monthly focus

surgical intervention video

Prostatectomie radicale robotisée en post-brachythérapie à l'aide de la plateforme robotique chirurgicale Versius

Over the years, many therapies have been launched for prostate cancer. Brachytherapy has had great prominence in the recent past. In this video, the authors demonstrate rescue surgery after more than 15 years after the implantation of more than 80 implants in the prostate parenchyma and the recurrent changes of this radiation. Recent studies demonstrate a higher recurrence rate after this procedure when compared to other techniques. In addition to biochemical relapse, the patient presented symptoms and signs of lower urinary tract symptoms (LUTS), with a worsening in quality of life. 



Bibliography:

1. A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER). Review Eur Urol. 2021 Sep;80(3):280-292. doi: 10.1016/j.eururo.2020.11.010. Epub 2020 Dec 11

2. Effect of Brachytherapy With External Beam Radiation Therapy Versus Brachytherapy Alone for Intermediate-Risk Prostate Cancer: NRG Oncology RTOG 0232 Randomized Clinical Trial. Randomized Controlled Trial J Clin Oncol. 2023 Aug 20;41(24):4035-4044. doi: 10.1200/JCO.22.01856. Epub 2023 Jun 14

3. Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU). Review Cancers (Basel). 2023 Nov 20;15(22):5485. doi: 10.3390/cancers15225485

4. Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2021 Mar 1;273(3):467-473. doi: 10.1097/SLA.0000000000003915

Robotic radical prostatectomy in post-brachytherapy using the Versius surgical robotic platform

In this educational video, the authors demonstrate a laparoscopic Boari flap and psoas hitch for the treatment of a left middle ureter injury in a patient undergoing Hartman sigmoidectomy and colostomy for the treatment of a complicated diverticulitis. The combination of the two techniques, Boari flap and psoas hitch, was first described by Kelâmi et al. (3). This technique can bridge up to 18cm of missing ureter with tension-free anastomosis (2). Some authors have reported that the length/width of the bladder flap should be no more than 3:1, and that the base of the flap should be no less than 4cm (1). Laparoscopy offers similar results to the open technique with a shorter hospital stay (4). Closing the colostomy with a gauze pad and nylon suture leaves the abdominal wall with more space for placing the trocars. Using a Foley catheter with the tip cut off facilitates the passage of the double-J catheter.

Bibliography:

1\. Guangpu Ding, Sida Cheng, Xinfei Li, Dong Fang, Kunlin Yang, Qi Tang, Peng Zhang, Han Hao, Xuesong Li, Liqun Zhou. Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures. Transl Androl Urol 2021;10(1):56-65 | [http://dx.doi.org/10.21037/tau-20-789.](http://dx.doi.org/10.21037/tau-20-789.) PMID: 33532296

2\. Ankur Bansal, Rahul Janak Sinha, Ankur Jhanwar, Gaurav Prakash, Bimalesh Purkait, Vishwajeet Singh. Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature. Turk J Urol 2017; 43(3): 313-8. DOI: 10.5152/tud.2017.44520. PMID: 28861304

3\. A. Kelâmi, U. Fiedler, V. Schmidt, A. Rost, M. Richter-Reichhelm, H. H. Hildebrand, and F. Weichler-Wolfgramm. Replacement of the Ureter Using the Urinary Bladder. Urol Res. 1973 Dec;1(4):161-5. DOI: 10.1007/BF00256617. PMID: 4789024

4\. Fugita OE, Dinlenc C, Kavoussi L. The laparoscopic Boari flap. J Urol. 2001 Jul;166(1):51-3. PMID: 11435821.

Laparoscopic Boari flap and psoas hitch for the management of a left mid-ureter injury

Confection d'un lambeau de Boari sur vessie psoïque par voie d'abord laparoscopique pour prise en charge d'une lésion de l'uretère moyen

The authors demonstrate a right nephroureterectomy with bladder cuff excision and retroperitoneal lymph node dissection (LND) performed in a strictly laparoscopic fashion. The European Association of Urology (EAU) guidelines recommend template-based lymph node dissection in all patients who plan to undergo radical nephroureterectomy, due to the inaccuracy of preoperative tumor staging (1). The right-side template is renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (2). The frequency of regional lymph node metastasis is as high as 20 to 30%. Lymphadenectomy does not increase overall and serious postoperative complication rates (3). In patients undergoing a laparoscopic nephroureterectomy, open excision of the bladder cuff is associated with a higher risk of intravesical recurrence (4).

Bibliography:

1\. Rouprêt M, Seisen T, Birtle AJ, Capoun O, Compérat EM, Dominguez-Escrig JL, Gürses Andersson I, Liedberg F, Mariappan P, Hugh Mostafid A, Pradere B, van Rhijn BWG, Shariat SF, Rai BP, Soria F, Soukup V, Wood RG, Xylinas EN, Masson-Lecomte A, Gontero P. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. Eur Urol. 2023 Jul;84(1):49-64. doi: 10.1016/j.eururo.2023.03.013. Epub 2023 Mar 24. PMID: 36967359.

2\. Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract. Urology. 2007 Feb;69(2):265-9. doi: 10.1016/j.urology.2006.10.014. PMID: 17320661.

