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Sidhu PS, Yusuf GT, Sellars ME, Deganello A, Fang C, Huang DYH. A review of multiparametric ultrasound imaging in the clinical setting: scrotal contents. Abdom Radiol (NY) 2025; 50:1363-1375. [PMID: 39297931 PMCID: PMC11821694 DOI: 10.1007/s00261-024-04587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 09/21/2024]
Abstract
The innovative techniques in ultrasound have added a new dimension to investigating superficially located areas such as the contents of the scrotal sac. High frequency transducers, improved technology with the addition of elastography, contrast enhanced ultrasound and microvascular imaging has resulted in a further improvement in diagnostic capabilities. The ability to clearly demonstrate the presence or absence of vascularity within the area under investigation adds an additional dimension to operator confidence in establishing the presence of infarction, global or segmental, or the walls and cavity of an abscess in the testis or epididymis. Increased vascularity of a tumor aids the differential diagnosis based on the flow dynamics of the microbubble contrast, benign lesions likely to retain contrast. Elastography has the ability to ascertain the stiffness of tissue, and when used in conjunction with other ultrasound methods adds to the understanding of the likelihood of a malignant abnormality being present. All the different techniques come under the umbrella term 'multiparametric ultrasound', with the application in the scrotal sac detailed in this article.
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Affiliation(s)
- Paul S Sidhu
- King's College London, London, UK.
- King's College Hospital, NHS Foundation Trust, London, UK.
| | - Gibran T Yusuf
- King's College London, London, UK
- King's College Hospital, NHS Foundation Trust, London, UK
| | | | - Annamaria Deganello
- King's College London, London, UK
- King's College Hospital, NHS Foundation Trust, London, UK
| | - Cheng Fang
- King's College London, London, UK
- King's College Hospital, NHS Foundation Trust, London, UK
| | - Dean Y H Huang
- King's College London, London, UK
- King's College Hospital, NHS Foundation Trust, London, UK
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Fan S, Liu H, Zhu Y, Zheng Z, Cui Q. Effect of fast-track surgery on postoperative wound pain in patients with prostate cancer: A meta-analysis. Int Wound J 2023; 21:e14417. [PMID: 37737032 PMCID: PMC10824699 DOI: 10.1111/iwj.14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
Fast track surgery (FTS) is widely used in many procedures and has been shown to reduce complications and accelerate recovery. However, no studies have been conducted to assess their effectiveness in treating wounds after radical prostatectomy (RP). The objective of this study was to evaluate the impact of FTS on RP. We went through 4 major databases. A study was conducted by PubMed, the Cochrane Library, Embase, and the Web of Science to determine the effect of comparison of FTS versus conventional surgery in RP on postoperative wound complications as of 1 July 2023. Based on the review of literature, data extraction and literature quality assessment, we conducted meta-analyses with RevMan 5.3. In the course of the study, the researchers selected 6 of the 404 studies to be analysed according to exclusion criteria. Data analysis showed that the FTS method reduced the postoperative pain associated with VAS and also decreased the rate of postoperative complications in post-surgical patients. However, there was no significant difference between FTS and conventional surgery in terms of blood loss, operation time, and postoperative infection rate. Therefore, generally speaking, FTS has less impact on postoperative complications in patients with minimal invasive prostatic cancer, but it does reduce postoperative pain and total postoperative complications.
