Arab Journal of Urology

ABSTRACT Objective To report on the surgical, oncological and early functional outcomes of robot-assisted radical prostatectomy (RARP) at our tertiary care centre, as there is a scarcity of reports on outcomes of robotic surgery from the Middle East. Patients and methods We reviewed the electronic health records for patients undergoing RARP between 2013 and 2019 at the American University of Beirut Medical Center. We collected patients’ demographics and preoperative oncological factors including prostate-specific antigen (PSA), clinical oncological stage, and World Health Organization (WHO) grade. PSA persistence, biochemical recurrence (BCR) and positive surgical margin (PSM) were reported. Complications were categorised by Clavien–Dindo grade. Moreover, the postoperative oncological outcomes including the rates of adjuvant and salvage androgen-deprivation therapy (ADT) and external-beam radiation therapy (EBRT), chemotherapy, and metastasis were reported. Additionally continence and potency results were retrieved. Results For the designated period, 250 patients underwent RARP of which 182 (72.8%) underwent lymph node dissection. The median (interquartile range) anaesthesia time was 330 (285–371) min and the estimated blood loss was 200 (200–300) mL. The overall complication rate was 8%, with 2% Clavien–Dindo Grade III–IV complications. The PSM and BCR rates were 21.6% and 6.4%, respectively. Adjuvant ADT and EBRT was administered to 7.2% of the patients. Functional data was available for 112 patients. Continence was 68%, 82% and 97% of the patients at 3, 6 and 12 months, respectively. For 65 patients who had bilateral nerve sparing potency was 37%, 60% and 83% at 3, 6 and 12 months, respectively. Conclusion This is the largest RARP series from the Middle East. The surgical, oncological and functional outcomes are consistent with those published in the literature. This confirms the safety and efficacy of applying robotic technology in our region during the implementation phase. Abbreviations: ADT: androgen-deprivation therapy; AJCC: American Joint Committee on Cancer; AUBMC: American University of Beirut Medical Center; BCR: biochemical recurrence; CPT: Current Procedural Terminology; EBRT external beam radiation therapy; IQR, interquartile ranges; LOS: length of stay; PLND: pelvic lymph node dissection; PSM: positive surgical margin; (O)(RA)RP, (open) (robot-assisted) radical prostatectomy

Muhieddine Labban

Muhammad Bulbul

Wassim Wazzan

Raja Khauli

Albert El Hajj

Robot-assisted radical prostatectomy in the Middle East: A report on the perioperative outcomes from a tertiary care centre in Lebanon

中东机器人辅助根治性前列腺切除术：来自黎巴嫩三级护理中心的围手术期结果报告

ABSTRACT Objective To compare the perioperative and pathological outcomes between robot-assisted laparoscopic radical prostatectomy (RALRP) and LRP based on the patient’s risk. Patients and methods The medical records of 588 patients with prostate cancer who underwent RP, using minimally invasive surgery (MIS) techniques (240 LRP and 348 RALRP) by a single surgeon during January 2008 to June 2018 at the Ramathibodi Hospital, were retrospectively reviewed. The patient’s risk was classified according to the National Comprehensive Cancer Network (NCCN) Guideline, 2018. The demographic, perioperative, and pathological data of patients were collected. The differences in perioperative and pathological outcomes between LRP and RALRP in each risk classification were assessed using chi-square, Fisher’s exact tests and logistic regression, as appropriate. Results In terms of positive margins, RALRP had significant advantages in high-risk patients when compared to LRP (adjusted odds ratio 0.46, 95% confidence interval 0.26–0.84), while there were no differences in the low- and intermediate-risk patients. Overall, the patients who underwent RALRP had significant advantages over those who underwent LRP in terms of operative time, estimate blood loss, and blood transfusion rate. While, adjacent organ injury rate and length of hospital stay were similar for both techniques in all subgroup analyses. Conclusion MIS techniques appear to be safe, especially RALRP, which has significantly better perioperative outcomes in all subgroups of patient risk classification, and in the high-risk patient group it seems to have better pathological outcomes when compared to LRP. Abbreviations EBL: estimated blood loss; LOS: length of hospital stay; PSM: positive surgical margin; (L)(O)(RAL)RP: (laparoscopic) (open) (robot-assisted laparoscopic) radical prostatectomy; MIS: minimally invasive surgery

