Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
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- Red system errors: at least one of the robotic arms not responding to the console, requiring shutdown and restart.
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- Yellow errors: blocked robotic arms that required removal and replacement of the arm with or without the trocar.
- -
- Significant conflicts between the robotic arms: when their positions interfere with each other’s movement.
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- Broken instruments: the laparoscopic robotic instrument was damaged and had to be replaced.
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- Social continence rate: defined as the use of no more than one pad per day [8].
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- Unfavorable positive surgical margins: a single positive margin greater than or equal to 3 mm or a multifocal positive margin [9].
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- Erectile function: using the International Index of Erectile Function Questionnaire (IIEF-5).
3. Results
3.1. Pre-Operative Data
3.2. Intra-Operative Data
3.3. Post-Operative Data
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Age, years, mean (±SD) | 66.1 (±6.8) |
BMI, kg/mq, mean (±SD) | 26.4 (±3.5) |
CCI, median (IQR) | 5 (1) |
ASA score, median (IQR) | 2 (0) |
Previous abdominal surgery, n (%) | 61 (46) |
| 36 (59.1) |
| 21 (34.4) |
| 4 (6.5) |
IPSS, median (IQR) | 7 (9) |
QoL, median (IQR) | 2 (2) |
IIEF-5, median (IQR) | 18 (9) |
PI-RADS index, median (IQR) | 4 (1) |
Lesion diameter, mm, mean (±SD) | 12.8 (±6.1) |
Preoperative PSA level, ng/mL, mean (±SD) | 10.72 (±10.81) |
Positive digital rectal examination, n (%) | 27 (20.4) |
Prostate volume, mL, mean (±SD) | 50.85 (±22.1) |
ISUP 1-2 at biopsy, n (%) | 91 (68.9) |
ISUP 3-5 at biopsy, n (%) | 41 (31.1) |
cN+, n (%) | 5 (3.8) |
Pelvic lymphadenectomy, n. (%) | 25 (18.9) |
Nerve-sparing procedure, total, n. (%) | 66 (50) |
| 33 (50) |
| 33 (50) |
Blood loss, mL, median (IQR) | 100 (100) |
Intra-operative complications, n. (%) | 0 (0) |
Red errors, n. (%) | 5 (4) |
Yellow errors, n. (%) | 12 (9) |
Significant robotic arms-conflicts, n. (%) | 8 (6) |
Broken robotic instruments, n. (%) | 9 (6.8) |
Bladder neck reconstruction, n. (%) | 18 (13.6) |
Total surgery time (in–out), min, mean (±SD) | 242 (±57) |
| 255 (±56) |
| 239 (±57) |
Operative time (incision to last stich), min, mean (±SD) | 189.3 (±57.3) |
| 200 (±68) |
| 186 (±53) |
Console time, min, mean (±SD) | 124 (±48) |
Docking time, min, mean (±SD) | 10 (±2) |
Patience entrance to skin incision, min, mean (±SD) | 37.8 (±13.2) |
Last stitch to patience exit, min, mean (±SD) | 18.8 (±8.1) |
Total | Console Time, Min, Median (IQR) | 117 (79) | ||
---|---|---|---|---|
Total Surgery Time (in–out), Min, Median (IQR) | 232 (77) | |||
Type of Adverse Event | Absence | Presence | p-Value | |
Errors cumulative (yellow or red) | Console time, min, median (IQR) | 112 (80) | 135 (87) | 0.119 |
Total surgery time (in–out), min, median (IQR) | 235 (74) | 214 (128) | 0.603 | |
Yellow error | Console time, min, median (IQR) | 115 (79) | 120 (76) | 0.559 |
Total surgery time (in–out), min, median (IQR) | 238 (75) | 210 (93) | 0.243 | |
Red error | Console time, min, median (IQR) | 113 (80) | 138 (93) | 0.068 |
Total surgery time (in–out), min, median (IQR) | 230 (76) | 250 (115) | 0.362 | |
Conflicts | Console time, min, median (IQR) | 117 (80) | 116 (106) | 0.715 |
Total surgery time (in–out), min, median (IQR) | 230 (74) | 248 (121) | 0.274 | |
Broken instruments | Console time, min, median (IQR) | 120 (81) | 88 (35) | 0.167 |
Total surgery time (in–out), min, median (IQR) | 215 (83) | 219 (46) | 0.381 | |
Technical robotic issues | Console time, min, median (IQR) | 118 (81) | 112 (52) | 1.000 |
Total surgery time (in–out), min, median (IQR) | 240 (78) | 210 (65) | 0.100 |
Post-operative pain (VAS in recovery), median (IQR) | 0 (1) |
Post-operative complication—Clavien–Dindo grade, median (IQR) | 1 (1) |
| 5 |
| 1 |
| 2 |
Catheter removal (POD), median (IQR) | 15 (6) |
POD of discharge, median (IQR) | 3 (1) |
Narcotic use, n. (%) | 1 (0.7) |
NSAIDs use, n. (%) | 4 (3) |
Paracetamol use, n. (%) | 65 (49.2) |
Prostate volume at final pathology, mL, mean (±SD) | 44.4 (±19.7) |
Tumor volume at final pathology, mL, mean (±SD) | 2.77 (±4.5) |
Primary Gleason at final pathology, median (IQR) | 3 (1) |
Secondary Gleason at final pathology, median (IQR) | 4 (1) |
ISUP at final pathology, median (IQR) | 2 (2) |
Perineural Invasion at final pathology, n. (%) | 113 (86.9) |
Global percentage of neoplasia, median (IQR) | 6 (10) |
Positive surgical margins, n. (%) | 54 (40.9) |
| 37 (28) |
pT stage | |
| 2 (1.5) |
| 96 (72.7) |
| 19 (14.4) |
| 15 (11.3) |
pN stage | |
| 21 (15.1) |
| 4 (3) |
| 107 (81) |
Follow-up data | |
| 125 (94.6) |
| 105 (92.1) |
| 100 (75.7) |
| 98 (86.0) |
| 9 (11) |
| 10 (12) |
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Totaro, A.; Scarciglia, E.; Marino, F.; Campetella, M.; Gandi, C.; Ragonese, M.; Bientinesi, R.; Palermo, G.; Bizzarri, F.P.; Cretì, A.; et al. Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center. Cancers 2024, 16, 1602. https://doi.org/10.3390/cancers16081602
Totaro A, Scarciglia E, Marino F, Campetella M, Gandi C, Ragonese M, Bientinesi R, Palermo G, Bizzarri FP, Cretì A, et al. Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center. Cancers. 2024; 16(8):1602. https://doi.org/10.3390/cancers16081602
Chicago/Turabian StyleTotaro, Angelo, Eros Scarciglia, Filippo Marino, Marco Campetella, Carlo Gandi, Mauro Ragonese, Riccardo Bientinesi, Giuseppe Palermo, Francesco Pio Bizzarri, Antonio Cretì, and et al. 2024. "Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center" Cancers 16, no. 8: 1602. https://doi.org/10.3390/cancers16081602