutch operation scores were 93.1%, 49.7%, and 89.1%, respectively, showing differences between the RS group and LS and N groups. Energizing operation scores were 90.9%, 85.2%, and 95.0%, respectively, with a significant difference between the LS and N groups. Suture sponge task scores were 90.6%, 43.1%, and 46.2%, respectively, with differences between the RS group and LS and N groups. For the suture ligation task, completion times were 368 s, 666 s, and 1095 s, respectively, indicating differences among groups. Suture scores were 12, 10, and 7 points, respectively, with differences between the RS and N groups. Conclusion: First-touch simulator-based robotic skills were partially influenced by prior robotic surgical experience, while suturing skills were affected by overall surgical experience. Thus, robotic training programs should be tailored to individual adaptability. [ABSTRACT FROM AUTHOR]

Objectives: There is a lack of data on the number of surgeries required for endoscopic combined intrarenal surgery (ECIRS). Accordingly, we aimed to identify the learning curve for ECIRS performed by multiple surgeons. Methods: We included 296 patients who underwent ECIRS at our university hospital between 2016 and 2021. A learning curve for percutaneous nephrolithotomy side was calculated considering urology‐resident surgeons. The learning curve was retrospectively analyzed for surgical time, renal puncture time, stone‐free rate, and complications and corrected for age, body mass index, stone size, computed tomography value, cumulative number of surgeries, and stone location. Results: This study included cases performed by 32 surgeons, including 30 residents and 2 attending surgeons. The median number of surgeries performed by the residents and attending surgeons prior to this study was 4.5 and 90, respectively. The median number of surgical procedures performed during the training period was seven. The surgical time of the residents decreased as the number of cases increased, reaching a median surgical time of 111 min for the attending surgeons after 16.4 cases. Renal puncture time was achieved in 20.1 cases. Complications related to renal access were observed in 13.0% (34 patients), Clavien–Dindo grade II in 1.9% (5 patients), and grade III or higher in 0.8% (2 patients). Comparing the first to fifth cases with the 21st and subsequent cases, the complication rate improved from 35% to 13%. Conclusion: Our study demonstrated that ECIRS training provided 16–20 cases with a learning curve to achieve acceptable surgical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of the prone split‐leg and the Galdakao‐modified supine Valdivia positions during endoscopic combined intrarenal surgery. Methods: A multi‐institutional, retrospective cohort study was conducted between January 2014 and December 2018. The stone‐free and complication rates were compared between the prone split‐leg and the Galdakao‐modified supine Valdivia positions. Anatomical variations were evaluated using contrast‐enhanced computed tomography imaging. Results: In total, 118 and 100 patients underwent endoscopic combined intrarenal surgery in the prone split‐leg and Galdakao‐modified supine Valdivia positions, respectively. Renal punctures in the prone split‐leg position were predominantly executed through the lower calyces (78.0%), whereas those in the Galdakao‐modified supine Valdivia position were primarily performed through the middle calyces (64.0%; P < 0.001). Surgical duration in the prone split‐leg position was significantly shorter than that in the Galdakao‐modified supine Valdivia position (106.5 vs 126.0 min; P = 0.0459). There were no significant differences in the stone‐free rate between the two positions (78.8% vs 76.0%; P = 0.629). Incidences of urinary tract injury (P = 0.033) and febrile urinary tract infection (23.7% vs 10.0%; P = 0.011) in the prone split‐leg position were significantly higher than that in the Galdakao‐modified supine Valdivia position. The tilt of the major renal axis was significantly greater in the prone position than the corresponding values in the oblique position (19.4° vs 8.5°; P = 0.019). Conclusions: Anatomical variation might result in the differences of renal puncture calyx. Endoscopic combined intrarenal surgery in the Galdakao‐modified supine Valdivia position may bring equal stone‐free status, with a longer surgical time but fewer complications including febrile urinary tract infection and urinary tract injury than the prone split‐leg position. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to analyze a feasible and suitable surgical precautionary preparatory technique. The techniques of double-gloving with hygienic hand wash (DH) and single-gloving with surgical hand wash (SS) were compared for their ability to prevent postoperative infection in robotic and laparoscopic minimally invasive surgeries., Materials and Methods: A prospective, non-randomized, multicenter study was conducted between January 2016 and June 2020. We divided the robotic and laparoscopic cases into two groups: DH and SS. Data on infectious outcomes were collected. Propensity score matching was performed to control for operative characteristics between the two groups. The primary endpoint was the presence of fever and surgical site infections (SSIs) indicating postoperative infection., Results: Among four medical centers, seven surgeons were allocated to either the DH or the SS group. A total of 221 and 251 patients underwent DH and SS, respectively. Propensity score matching, which included 171 cases from each group, showed that the incidence of fever during hospitalization was significantly lower in the DH group than that in the SS group (11.7% vs. 23.4%, p=0.007). Multivariable analysis revealed that DH was associated with a reduced odds ratio for developing postoperative fever during hospitalization (risk ratio: 0.49, p=0.043). No differences were found in SSI before and after hospitalization between the two groups., Conclusion: DH resulted in less postoperative fever and had a comparable effect in preventing SSIs. This procedure could be an alternative to the SS protocol in some minimally invasive surgeries.

