Kyotaro Fukuta, Tomoya Fukawa, Saki Kobayashi, Keito Shiozaki, Yutaro Sasaki, Kosuke Seto, Ryoichi Nakanishi, Hirofumi Izaki, Masayuki Takahashi, Kazuya Kanda, Hiro-omi Kanayama and Junya Furukawa : Efficacy of educational stepwise robot-assisted radical prostatectomy procedure for urology residents., Asian Journal of Endoscopic Surgery, Vol.17, No.3, e13334, 2024.
(要約)
To evaluate the effectiveness of an educational stepwise robot-assisted radical prostatectomy (RARP) procedure for urology residents. We performed a detailed evaluation of 42 RARP procedures performed by a single urology resident from July 2019 to February 2022. The RARP procedures were divided into the following nine steps: (1) bladder dissection, (2) endopelvic fascia dissection, (3) bladder neck dissection, (4) seminal vesicle dissection, (5) Denonvilliers' fascia dissection, (6) dorsal vascular complex ligation, (7) dissection of the prostatic apex, (8) posterior anastomosis, and (9) urethro-vesical anastomosis. The procedures were further subcategorized as anatomical understanding, spatial recognition, and technical skills for evaluation of resident training. The surgeries were divided into first and second halves, and patient characteristics and operative outcomes were statistically analyzed. The operative time of each of the nine steps and the reasons for proctor intervention were compared. Among 42 patients, there were no significant differences in operative outcomes between the two groups. The median operative time was 169 min (164 vs. 179 min, p = .12), and the median console time was 128 min (127 vs. 130 min, p = .74). Although there were no significant differences in the time of the nine steps, the resident significantly overcame (7) dissection of the prostatic apex and (8) posterior anastomosis based on the evaluation of the proctored reasons for intervention. Urology residents can safely perform and efficiently learn RARP with this stepwise educational system. This educational stepwise RARP procedure can effectively help residents to develop their skills.
Yutaro Sasaki, Yoshito Kusuhara, Takuro Oyama, Mitsuki Nishiyama, Saki Kobayashi, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Hiroomi Kanayama and Junya Furukawa : Radical prostatectomy using the Hinotori robot-assisted surgical system: Docking-free design may contribute to reduction in postoperative pain., The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS, Vol.20, No.3, e2648, 2024.
(要約)
The docking-free design of the Japanese Hinotori surgical robotic system allows the robotic arm to avoid trocar grasping, thereby minimising excessive abdominal wall stress. The aim of this study was to evaluate the safety and efficacy of robotic-assisted radical prostatectomy (RARP) using the Hinotori system and to explore the potential contribution of its docking-free design to postoperative pain reduction. This study reviewed the clinical records of 94 patients who underwent RARP: 48 patients in the Hinotori group and 46 in the da Vinci Xi group. Hinotori group had significantly longer operative and console times (p = 0.030 and p = 0.029, respectively). Perioperative complications and oncologic outcomes did not differ between the two groups. On postoperative day 4, the rate of decline from the maximum visual analogue scale score was marginally significant in the Hinotori group (p = 0.062). The docking-free design may contribute to reducing postoperative pain.
Yutaro Sasaki, Masayuki Takahashi, Mitsuki Nishiyama, Saki Kobayashi, Yoshiteru Ueno, Junya Furukawa and Kenji Shimada : A novel treatment strategy for bladder hypoplasia: A case of megaureter in a functional solitary kidney., IJU Case Reports, Vol.7, No.3, 243-246, 2024.
(要約)
We report a case of megaureter in a functional solitary kidney in which surgery was performed after bladder capacity was increased by home bladder cycling. A 6-day-old girl with a left megaureter, a right multicystic dysplastic kidney, and bladder hypoplasia underwent percutaneous left nephrostomy for obstructive renal failure. At 8 months, home bladder cycling was initiated to increase bladder capacity before the planned ureterocystoneostomy. Surgery was performed after bladder capacity increased. The left ureter was compressed by the left umbilical ligament, so ureteral end-to-end anastomosis was performed at 1 year and 4 months. At 2 years and 8 months, cystometry showed age-appropriate bladder capacity and improved bladder compliance. To the best of our knowledge, this is the first report of bladder hypoplasia treated by home bladder cycling.
