Page 5 - CUA2018 Abstracts - Robotics

Poster session 8: robotics/Other Urology topics

Results: A total of 34 RARP cases had complete surgeon and assistant year–old group. Clavien I–II accounted for the majority of postoperative
assessment data for analysis. Four experienced faculty (>50 cases) and 10 complications and Clavien III–IV for less than 2.5% of all complications.
trainee bedside assistants were included in the study. Trainee experience Conclusions: Our results suggest that RARP is safe in all groups of elderly
ranged from 0 cases as bedside assist to more than 30. aOSATS score patients. Urinary continence outcomes differ significantly according to
was significantly associated with bedside experience (p=0.001), console age, with better return of urinary function in elderly patients 66–69 years
experience (p=0.005), but not prior laparoscopic experience (p=0.217). old compared with those 70 years or older.
aOSATS score showed moderate positive correlation with surgeon GEARS
score (0.533; p=0.001) (Fig. 1; available at https://cua.guide/). UP–8.1
Conclusions: This is the first study to assess the impact of assistant techni-
cal skill on surgeon performance in RARP. We have additionally provided Robotic vs. open surgery in urology: A systematic review with
validity evidence for a modified OSATS GRS for training and assessing meta–analysis of randomized control trials 1
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bedside assistant performance. Our hypothesis–generating data suggests Wendy Liu , Tamara Johnson , Marcus Handmer , Ahmed Goolam , Henry
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that bedside assistants must be technically skilled to allow the surgeon Woo , Venu Chalasani 2
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to perform at his/her best. Surgery, Northern Sydney Local Health District, Sydney, Australia; School
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References: of Medicine, Western Sydney University, Sydney, Australia; Sydney
1. Goh AC, Goldfarb DW, Sander JC, et al. Global evaluative assess- Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
ment of robotic skills: Validation of a clinical assessment tool to Introduction: Minimally invasive robotic surgery (RS) has gained favour
measure robotic surgical skills. J Urol 2012;187:247–52. https://doi. as an alternative to open surgery in urological procedures, in particular
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org/10.1016/j.juro.2011.09.032 radial prostatectomy and cystectomy. Previous systematic reviews have
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2. Martin JA, Regehr G, Reznick R, et al. Objective structured assess- been restricted to comparing outcomes for one specific procedure. This
ment of technical skill (OSATS) for surgical residents. Br J Surg paper aims to systematically review and analyze outcomes that are com-
1997;84:273–8. https://doi.org/10.1002/bjs.1800840237 mon regardless of the procedure.
Methods: A search was performed in electronic databases and stud-
ies were screened for relevance by two authors. The inclusion criteria
MP–8.12 included randomized controlled trials (RCTs) with a minimum 12–week
Functional outcomes and postoperative complications in elderly followup, comparing open to robotic urological surgery, published from
patients (>70 years old) undergoing robotic–assisted radical 2000–2017. Included studies were assessed for risk of bias. The data was
prostatectomy extracted, and statistical analysis performed using RevMan 5.3 software.
Sabrina Harmouch , Samer Traboulsi , Félix Couture , Cristina Negrean , A random effects model was used.
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Mila Mansour , Khaled Ajib , Côme Tholomier , Pierre Karakiewicz , Results: Included for analysis were seven RCTs involving 1054 patients
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Assaad El–Hakim , Kevin Zorn 1 (508 prostatectomy, 546 radical cystectomy) that met the eligibility crite-
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1 Urology, Université de Montréal, Montreal, QC, Canada; Urology, ria. RS was associated with reduced intraoperative estimated blood loss
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McGill University, Montreal, QC, Canada. (EBL) (mean difference 417 ml; p=0.001; 95% confidence interval [CI]
Introduction: Urinary continence and erectile function following robotic– –667.69 to –165.37), and shorter hospital stay (mean difference 1.1 days;
assisted radical prostatectomy (RARP) have significant impact on quality p=0.04). There was no difference in complications (RS 162 events vs. open
of life in patients with prostate cancer (PCa). We aimed to compare surgery 181 events; relative risk [RR] 0.9; 95% CI 0.75–1.07; p=0.22) or
functional and perioperative outcomes, along with postoperative com- operative time (mean difference 49.6 minutes longer for RS; p=0.05; 95%
plications in elderly patients stratified by age. CI –1.02 to 100.21). There were more positive surgical margins in the
Methods: A retrospective review of patients who underwent RARP RS group (68 vs. 49), with this result approaching statistical significance
between January 2007 and April 2017 was performed. Patients over 65 (p=0.06; RR 1.39; 95% CI 0.98–1.96).
years of age were selected (n=280) and then stratified according to age Conclusions: Compared to open surgery, RS has a number of advantages,
66–69 years old (n=197) or age ≥70 years old (n=83). Continence was including a statistically significant improvement in EBL and shorter hos-
defined as 0 pad per day usage and potency as Sexual Health Inventory pital stay. There were no differences in complications or operative time.
for Men (SHIM) score ≥20. Perioperative, postoperative, and functional While not statistically significant, the studies suggest a potential positive
outcomes were assessed. Kaplan–Meier (KM) method was used to estimate correlation between RS and positive surgical margins. The differences in
time to recovery of continence in both groups. this outcome are potentially clinically relevant and justify further evalu-
Results: In the 66–69–year old group, continence rates at one, three, six, ation.
nine, and 12 months were 41%, 63%, 74%, 82%, and 87%, respectively. References:
Continence rates in the ≥70–year–old group were 29%, 51%, 63%, 64%, 1. Gonzalez P, Queralt P, Bayarri S, et al. Evolution of open vs. laparo-
and 65%, respectively. KM estimates demonstrated significantly superior scopic/robotic surgery: 10 years of changes in urology. Actas Urol Esp
continence outcomes in the groups of patients aged 66–69 years (p–log– 2010;34:223–31. https://doi.org/10.1016/S2173–5786(10)70053–6
rank=0.012) (Fig. 1; available at https://cua.guide/). In the 66–69–year– 2. Steffens D, Thanigasalam R, Leslie S, et al. Robotic surgery in uro–
old group, 10% of patients who had unilateral nerve–sparing and 9% of oncology: A systematic review and meta–analysis of randomized
patients who had bilateral nerve–sparing were potent at 18 months. None controlled trials. J Urol 2017;106:9–17. https://doi.org/10.1016/j.
of the patients who had unilateral nerve–sparing and 17% of patients urology.2017.03.015
who had bilateral nerve–sparing were potent at 18 months in the ≥70–

S112 CUAJ • June 2018 • Volume 12(6Suppl2)