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Affiliation(s)
- Shicheng Fan
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Haolin Liu
- Department of UrologyInstitute of Urology, West China Hospital, Sichuan UniversityChengduChina
| | - Yuanquan Zhu
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Zhiqiang Zheng
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Qingpeng Cui
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
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Li Marzi V, Pecoraro A, Gallo ML, Caroti L, Peris A, Vignolini G, Serni S, Campi R. Robot-assisted kidney transplantation: Is it getting ready for prime time? World J Transplant 2022; 12:163-174. [PMID: 36051450 PMCID: PMC9331411 DOI: 10.5500/wjt.v12.i7.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/08/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, providing a better survival rate and quality of life compared to dialysis. Despite the progress in the medical management of KT patients, from a purely surgical standpoint, KT has resisted innovations during the last 50 years. Recently, robot-assisted KT (RAKT) has been proposed as an alternative approach to open surgery, especially due to its potential benefits for fragile and immunocompromised recipients. It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea, Development, Exploration, Assessment, Long-term follow-up recommendations for introducing surgical innovations into real-life practice. During the last years, mirroring the Vattikuti-Medanta technique, several centers developed RAKT program worldwide, providing strong evidence about the safety and the feasibility of this procedure. However, the majority of RAKT are still performed in the living donor setting, as an “eligible” procedure, while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation. In addition, despite the spread of minimally-invasive (predominantly robotic) surgery worldwide, many KTs are still performed in an open fashion. Regardless of the type of incision employed by surgeons, open KT may lead to non-negligible risks of wound complications, especially among obese patients. Particularly, the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications. In this context, robotic surgery could offer several benefits, including providing a better exposure of the surgical field and better instrument maneuverability, as well as the possibility to integrate other technological nuances, such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis. Therefore, our review aims to report the more significant experiences regarding RAKT, focusing on the results and future perspectives.
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Affiliation(s)
- Vincenzo Li Marzi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Alessio Pecoraro
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Maria Lucia Gallo
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | | | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Careggi Hospital, Florence 50134, Italy
| | - Graziano Vignolini
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Sergio Serni
- Department of Minimally Invasive and Robotic Urologic Surgery, University of Florence, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Riccardo Campi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
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Fan Y, Zhao J, Zu Q, Gao Y, Shen D, Zhu Q, Huang S, Chen X, Dong J, Zhang X. Robot-Assisted Kidney Transplantation: Initial Experience with a Modified Hypothermia Technique. Urol Int 2022; 106:504-511. [DOI: 10.1159/000521959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> The aim of the study was to report our initial experience of robot-assisted kidney transplantation (RAKT) with a modified hypothermia technique. <b><i>Methods:</i></b> Between March 2018 and May 2020, 12 patients with end-stage renal disease underwent RAKT at the Chinese PLA General Hospital, and a modified regional hypothermia was implemented by wrapping the kidney in a sealed plastic jacket filled with ice slush. Baseline, surgical, and functional outcomes were analyzed. <b><i>Results:</i></b> All surgeries were successfully performed. The mean operative time was 180.5 min, with a mean console time of 133.3 min. Mean warm ischemia, cold ischemia, and rewarming times were 1.5, 135.1, and 48.4 min, respectively. The median blood loss was 50 mL, and the median hospital stay was 9.5 days. No complications were observed. The mean serum creatinine levels were 119.4, 100.5, 108, and 108.5 μmol/L 7 days, 1 month, 6 months, and 1 year postoperatively, respectively. All patients and grafts survived at a median follow-up of 32.2 months. <b><i>Conclusion:</i></b> RAKT is a safe and feasible procedure for surgical teams with expertise in open kidney transplantation and robotic surgery. Our modification of the hypothermia technique can maintain the kidney at a constant low temperature without repeatedly adding ice and prevent the complication of paralytic ileus.
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Spiers HVM, Sharma V, Woywodt A, Sivaprakasam R, Augustine T. Robot-assisted kidney transplantation: an update. Clin Kidney J 2021; 15:635-643. [PMID: 35371439 PMCID: PMC8967665 DOI: 10.1093/ckj/sfab214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.
