Lower Ureteral Stones Revisited: Expanding the Horizons of Robotics

doi:10.1016/j.urology.2013.02.059

Urology

Volume 82, Issue 1, July 2013, Pages 95-99

https://doi.org/10.1016/j.urology.2013.02.059 Get rights and content

Objective

To study the feasibility of robot-assisted laparoscopic ureterolithotomy for large (>2 cm) or impacted lower ureteral stones and the immediate outcome measures such as the stone-free rate and occurrence of intra- and postoperative complications.

Materials and Methods

From April 2010 to August 2012, 52 robotic stone surgeries were performed in our department. Robot-assisted laparoscopic ureterolithotomy was performed in 16 patients for large (>2 cm) or impacted lower ureteral stones.

Results

The stone was most commonly located in the juxtavesical position in all 16 patients. The average stone size was 2.2 cm, and all stones were impacted. The mean operative time was 45.3 minutes (range, 38-63), including stent placement time, and the mean blood loss was 10 mL. The mean console time was 20.3 minutes. No conversion to an open procedure was required.

Conclusion

Robot-assisted laparoscopic ureterolithotomy for large, impacted, lower ureteral stones is an acceptable alternative. The ease of surgery and shorter operative times are significant advantages compared with the laparoscopic approach.

Section snippets

Material and Methods

From April 2010 to August 2012, 246 ureteroscopic, 188 extracorporeal shock wave lithotripsy, and 5 open ureterolithotomy procedures were performed for stones in the ureter at our institute. During the same period, 52 robotic stone surgeries were performed. Of these, robot-assisted laparoscopic ureterolithotomy was performed in 16 patients with lower ureteral stones. The selection criteria for these patients were large (>2 cm), impacted stones, located in lower ureter in patients who were fit

Results

The stone was most commonly located in the juxtavesical position in all 16 patients. The average stone size was 2.2 cm, and all the stones were impacted (Table 1). The mean operative time was 45.3 minutes (range 38-63), including stent placement time, and the mean blood loss was 10 mL. The mean console time was 20.3 minutes. No conversion to an open procedure was required. All patients were allowed to intake orally the next morning, and the average parenteral analgesic requirement during the

Comment

The success of shock wave lithotripsy and ureteroscopy has been high for most ureteral stones. Ureteroscopic treatment for distal ureteral stones has had high clearance (≤94%) and low complication rates, with a noted decrease in the stone-free rates when treating larger stones.⁶ The success rates of extracorporeal shock wave lithotripsy for lower ureteral calculi have been similar to those for stones in the upper ureter (77%-89%); however, this success is drastically reduced for stones >1 cm

Conclusion

Although laparoscopic ureterolithotomy is an option for large, impacted, lower ureteral stones, robot-assisted laparoscopic ureterolithotomy for such ureteral stones is an acceptable alternative. The ease of surgery and shorter operative times are significant advantages compared with the laparoscopic approach. Greater clearance rates and a lower incidence of complications compared with the ureteroscopic approach for such large stones in the lower ureter were seen with the patients operated

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Cited by (15)

Expanding the indications of robotic surgery in urology: A systematic review of the literature
2018, Arab Journal of Urology
Citation Excerpt :
LOS, interval to drain removal, and complication rates, were significantly shorter than for comparative laparoscopic series. At 20 months follow-up no ureteric strictures were evident [65]. Although many authors acknowledge that endourology remains the standard of care, with falling anticipated costs and rising experience, RAS has the potential to displace procedures such as PCNL in selected cases.
To evaluate the recent developments in robotic urological surgery, as the introduction of robotic technology has overcome many of the difficulties of pure laparoscopic surgery enabling surgeons to perform complex minimally invasive procedures with a shorter learning curve. Robot-assisted surgery (RAS) is now offered as the standard for various surgical procedures across multiple specialities.
A systematic search of MEDLINE, PubMed and EMBASE databases was performed to identify studies evaluating robot-assisted simple prostatectomy, salvage radical prostatectomy, surgery for urolithiasis, distal ureteric reconstruction, retroperitoneal lymph node dissection, augmentation ileocystoplasty, and artificial urinary sphincter insertion. Article titles, abstracts, and full text manuscripts were screened to identify relevant studies, which then underwent data extraction and analysis.
In all, 72 studies evaluating the above techniques were identified. Almost all studies were retrospective single-arm case series. RAS appears to be associated with reduced morbidity, less blood loss, reduced length of stay, and comparable clinical outcomes in comparison to the corresponding open procedures, whilst having a shorter operative duration and learning curve compared to the equivalent laparoscopic techniques.
Emerging data demonstrate that the breadth and complexity of urological procedures performed using the da Vinci® platform (Intuitive Surgical Inc., Sunnyvale, CA, USA) is continually expanding. There is a gaining consensus that RAS is producing promising surgical results in a wide range of procedures. A major limitation of the current literature is the sparsity of comparative trials evaluating these procedures.
Robotic stone surgery – Current state and future prospects: A systematic review
2018, Arab Journal of Urology
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However, laparoscopic surgery for impacted ureteric stones is considered a suitable alternative [28]. In 2013, Dogra et al. [29] published, to their knowledge, the first clinical experience with a da Vinci system for this type of stone. From 2010 to 2012, they performed robot-assisted ureterolithotomy in 16 patients and reported no conversions to open surgery.
To provide a comprehensive review of robot-assisted surgery in urolithiasis and to consider the future prospects of robotic approaches in stone surgery.
We performed a systematic PubMed© literature search using predefined Medical Subject Headings search terms to identify PubMed-listed clinical research studies on robotic stone surgery. All authors screened the results for eligibility and two independent reviewers performed the data extraction.
The most common approach in robotic stone surgery is a robot-assisted pyelolithotomy using the da Vinci™ system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Several studies show this technique to be comparable to classic laparoscopic and open surgical interventions. One study that focused on ureteric stones showed a similar result. In recent years, promising data on robotic intrarenal surgery have been reported (Roboflex Avicenna™; Elmed Medical Systems, Ankara, Turkey). Initial studies have shown its feasibility and high stone-free rates and prove that this novel endoscopic approach is safe for the patient and comfortable for the surgeon.
The benefits of robotic devices in stone surgery in existing endourological, laparoscopic, and open treatment strategies still need elucidation. Although recent data are promising, more prospective randomised controlled studies are necessary to clarify the impact of this technique on patient safety and stone-free rates.
Robotic-assisted laparoscopic surgery: Recent advances in urology
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Citation Excerpt :
Robotic-assisted stone surgery has been recently explored as a possible alternative to standard therapeutic options in this setting. Dogra et al. (59) explored the feasibility of robotic-assisted laparoscopic ureterolithotomy for large (average stone size, 2.2 cm) or impacted lower ureteral stone. They outlined the ease of surgery and that shorter operative times are significant advantages compared with the laparoscopic approach.
The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology.
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: Financial Disclosure: The authors declare that they have no relevant financial interests.

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Laparoscopy and RoboticsLower Ureteral Stones Revisited: Expanding the Horizons of Robotics

Objective

Materials and Methods

Results

Conclusion

Section snippets

Material and Methods

Results

Comment

Conclusion

Urology

Prog Urol

J Urol

Urol Clin North Am

Urology

Urology

Urology

Arab J Urol

Laparoscopy and Robotics
Lower Ureteral Stones Revisited: Expanding the Horizons of Robotics