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All content in this area was uploaded by Juhi Deolankar on Oct 14, 2021
Content may be subject to copyright.
laparoscopic radical prostatectomy (spRALRP) and standard robot-
assisted laparoscopic radical prostatectomy (RALRP) at our large-vol-
ume institution.
METHODS: We retrospectively identified patients who under-
went spRALRP at our institution from December 2018 eSeptember
2019 and collected 30-day outcomes data after surgery, with compli-
cations categorized by the Clavien-Dindo system. The comparison
cohort consisted of patients who underwent standard RALRP at our
institution and were followed prospectively in an unrelated trial
(NCT03006562, PREVENTER). Pelvic lymph node dissection (PLND)
was performed at the discretion of the attending surgeon. Post-opera-
tive outcomes were compared using Wilcoxon rank-sum and Fisher's
exact test as appropriate.
RESULTS: A total of 24 men underwent spRALRP and 376
underwent standard RALRP with 328 (82.0%) overall receiving a
PLND. There was no difference in median operative time (177 vs. 180
min, p [0.9), length of stay (1 vs. 1 day, p [0.2), or number of
lymph nodes removed (4.5 vs 9, p [0.1) between spRALRP and
RALRP. Median estimated intraoperative blood loss was lower for
spRALRP compared to RALRP (100mL vs. 150mL, p [0.02). There
was no difference in pathological Gleason score distribution between
groups (p [0.4).The spRALRP cohort had a total of 4 (16.7%)
Clavien (I-V) complications which was consistent with the standard
RALRP cohort (17.3%, p[1.0). Only 1 (4.2%) major (Clavien III)
complication, a delayed rectourethral fistula requiring diverting co-
lostomy and correction of the vesicourethral anastomosis, occurred
in the spRALRP cohort which was comparable to the rate of major
complications for standard RALRP (3.7%, p [0.6). There was no
difference in maximum patient-reported pain scores in the 24 hours
prior to discharge (5.5 vs. 6, p [0.2) or in the last pain score at
discharge (2 vs. 3, p [0.2) between groups.
CONCLUSIONS: Based on an early experience with spRALRP
at a high-volume center, there appears to be equivalent outcomes and
complication rates compared to standard RALRP. Future studies may
compare the cost equivalence and patient-centered outcomes between
approaches.
Source of Funding: None.
MP04-11
SINGLE PORT VS. MULTIPORT ROBOTIC SURGERY FOR THE
UPPER URINARY TRACT: SHORT TERM PERI-OPERATIVE
OUTCOME ANALYSIS
Michael Stifelman, Bethany Desroches*, Hackensack, NJ;
Juhi Deolankar, Newark, NJ; Gregory Lovallo, Ravi Munver,
Mutahar Ahmed, Hackensack, NJ
INTRODUCTION AND OBJECTIVE: In June 2018, the FDA
approved the Intuitive single port (SP) robot for urologic procedures. In
January 2019, Hackensack University Medical Center acquired this
technology and trained 5 high volume robotic urologic surgeons. This
study is designed to evaluate the peri-operative outcomes of SP
compared to those of the multiport (MP) robot for procedures of the
upper urinary tract to determine the feasibility, safety, and reproducibility
of single port robotic surgery.
METHODS: Using a prospective IRB database, we compared
patients undergoing SP robotic nephrectomy, partial nephrectomy,
pyeloplasty, and buccal mucosa ureteroplasty to a 1:1 matched cohort
of patients utilizing a MP approach. We used age, sex, BMI, and when
appropriate nephrometry score, to create our case matched cohort.
Peri-operative outcomes measured included operative time (OR time),
warm ischemia time (WIT), estimated blood loss (EBL), Clavien grade
greater than 2 complications, positive margin rate, and rate of read-
mission within 30 days. Due to the 1:1 matching between SP and MP,
we treated each analysis as paired data. For the OR comparisons, we
performed paired t-tests. For the EBL and LOS comparisons, we per-
formed Wilcoxon signed rank t-tests since these outcomes did not meet
normality criteria.