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Affiliation(s)
- Harry V M Spiers
- Department of Transplantation, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Rajesh Sivaprakasam
- Department of Transplant and Robotic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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Krüger CM, Rückbeil O, Sebestyen U, Schlick T, Kürbis J, Riediger H. [DeRAS I-German situation of robotic-assisted surgery-an online survey]. Chirurg 2021; 92:1107-1113. [PMID: 34170354 PMCID: PMC8629862 DOI: 10.1007/s00104-021-01404-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund Die robotische Assistenz hat sich in der Chirurgie etabliert, ist aber noch kein Standard. Der aktuelle Stand der klinischen Verbreitung in Deutschland ist weiter unklar. Industrieunabhängige Quellen sind rar. Ziel der Arbeit Ziel dieser Umfrage ist es, den aktuellen Stand der robotisch assistierten Chirurgie (RAS) fachübergreifend in Deutschland im Zeitraum von 2014 bis 2018 zu untersuchen. Materialien und Methoden Mit einer Internetrecherche wurden Krankenhäuser (KH) und Fachabteilungen (FA) mit Zugang zur RAS identifiziert. Die FA wurden aufgefordert, ihre Daten aus den Jahren 2014 bis 2018 zu teilen. Neben klinischen Daten wurden Daten zu Nutzung, Implementierung, Training und Finanzierung abgefragt. Ergebnisse Am 31.12.2018 wurde die RAS an 121 KH in Deutschland angeboten. 383 FA mit Zugang zur RAS wurden identifiziert. 26 % (n = 98) der FA haben geantwortet. Im Mittel verfügte jede FA über zwei Konsolenchirurgen. 10 % der KH verfügten über mehr als 1 RAS-System. 100 % der erfassten RAS-Systeme stammten von der Firma Intuitive Surgical Inc., CA, USA. Die RAS wurde zu 65 % in der Urologie implementiert, zu 12 % in der Viszeralchirurgie (VC). 21 % der Programme erfolgten interdisziplinär und 4 % multidisziplinär (> 3). 83 % der Systeme wurden gekauft, 17 % anderweitig finanziert. Bei den Operationsmehrkosten gaben 74 % der Kliniken an, diese selbst zu tragen. 14 % wählten eine Umlage. Seit 2014 steigerten sich die Eingriffe um den Faktor 4 auf ca. 8000. Der Anteil der VC steigerte sich um das Fünffache seit 2016. Schlussfolgerung Die RAS erlebte in Deutschland bis 2018 ein starkes Wachstum. Das Eingriffsspektrum entspricht dem der Laparoskopie. Bei aktuell fehlender Kostenerstattung für den technischen Mehraufwand, wird die RAS überwiegend im mittel- und hochkomplexen Bereich eingesetzt. Der Online-Survey ist eine gute Methode, ohne hohen administrativen Aufwand unabhängige Daten zu erheben.
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Affiliation(s)
- C M Krüger
- Abteilung Chirurgie/Zentrum für Robotik, Immanuel Klinikum Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf b. Berlin, Deutschland.
