V. Flamand

A Novel Robotic System for Single-port Urologic Surgery: First Clinical Investigation

BACKGROUND The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery. OBJECTIVE To determine the clinical feasibility and safety of single-port urologic procedures by using a novel robotic surgical system. DESIGN, SETTING, AND PARTICIPANTS This was a prospective institutional review board-approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. INTERVENTION Different types of urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes. RESULTS AND LIMITATIONS A total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38 min. At 3-yr follow-up all patients presented a preserved renal function; none had tumor recurrence. Study limitations include the small sample and the lack of a control group. CONCLUSIONS We describe the first clinical application of a novel robotic platform specifically designed for single-port urologic surgery. Major urologic procedures were successfully completed without conversions. Further assessment is warranted to corroborate these promising findings. PATIENT SUMMARY A novel purpose-built robotic system enables surgeons to perform safely and effectively a variety of major urologic procedures through a single small abdominal incision. TRIAL REGISTRATION The study was registered on www.ClinicalTrials.gov (NCT02136121).

Robot-assisted Laparoscopic Approach for Artificial Urinary Sphincter Implantation in 11 Women with Urinary Stress Incontinence: Surgical Technique and Initial Experience

BACKGROUND Artificial urinary sphincter (AUS) implantation is recommended for women suffering urinary stress incontinence. Robot-assisted laparoscopy allows improved dexterity and visibility compared to traditional laparoscopy, potentially providing significant advantages for deep pelvic surgery. OBJECTIVE To report our surgical technique and initial experience in transperitoneal robot-assisted laparoscopic AUS implantation in women with urinary stress incontinence. DESIGN, SETTING, AND PARTICIPANTS Eleven eligible patients with AUS implantation or revision using robot-assisted laparoscopy for urinary stress incontinence were included between January 2012 and February 2014 at Department of Urology, Lille University Hospital. SURGICAL TECHNIQUE Procedures were performed with the assistance of a four-arm da Vinci robot. The urethrovaginal space was dissected after transperitoneal access to the Retzius space. An 11-mm port placed in the right iliac fossa allowed introduction of the AUS device. The cuff and balloon tubes were externalised via a 5-mm suprapubic incision. The peritoneum was finally sutured. MEASUREMENTS Clinical data were prospectively collected before, during, and after the procedure. Results were classified as complete continence (no leakage and no pad usage), social continence (leakage and/or pad usage with no impact on social life), or failure (leakage and/or pad usage impacting social life). RESULTS AND LIMITATIONS After mean follow-up of 17.6 mo (interquartile range 10.8-26 mo), eight patients (72.7%) had a successful AUS implantation, of whom seven (87.5%) reported complete continence and one had social continence. Two vaginal injuries and two bladder injuries occurred intraoperatively. Two patients experienced early minor postoperative complications and two had a major postoperative complication. CONCLUSIONS Robot-assisted laparoscopic AUS implantation is a feasible procedure. Further studies will better assess the place of robot-assisted laparoscopy in AUS implantation. PATIENT SUMMARY We investigated the treatment of 11 patients with stress urinary incontinence using robot-assisted implantation of an artificial urinary sphincter (AUS). The results show that the procedure is feasible procedure, and future studies will to help assess the place of robot-assisted laparoscopy in AUS implantation.

Techniques de réimplantation urétéro-vésicale sur vessie psoïque, avec ou sans lambeau vésicale, par voie cœlioscopique robot-assistée

The National Library of Australia has a relatively small but important collection of digital materials on physical carriers, including both published materials and unpublished manuscripts in digital form. To date, preservation of the Library’s physical format digital collections has been largely hand-crafted, but this approach is insufficient to deal effectively with the volume of material requiring preservation. The Digital Preservation Workflow Project aims to produce a semi-automated, scalable process for transferring data from physical carriers to preservation digital mass storage, helping to mitigate the major risks associated with the physical carriers: deterioration of the media and obsolescence of the technology required to access them. The workflow system, expected to be available to Library staff from June 2008, also aims to minimise the time required for acquisition staff to process relatively standard physical media, while remaining flexible to accommodate special cases when required. The system incorporates a range of primarily open source tools, to undertake processes including media imaging, file identification and metadata extraction. The tools are deployed as services within a service-oriented architecture, with workflow processes that use these services being coordinated within a customised system architecture utilising Java based web services. This approach provides flexibility to add or substitute tools and services as they become available and to simplify interactions with other Library systems.