Napat Amornratananont

Kun Sirisopana

Suchin Worawichawong

Panas Chalermsanyakorn

Premsant Sangkum

Suthep Pacharatakul

Charoen Leenanupunth

Wisoot Kongchareonsombat

Perioperative outcomes of robot-assisted laparoscopic radical prostatectomy (RALRP) and LRP in patients with prostate cancer based on risk groups

基于风险组的机器人辅助腹腔镜根治性前列腺切除术(RALRP)和开放性前列腺切除术(LRP)患者的围手术期结果

Mahmoud A. Abdelhakim

Mohamed Abdelwahab

Robot-assisted radical prostatectomy with the Versius surgical platform: An objective criticism and a guide for an optimal surgical setup

机器人辅助根治性前列腺切除术与Versius手术平台：客观批评与最佳手术设置指南

Background and objectives The widespread utilization of robotic surgeries in urology encouraged several teams to explore the option of performing robot-assisted partial nephrectomy (RAPN), taking advantage of its magnified stereoscopic vision and the articulating instruments that facilitate tumor resection and the reconstructive steps of hemostasis and renorrhaphy. The implementation of the CMR Versius system in RAPN, especially in complex masses, has not been explored yet. Herein, we present our initial experience in performing RAPN in complex renal masses using this novel platform.

Robot-assisted partial nephrectomy in complex renal tumors using the Versius platform: An initial but promising experience

使用Versius平台对复杂肾肿瘤进行机器人辅助部分肾切除术：初步但有前景的经验

Objectives To compare oncological outcomes of open (ORNU) and laparoscopic radical nephroureterectomy (LRNU) after controlling for preoperative patient-derived factors.Patients and methods We evaluated a multi-institutional collaborative database composed of 3984 patients diagnosed with upper tract urothelial carcinoma (UTUC) treated with RNU between 2006 and 2018. To adjust for potential selection bias, propensity score matching adjusted for age, gender and American society Anesthesiology (ASA) score was performed with one ORNU patient matched to one LRNU patient. Uni- and multivariable Cox regression evaluating the risk of overall recurrence, cancer-specific mortality (CSM) and overall mortality (OM) in the overall population and after propensity matching were performed.Results In total, 3984 patients underwent RNU, of these 3227 (81%) patients were treated with ORNU and 757 (19%) patients with LRNU. Within a median follow-up of 62 months, 1276 recurrences, 844 CSMs and 1128 OMs were recorded. On multivariable analyses, the LRNU approach was associated with an increased risk of overall recurrence (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.03–1.54; P = 0.02), but on the other hand LRNU was associated with a protective effect on CSM (HR 0.74, 95% CI 0.56–0.98; P = 0.04). After propensity matching analyses adjusted for age, gender and ASA score, 757 patients treated with LRNU and 757 patients treated with ORNU were available for the analyses. On multivariable Cox regression, LRNU vs ORNU was not associated with any difference in overall recurrence (P = 0.08), CSM (P = 0.1) or OM (P = 0.9).Conclusion Our present data suggest that even if the type of approach to RNU was associated with different survival outcomes considering the overall population, this difference vanished when adjusted for potential confounders in propensity matching analyses. Therefore, we found that LRNU is not inferior to the ORNU approach for the treatment of UTUC.Abbreviations ASA: American Society of Anesthesiology; CIS: carcinoma in situ; CSM: cancer-specific mortality; HR: hazard ratio; IQR: interquartile range; LN: lymph node; LNI: lymph node invasion; LVI: lymphovascular invasion; OM: overall mortality; pT: pathological tumour stage; RCT: randomised controlled trial; (L)(O)RNU: (laparoscopic) (open) radical nephroureterectomy; UTUC: upper tract urothelial carcinoma