| | - O Rückbeil
- Abteilung Chirurgie/Zentrum für Robotik, Immanuel Klinikum Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf b. Berlin, Deutschland
| | - U Sebestyen
- Abteilung Chirurgie/Zentrum für Robotik, Immanuel Klinikum Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf b. Berlin, Deutschland
| | - T Schlick
- Abteilung Chirurgie/Zentrum für Robotik, Immanuel Klinikum Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf b. Berlin, Deutschland
| | - J Kürbis
- SurgiData UG, Mahlow, Deutschland
| | - H Riediger
- Department für Chirurgie, Vivantes Humboldt Klinikum, Berlin, Deutschland
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Carneiro A, Cha JD, Baccaglini W, Husain FZ, Wroclawski ML, Nunes-Silva I, Sanchez-Salas R, Ingels A, Kayano PP, Claros OR, Saviano Moran NK, Sotelo R, Lemos GC. Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis. Ther Adv Urol 2019; 11:1756287218816595. [PMID: 30671139 PMCID: PMC6329037 DOI: 10.1177/1756287218816595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/06/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Low-dose aspirin use has been correlated with an increased risk of bleeding and overall complications in surgical and invasive diagnostic procedures. In this review, our aim was to analyze the current literature on whether robot-assisted radical prostatectomy (RARP) is feasible and safe in patients taking low-dose aspirin perioperatively. Methods: A systematic review was performed identifying a total of 767 studies, published between January 2000 and September 2017, with five of these studies meeting the inclusion criteria for the meta-analysis, totalizing 1481 patients underwent RARP. Patients were divided into two groups: taking aspirin (group A) and those not taking aspirin (group B) perioperatively. Results: There were no significant differences between groups in the overall [group A 10.7% versus group B 15.7%, risk ratio (RR) 0.83; p = 0.45; I2 = 0%] or major complication rates (group A 1% versus group B 3%, RR 0.98; p = 0.98; I² = 0%), rate of cardiovascular events (group A 1.4% and group B 0.5%, RR 2.06; p = 0.24; I2 = 9%), blood loss (group A 278 ml versus group B 307 ml, SMD −0.12; p = 0.91; I2 = 96%), or hospital length of stay [group A 4 days (3–5) and group B 4 days (3–4), SMD −0.09; p = 0.52; I² = 0%]. There was a slightly higher blood-transfusion rate in group A (2.6%) versus group B (1.6%) (RR, 5.05; p = 0.04; I2 = 0%). Conclusion: Continued aspirin use in the perioperative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay. There was a slightly higher blood-transfusion rate in patients taking low-dose aspirin (group A) perioperatively.
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Affiliation(s)
- Arie Carneiro
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Jonathan Doyun Cha
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Willy Baccaglini
- Discipline of Urology - ABC Medical School, Av. Lauro Gomes, 2000 - Anexo II, Vila Sacadura Cabral - Santo André/SP, CEP: 09060-870, Brazil
| | - Fatima Z Husain
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Marcelo Langer Wroclawski
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Igor Nunes-Silva
- Arnaldo Vieira de Carvalho Cancer Institute - IAVC, São Paulo, Brazil
| | | | - Alexandre Ingels
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - René Sotelo
- Institute of Urology, University of Southern California, Los Angeles, California, USA
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Territo A, Gausa L, Alcaraz A, Musquera M, Doumerc N, Decaestecker K, Desender L, Stockle M, Janssen M, Fornara P, Mohammed N, Siena G, Serni S, Sahin S, Tuǧcu V, Basile G, Breda A. European experience of robot-assisted kidney transplantation: minimum of 1-year follow-up. BJU Int 2018; 122:255-262. [PMID: 29645355 DOI: 10.1111/bju.14247] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate functional results, graft survival and late complications in patients who underwent robot-assisted kidney transplantation (RAKT) and who had a minimum of 1 year of follow-up data, and to analyse the correlations between surgical data and functional results at a minimum of 1-year postoperatively and between renal function in the immediate postoperative period and after 1 year. MATERIALS AND METHODS A common prospectively collected RAKT database was created by the European Robotic Urological Section (ERUS) RAKT working group, which included eight different European centres. In each centre RAKTs were performed with kidneys from living donors. Data on demographic variables, surgical results, graft survival, functional outcomes (creatinine and estimated glomerular filtration rate [eGFR]) on postoperative days 7 and 30 and at 1 year, and late complications were extracted from the common database. RESULTS A total of 147 RAKTs were performed by the ERUS RAKT