RESULTS: Please see Table 1 for a summary of our results.
We found statistically significant differences only in the partial ne-
phrectomy cohort ewhich included SP having longer OR time (117 vs
91; p<0.022) and WIT (21 vs 8; p<0.002). EBL was higher for the MP
group (130 vs 69; p <0.031).
CONCLUSIONS: We compared the peri-operative outcomes of
21 patients undergoing upper urinary tract SP robotic surgery to a 1:1
matched MP cohort. Significant differences were noted in OR time and
WIT, which favored the MP group, whereas there was higher EBL in the
MP group. These differences may be attributed to the fact that two
patients' surgeries in the MP group were performed off clamp. We
conclude that SP surgery is safe, reproducible, and offers minimal to no
increase in intra- and peri-operative risks compared to MP robotic
surgery for upper urinary tract procedures.
Source of Funding: None
MP04-12
PREDICTORS OF EARLY RE-INTERVENTION AFTER URETERAL
TUMORSTENT INSERTION FOR OBSTRUCTIVE UROPATHY
Alexander Gu, Lisa Oyo, C
edric Poyet, Thomas Hermanns,
Daniel Schmid, Tullio Sulser, Daniel Eberli, Etienne Xavier Keller*,
Zurich, Switzerland
INTRODUCTION AND OBJECTIVE: Ureteral Tumorstents are
known for their robustness and can be used for long-term therapy of
obstructive uropathy. Generally, manufacturers recommend a maximal
dwell time of 6 months. Aim of this study was to evaluate predictors of
early re-intervention after first-time Tumorstent insertion.
METHODS: We analyzed all patients treated with a Tumorstent
(BardÒangiomed UROSOFT) between 2010 and 2018. Patients with
planned temporary dwell time (e.g. protective insertion before abdom-
inal surgery) were excluded. Primary endpoint was time to re-inter-
vention (Tumorstent exchange or nephrostomy tube insertion) after first-
time Tumorstent insertion. Elective Tumorstent exchange was usually
undertaken within 1 month prior to maximal dwell time (i.e. between 5 to
6 months after insertion). Therefore, only the first 5 months after
insertion were considered for analysis of early re-intervention. Pro-
portions were compared with Chi Square tests. Time-dependent vari-
ables were evaluated with Kaplan-Meier curves, log-rank tests and Cox-
regression analyses.
RESULTS: A total of 129 patients were available for analysis.
Thereof, 78 (60%) were male and 60 (47%) were female. Mean age was
64.7 years. Left, right or bilateral disease was present in 60 (47%), 54
(42%) and 24 (19%) cases, respectively. Prior to first-time Tumorstent
insertion, 54 (42%) and 12 (9%) patients had a polymeric ureteral stents
or nephrostomy tubes in place, respectively, while 72 (56%) cases had
no prior upper urinary tract drainage. No significant association was
found between Tumorstent diameter and length (p[0.29) (65% 7F/
32cm, 16% 7F/28cm, 12% 6F/32cm and 7% 6F/28cm). Re-intervention-
free survival at 1, 2, 3, 4 and 5 months was 90%, 83%, 76%, 64% and
55%, respectively. Of all pre-operative and peri-operative parameters,
we found shorter Tumorstent length, right-sided or bilateral disease and
absence of prior upper urinary drainage as significant predictors of early
re-intervention (Figure 1-3) (all p <0.05).
CONCLUSIONS: Early re-intervention occurs in up to 45% of all
patients after first-time Tumorstent insertion for obstructive uropathy.
Shorter Tumorstent length, right-sided and bilateral disease, as well as
absence of prior upper urinary tract drainage seem to be predictors of
early re-intervention. Patients and physicians must be aware that
e36 THE JOURNAL OF UROLOGY
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Vol. 203, No. 4S, Supplement, Friday, May 15, 2020
Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.