{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:57:05Z","timestamp":1790582225742,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We evaluated the impact of incorporating systematic fourth\u2010arm traction and articulating\u2010needle drivers on the perioperative and oncological outcomes of Senhance robotic radical prostatectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective single\u2010center analysis of 30 consecutive patients who underwent Senhance robotic radical prostatectomy procedures between October 2024 and December 2025. The patients were stratified into an initial cohort (cases 1\u201315), which underwent surgery using a three\u2010arm robotic configuration and conventional straight needle drivers, and a refined cohort (cases 16\u201330), in which continuous fourth\u2010arm traction and articulating\u2010needle drivers were used. The primary endpoints were operative time and positive surgical margin rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median operative time decreased significantly, from 260\u2009min in the initial cohort to 200\u2009min in the refined cohort (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). This figure was further reduced, from 244 to 194\u2009min (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), after all cases involving lymphadenectomy were excluded. The positive surgical margin rate showed a non\u2010significant trend toward reduction from 33% to 7% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.17). Early urinary continence was also evaluated as an initial functional outcome, with no significant difference between the two cohorts. A learning curve analysis demonstrated a progressive improvement in operative efficiency (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.57,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). No major complications (Clavien\u2013Dindo grades \u2265 III) occurred in either cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The refined protocol was associated with shorter operative time and a non\u2010significant trend toward a lower positive surgical margin rate. These findings should be interpreted cautiously, as our refinement of the surgical protocol overlapped with the learning curve of the surgeon who performed the procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70644","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T02:08:27Z","timestamp":1789524507000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of Systematic Fourth\u2010Arm Traction and Articulating\u2010Needle Drivers in Senhance Robotic Radical Prostatectomy: Initial Experience"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4118-7166","authenticated-orcid":false,"given":"Zenkichi","family":"Sekiguchi","sequence":"first","affiliation":[{"name":"Department of Urology St. Marianna University Yokohama Seibu Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5051-432X","authenticated-orcid":false,"given":"Masahide","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Urology St. Marianna University Yokohama Seibu Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaori","family":"Matsumura","sequence":"additional","affiliation":[{"name":"Department of Urology St. Marianna University Yokohama Seibu Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitsugu","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Urology St. Marianna University Yokohama Seibu Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakurako","family":"Tomokiyo","sequence":"additional","affiliation":[{"name":"Department of Urology St. Marianna University School of Medicine  Kawasaki Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuto","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Department of Urology St. Marianna University School of Medicine  Kawasaki Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1624-6676","authenticated-orcid":false,"given":"Eiji","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Urology St. Marianna University School of Medicine  Kawasaki Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"9","key":"e_1_2_12_2_1","article-title":"Laparoscopic and Robotic\u2010Assisted Versus Open Radical Prostatectomy for the Treatment of Localised Prostate Cancer","volume":"9","author":"Ilic D.","year":"2017","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euros.2024.06.014"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3325\/cmj.2019.60.556"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-021-03792-5"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-023-04732-1"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/rcs.2549"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41391-023-00717-8"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-021-01245-0"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000000700"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2006.10.014"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(02)02543-8"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15819"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2005.05274.x"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2006.0239"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/9073807"},{"key":"e_1_2_12_17_1","first-page":"103","article-title":"The TransEnterix European Patient Registry for Robotic\u2010Assisted Laparoscopic Procedures in Urology, Abdominal, Thoracic, and Gynecologic Surgery (\u2018TRUST\u2019)","volume":"38","author":"Stephan D.","year":"2021","journal-title":"Surgical Technology International"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/rcs.2261"}],"container-title":["International Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iju.70644","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iju.70644","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iju.70644","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:29:01Z","timestamp":1790580541000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iju.70644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":17,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/iju.70644"],"URL":"https:\/\/doi.org\/10.1111\/iju.70644","archive":["Portico"],"relation":{},"ISSN":["0919-8172","1442-2042"],"issn-type":[{"value":"0919-8172","type":"print"},{"value":"1442-2042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-03-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70644"}}