working group. Of the 147 patients, 83 had at least 1-year follow-up (mean [range] 21 [13-27] months). Of these 83 patients, 30 were women. The patients' median (range) age was 43 (30-75) years, body mass index was 25.3 (20-40) kg/m2 , pre-transplantation serum creatinine was 517 (198-1 414) μmol/L and estimated GFR (eGFR) was 10 (3-29) mL/min per 1.73 m2 . Of the 83 cases, 46 were pre-emptive. The median (range) overall ischaemia time was 116 (53-377) min. The median (range) rewarming time was 60 (35-110) min. At 1-year follow-up, the median (range) serum creatinine was 131 (66-244) μmol/L, with a median (range) eGFR of 57.4 (28-97) mL/min per 1.73 m2 . There was no statistically significant difference between functional data at postoperative day 30 and those at 1 year for creatinine (P = 0.78) or eGFR (P = 0.91). Regarding the correlation between the surgical data and the functional outcomes, the data showed that overall operating time and rewarming time did not affect the graft function at 1 year. Three cases of graft loss occurred as a result of massive arterial thrombosis within the first postoperative week. Late complications comprised one case of ureteric stenosis and one case of graft pyelonephritis. No late vascular complications or cases of incisional hernia were recorded. CONCLUSION Findings at 1-year follow-up indicate RAKT from a living donor to be a safe procedure in a properly selected group of recipients. RAKT was associated with a low complication rate and there was maintenance of excellent graft survival and function. This is the first and largest study to report functional results after RAKT from a living donor with a minimum follow-up of 1 year.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Lluis Gausa
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | | | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michael Stockle
- Department of Urology, University Saarland, Homburg/Saar, Germany
| | - Martin Janssen
- Department of Urology, University Saarland, Homburg/Saar, Germany
| | - Paolo Fornara
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Nasreldin Mohammed
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Selcuk Sahin
- Bakirkoy Sadi Konuk Training and Research Hospital Centre, Istanbul, Turkey
| | - Volkan Tuǧcu
- Bakirkoy Sadi Konuk Training and Research Hospital Centre, Istanbul, Turkey
| | - Giuseppe Basile
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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9
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Breda A, Territo A, Gausa L, Tuğcu V, Alcaraz A, Musquera M, Decaestecker K, Desender L, Stockle M, Janssen M, Fornara P, Mohammed N, Siena G, Serni S, Guirado L, Facundo C, Doumerc N. Robot-assisted Kidney Transplantation: The European Experience. Eur Urol 2018; 73:273-281. [DOI: 10.1016/j.eururo.2017.08.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/27/2017] [Indexed: 01/13/2023]
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10
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Robotic kidney transplantation: one year after the beginning. World J Urol 2017; 35:1507-1515. [PMID: 28229210 DOI: 10.1007/s00345-017-2006-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Kidney transplantation (KT) is the preferred treatment for patients with end-stage renal disease (ESRD). To reduce the morbidity of the open surgery, a robotic-assisted approach has been recently introduced. Our aim is to evaluate surgical and functional results on 17 cases of robotic-assisted kidney transplantation (RAKT) performed at the same institution. MATERIALS AND METHODS From July 2015 to June 2016, we performed 17 cases of RAKT from living donors in pre-emptive patients, who underwent laparoscopic nephrectomy. A prospective pilot study was made at Fundació Puigvert (Barcelona), evaluating functional and surgical outcomes. In this series, we considered the functional results, surgical outcomes and complications rates. RESULTS Seventeen patients successfully underwent RAKT, in particular surgical console time was 181 min (150-200) with vascular suture time 42 min (32-48), and estimated blood loss <70 ml. Overall ischemia time was 98.9 min (84-140). No patient was converted to open transplantation. No major surgical intra-operative complications were observed. The mean post-operative serum creatinine level 160 μmol/L (81-479). We reported a case of delayed graft function (DGF), one case of graft arterial thrombosis and one case of intraperitoneal hematoma. No anastomosis revision and wounds infections occurred. CONCLUSION RAKT with regional hypothermia appears to be a safe surgical procedure in a properly selected group of patients. The potential advantages of RAKT are related to the quality of the vascular anastomosis, the possible lower complication rate and the shorter recovery of the recipients.