Marco Moschini

Stefania Zamboni

Luca Afferi

Benjamin Pradere

Mohammad Abufaraj

Francesco Soria

David D’Andrea

Morgan Roupret

Alexandre De la Taille

Claudio Simeone

Agostino Mattei

Romain Mathieu

Karim Bensalah

Manfred Peter Wirth

Francesco Montorsi

Alberto Briganti

Andrea Gallina

Giuseppe Simone

Michele Gallucci

Carlo Di Bona

Giancarlo Marra

Andrea Mari

Ettore Di Trapani

Mario Alvarez Maestro

Wojciech Krajewski

Shahrokh F. Shariat

Evanguelos Xylinas

Philipp Baumeister

Comparing oncological outcomes of laparoscopic vs open radical nephroureterectomy for the treatment of upper tract urothelial carcinoma: A propensity score-matched analysis

比较上尿路尿路上皮癌治疗中腹腔镜与开放性根治性肾输尿管切除术的肿瘤学结果：倾向评分匹配分析

Aly M. Abdel-Karim

Ahmed M. Bakr

Mustafa A. Shamaa

Mokhtar A. Metawee

Ahmed I. El-Sakka

Urinary transforming growth factor beta-1 levels correlate with the effect of renorrhaphy on functional outcomes post-laparoscopic partial nephrectomy: A pilot-study

尿液转化生长因子β-1水平与腹腔镜部分肾切除术后肾缝合术对功能结果的影响相关：一项初步研究

Ahmed Mahmoud Hasan

Ahmed Mamdouh Abdelhamid

Mostafa Abdelrazek Ahmed

Ahmed Mahmoud Reyad

Percutaneous nephrostomy tube versus double J ureteric stent for the management of non-septic calcular anuria in adults: Prospective randomized study

经皮肾造瘘管与双J型输尿管支架在成人非感染性结石性无尿症管理中的比较：前瞻性随机研究

Mohammed Abdou Abdel-Rassoul

Amr Amin Mohamed Ragab

Amr Mostafa Ibrahim

Khaled Mursi Hammoud

Galal Mohamed El Shorbagy

Safety and efficacy evaluation of intracavernosal injection of platelets rich plasma in treatment of vasculogenic erectile dysfunction

海绵体注射富血小板血浆治疗血管性勃起功能障碍的安全性和有效性评估

Abbreviation	Arab J. Urol.
Journal Impact	1.22
Quartiles(Global)	UROLOGY & NEPHROLOGY(Q3)

ISSN	2090-598X, 2090-5998
h-index	30

Publication Information	Publisher: Taylor and Francis Ltd.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2011，Proportion of original research papers: 73.81%，Self Citation Rate:7.70%， Gold OA Rate: 100.00%

Arab Journal of Urology

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Robot-assisted radical prostatectomy in the Middle East: A report on the perioperative outcomes from a tertiary care centre in Lebanon

Perioperative outcomes of robot-assisted laparoscopic radical prostatectomy (RALRP) and LRP in patients with prostate cancer based on risk groups

Robot-assisted radical prostatectomy with the Versius surgical platform: An objective criticism and a guide for an optimal surgical setup

Robot-assisted partial nephrectomy in complex renal tumors using the Versius platform: An initial but promising experience

Comparing oncological outcomes of laparoscopic vs open radical nephroureterectomy for the treatment of upper tract urothelial carcinoma: A propensity score-matched analysis

Robot-assisted partial nephrectomy in complex renal tumors using the Versius platform: An initial but promising experience

Robot-assisted radical prostatectomy with the Versius surgical platform: An objective criticism and a guide for an optimal surgical setup

Urinary transforming growth factor beta-1 levels correlate with the effect of renorrhaphy on functional outcomes post-laparoscopic partial nephrectomy: A pilot-study

Percutaneous nephrostomy tube versus double J ureteric stent for the management of non-septic calcular anuria in adults: Prospective randomized study

Safety and efficacy evaluation of intracavernosal injection of platelets rich plasma in treatment of vasculogenic erectile dysfunction