3\. Kanno T, Kobori G, Ito K, Nakagawa H, Takahashi T, Takaoka N, Somiya S, Nagahama K, Ito M, Megumi Y, Higashi Y, Moroi S, Akao T, Yamada H. Complications and their management following retroperitoneal lymph node dissection in conjunction with retroperitoneal laparoscopic radical nephroureterectomy. Int J Urol. 2022 May;29(5):455-461. doi: 10.1111/iju.14814. Epub 2022 Feb 10. PMID: 35144321.

4\. Huang EY, Tai MC, Chung HJ, Chang YH, Huang WJ. Effects of different combinations of radical nephroureterectomy and bladder cuff excision procedures for upper tract urothelial carcinoma on bladder recurrence. Int Braz J Urol. 2023 Jul-Aug;49(4):469-478. doi: 10.1590/S1677-5538.IBJU.2023.0031. PMID: 37267612; PMCID: PMC10482446.

Laparoscopic right nephroureterectomy with bladder cuff excision and lymph node dissection

Néphro-urétérectomie droite laparoscopique avec excision du collet vésical et dissection des ganglions lymphatiques

Prostatectomie radicale robotisée après prostatectomie simple selon la technique de Millin 

In this educational video, the authors demonstrate a robotic radical prostatectomy using the da Vinci X™ surgical robotic platform in a patient who had had a simple prostatectomy surgery using the conventional Millin technique 7 years earlier. The case is interesting due to the large amount of fibrosis, scars, and local adhesions, distinct from other cases such as post-TURP, radiotherapy, HIFU or even cases of patients after laparoscopic herniorrhaphy surgery. Of note, in our case, the patient has a large abdominal circumference. Despite a greater technical difficulty, the robotic route proved to be of great value. The patient presented excellent postoperative outcomes.

Bibliography:

1\. Creta M, Manfredi C, Arcaniolo D, Spirito L, A Kaplan S, H Woo H, De Nunzio C, Gilling P, Bach T, De Sio M, Imbimbo C, Mirone V, Longo N, Fusco F. Functional and oncological outcomes after radical prostatectomy in patients with history of surgery for lower urinary tract symptoms related to benign prostatic enlargement: A systematic review with meta-analysis. Prostate Cancer Prostatic Dis. 2024 Sep;27(3):367-384. doi: 10.1038/s41391-023-00678-y. Epub 2023 May 27. PMID: 37244971

2\. Gacci M, Sebastianelli A, Salvi M, De Nunzio C, Tubaro A, Gravas S, Moncada I, Serni S, Maggi M, Vignozzi L. The Impact of Central Obesity on Storage Luts and Urinary Incontinence After Prostatic Surgery. Curr Urol Rep. 2016 Sep;17(9):61. doi: 10.1007/s11934-016-0620-4. PMID: 27432378

3\. Su YK, F Katz B, S Sehgal S, S Yu SJ, Su YC, Lightfoot A, Lee Z, Llukani E, Monahan K, I Lee K. Does previous transurethral prostate surgery affect oncologic and continence outcomes after RARP? J Robot Surg. 2015 Dec;9(4):291-7. doi: 10.1007/s11701-015-0529-9. Epub 2015 Aug 8. PMID: 26530840

4\. Tugcu V, Atar A, Sahin S, Kargi T, Gokhan Seker K, Ilker Comez Y, IhsanTasci A. Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery. JSLS. 2015 Sep-Dec;19(4):e2015.00080. doi: 10.4293/JSLS.2015.00080. PMID: 26648678 PMCID: PMC4653581

Robotic radical prostatectomy after simple prostatectomy with Millin technique 

video lecture

Cystectomie radicale assistée par robot

In this authoritative lecture, Professor Rafael Coelho, MD, PhD outlines robot-assisted radical cystectomy (RARC).

Robotic assisted radical cystectomy (RARC)

In this authoritative lecture, Dr. Filippo Annino, MD, outlines the technical principles of robotic urinary diversion after cystectomy. Step-by-step techniques for robotic urinary diversion after radical cystectomy are presented.&#x20;
The first focus is on the ERAS protocol for fast-track surgery, which facilitates a faster recovery for patients.
The author also details the operating room set-up, the port placement for pelvic surgery, and the techniques to improve bowel mobilization during the reconstruction phase.
In the reconstruction phase, the video demonstrates how to identify the precise point to cut the ileum, using specific landmarks to aid orientation and minimize the risk of errors. The proper orientation of the stapler (robotic or laparoscopic) is also explained.
Regarding urinary diversions, every step is meticulously detailed for both the ileal conduit and the neobladder, adhering to the Bordeaux technique.
This stepwise approach is systematically applied to all bladder cancer patients undergoing robotic cystectomy with urinary diversion. Performing this procedure with precision simplifies its execution, reducing the risk of intraoperative errors and decreasing surgical duration.

Technical principles of robotic urinary diversion after cystectomy

Principes techniques de la dérivation urinaire robotique après cystectomie

Rôle de la chirurgie robotique à trocart unique en urologie

In this authoritative lecture, Dr. Simone Crivellaro, MD, MHA outlines the role of single port robotic surgery in urology.&#x20;

Focus on laparoscopic and robotic urologic surgery