Fumiya Kadoriku, Yutaro Sasaki, Kyotaro Fukuta, Mitsuki Nishiyama, Seiya Utsunomiya, Saki Kobayashi, Keito Shiozaki, Kei Daizumoto, Yoshiteru Ueno, Kosuke Seto, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi and Junya Furukawa : Robot-assisted intracorporeal ileal conduit urinary diversion: A two-center comparative study of Bricker versus Wallace ureteroileal anastomosis, Asian Journal of Endoscopic Surgery, Vol.17, No.2, e13307, 2024.
(要約)
This study was performed to evaluate the differences in the perioperative results, renal function, and incidence of hydronephrosis over time between the use of Bricker anastomosis and Wallace anastomosis for robot-assisted intracorporeal ileal conduit urinary diversion (RICIC). Fifty-five patients who underwent RICIC at two institutions were evaluated (Bricker, n = 23; Wallace, n = 32). We investigated changes in estimated glomerular filtration rate and hydronephrosis before surgery and at 3, 6, and 12 months after surgery. The patients in the Bricker group were significantly older than those in the Wallace group. The urinary diversion time was significantly longer in the Bricker group. No significant difference in postoperative renal function was observed. Additionally, no significant difference was observed in the incidence of postoperative hydronephrosis. However, the incidence of right hydronephrosis tended to be high overall, especially in the Wallace group. No patients in either group required repair surgery or ureteral stent placement. In patients undergoing RICIC, there was no difference in postoperative renal function or the incidence of hydronephrosis between Wallace and Bricker anastomosis. Symptomatic hydronephrosis was not observed in either group. The present study showed that each method was equally effective and safe.
Yutaro Sasaki, Kazuyoshi Izumi, Kyotaro Fukuta, Fumiya Kadoriku, Yuichiro Atagi, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Masahito Yamanaka and Junya Furukawa : Impact of lymph node dissection on surgical and oncological outcomes in patients undergoing robot-assisted radical cystectomy for bladder cancer: a multicenter retrospective study, Journal of Robotic Surgery, Vol.18, No.1, 141, 2024.
(要約)
This study was performed to clarify the therapeutic and diagnostic roles of lymph node dissection (LND) by examining the impact of LND and lymph node yield (LNY) on oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC). Between 2014 and 2021, 216 patients underwent LND during RARC at Tokushima University Hospital and affiliated hospitals. Among the 216 patients, we compared 115 patients with an LNY of ≥ 20 and 101 with an LNY of < 20 to investigate the impact of LNY on surgical and oncological outcomes. Furthermore, we investigated the impact of LNY and the extent of LND on oncological outcomes by dividing the extent of LND into two groups (standard and extended). The 3-year rates of overall survival (OS) (p = 0.256), cancer-specific survival (CSS) (p = 0.791), and recurrence-free survival (RFS) (p = 0.953) did not differ between the two groups divided by the LNY. A higher LNY was associated with a significantly higher lymph node positivity rate (p = 0.020). The incidence of LND-related major complications was not significantly different between the two groups (p = 0.910). The 3-year survival rates did not differ between the two groups divided by the extent of LND: OS (p = 0.366), CSS (p = 0.814), and RFS (p = 0.689). The LNY and extent of LND were not associated with oncological outcomes in patients undergoing LND during RARC, whereas a higher LNY was associated with lymph node positivity. In the era of adjuvant therapy with immune checkpoint inhibitors, LND during RARC has an important diagnostic role in the detection of pathological node positivity.
Yutaro Sasaki, Yasuyo Yamamoto, Saki Kobayashi, Masaaki Nishi, Masayuki Takahashi and Junya Furukawa : A case of laparoscopically assisted transperineal repair of anterior enterocele dehiscence with small bowel evisceration after robot-assisted radical cystectomy, Urology Case Reports, Vol.52, 102629, 2024.
(要約)
We herein report a case of successful laparoscopically assisted transperineal repair of anterior enterocele dehiscence with small bowel evisceration after robot-assisted radical cystectomy. A 75-year-old woman underwent robot-assisted radical cystectomy with anterior vaginectomy and urethrectomy for bladder cancer (pTisN0M0). Vaginal reconstruction was performed using the posterior vaginal wall. Four months after surgery, she presented with small bowel evisceration due to anterior enterocele dehiscence. She underwent laparoscopically assisted transperineal repair. The anterior enterocele dehiscence did not occur at the vaginal closure site but instead between the vaginal wall and posterior pubic bone. No recurrence had developed at 2 months postoperatively.