Objectives: The objective of this work is to investigate the impact of the pelvicalyceal anatomical system (PCS) on calyceal stone formation and surgical outcomes of endoscopic combined intrarenal surgery (ECIRS) for renal and/or proximal ureteral stones with a diameter >15 mm., Patients and Methods: PCS was classified as Type I (single pelvis) or Type II (divided pelvis) according to the simple anatomical Takazawa classification. Using prospectively collected data from January 2016 to April 2020, 219 patients were retrospectively reviewed. After excluding patients who underwent a staged procedure, had hydronephrosis greater than grade 2, prior nephrostomy tubes, and failed to access the renal collecting system, 115 patients (Type I: 81, Type II: 34) were included, and the distribution of calyceal stones and surgical outcomes in ECIRS were compared between Types I and II PCS., Results: The median number of renal stone calyces in the Type II group was significantly more than that in the Type I group ( p  = 0.016). In particular, the Type II group possessed more upper stone calyces. Multivariate logistic regression analysis revealed that Type II PCS was associated with an increased odds ratio (OR) for the presence of upper stone calyces (OR: 2.93, p  = 0.018). The stone-free (SF) status at 1 month after surgery, confirmed by abdominal plain radiography, was significantly higher in the Type I group compared with that in Type II (67.9% vs. 39.4%, respectively; p  = 0.006). The requirement for additional surgical interventions was significantly higher in the Type II group compared with that in Type I (35.4% vs. 7.4%, respectively; p  < 0.001). Multivariate analysis revealed that the number of stone calyces (OR: 4.26; p  = 0.001) and Type II PCS (OR: 3.43; p  = 0.009) were independent predictors of residual stones after ECIRS., Conclusion: We first revealed that the anatomic properties of PCS play a role in both upper calyceal stone formation and in the success of the ECIRS procedure. Because the SF rate in Type II PCS was significantly lower than that in Type I PCS, additional percutaneous nephrolithotomy tracts might be required, even for ECIRS., Competing Interests: The authors declare that they have no conflict of interest., (© 2022 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)

Background: This study aimed to evaluate the safety and efficacy of an inner ureteral access sheath (i-UAS) with a double-lumen channel used in ureteroscopic lithotripsy (URS) as a dilator for the percutaneous tract in endoscopic combined intrarenal surgery (ECIRS)., Methods: This was a single-center cohort study conducted from January 2016 to April 2020. We used an i-UAS as a dilator and a double-lumen catheter to insert a safety guidewire during the creation of the nephrostomy tract in ECIRS. Univariate and multivariate analyses were performed to assess the association between the perioperative parameters and the use of i-UAS. The primary endpoint was perioperative complications, and secondary endpoints were stone-free rate (SFR), operative time, fluoroscopy time, and duration of hospitalization., Results: In total, 221 patients were enrolled during the study period. Patients were divided into an i-UAS dilation group (n=108) and a one-shot dilation group (n=113). No differences were observed between the two groups in terms of patient history. Univariate analyses indicated that, in the i-UAS dilation group, the operative time was shorter [105.50 (83.75-143.25) vs. 121.00 (90.00-155.00) min; P=0.02] and the modified Valdivia position was more frequently selected. Multivariate analyses showed no significant differences in the frequency of complications, such as urinary injury or postoperative pyelonephritis, but it showed a significantly shorter operative time as well as fewer tract creation troubles in the i-UAS dilation group., Conclusions: Using an i-UAS as a dilator and a double-lumen catheter to insert a safety guidewire during ECIRS is a convenient and safe technical method for creating a nephrostomy tract that can reduce the operative time., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tau-21-611). The authors have no conflicts of interest to declare., (2021 Translational Andrology and Urology. All rights reserved.)