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11
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Abstract
Radical retropubic prostatectomy is the current gold standard for surgical removal of the prostate gland. Recently, laparoscopic radical prostatectomy has been developed in an attempt to decrease surgical morbidity, and the technical difficulty of laparoscopy has been countered with the development of the da Vinci robotic interface. Studies that have compared the minimally invasive approaches with the traditional open approach have reported comparable perioperative outcomes. While long-term oncological data are available for open prostatectomy, there are only short-term studies available for laparoscopic prostatectomy. Functional outcomes, including urinary continence and sexual function, appear to be similar between the surgical approaches in the short term. However, currently, costs appear to favor open surgery, with the da Vinci-assisted prostatectomy having the highest expenses. Longer-term data are required to confidently determine the optimal balance between morbidity, oncological efficacy, functional outcomes and cost among the differing surgical approaches.
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Affiliation(s)
- Carter Q Le
- Department of Urology, Mayo Clinic, Gonda 7S, 200 First Street, SW, Rochester, MN 55905, USA.
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12
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Nowfar S, Kopp R, Palazzi-Churas K, Derweesh IH, Kane CJ. Initial Experience with Aspirin Use During Robotic Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2012; 22:225-9. [DOI: 10.1089/lap.2011.0388] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sepehr Nowfar
- Department of Surgery/Urology, University of California San Diego, La Jolla, California
| | - Ryan Kopp
- Department of Surgery/Urology, University of California San Diego, La Jolla, California
| | - Kerrin Palazzi-Churas
- Department of Surgery/Urology, University of California San Diego, La Jolla, California
| | - Ithaar H. Derweesh
- Department of Surgery/Urology, University of California San Diego, La Jolla, California
- Moores UCSD Cancer Center, La Jolla, California
- VA San Diego Medical Center, La Jolla, California
| | - Christopher J. Kane
- Department of Surgery/Urology, University of California San Diego, La Jolla, California
- Moores UCSD Cancer Center, La Jolla, California
- VA San Diego Medical Center, La Jolla, California
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13
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Corona R, Verguts J, Binda MM, Molinas CR, Schonman R, Koninckx PR. The impact of the learning curve on adhesion formation in a laparoscopic mouse model. Fertil Steril 2011; 96:193-7. [PMID: 21601846 DOI: 10.1016/j.fertnstert.2011.04.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/15/2011] [Accepted: 04/15/2011] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the impact of surgeon training on adhesion formation in a laparoscopic mouse model. Laparoscopic surgery and bowel manipulation was demonstrated to enhance postoperative adhesion formation. DESIGN Prospective randomized, controlled trial. SETTING University laboratory research center. ANIMAL(S) 200 BALB/c and 200 Swiss female mice. INTERVENTION(S) Adhesions were induced by opposing bipolar lesions and 60 minutes of pneumoperitoneum. Each surgeon operated on 80 mice (40 Swiss and 40 BALB/c), the only variable thus being his/her increasing experience. Some surgeons were already experienced gynecologists, others were starting their training. MAIN OUTCOME MEASURE(S) End points were the duration of surgery while performing the lesions. The adhesion formation was scored quantitatively (proportion and total) and qualitatively (extent, type, and tenacity) after 7 days. RESULT(S) With training, duration of surgery and adhesion formation decreased exponentially for all surgeons, whether experienced or not. Experienced surgeons had initially a shorter duration of surgery, less adhesion formation, and less de novo adhesions than inexperienced surgeons. CONCLUSION(S) These data suggest that laparoscopic skills improve with training, leading to a decrease in the duration of surgery and formation of adhesions. Therefore completion of a standardized learning curve should be mandatory when initiating adhesion formation studies both in laboratory or clinical setting.
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Affiliation(s)
- Roberta Corona
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Watts R, Botti M, Beale E, Crowe H, Costello AJ. Patient outcomes in the acute recovery phase following robotic-assisted prostate surgery: A prospective study. Int J Nurs Stud 2009; 46:442-9. [PMID: 17825304 DOI: 10.1016/j.ijnurstu.2007.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 03/20/2007] [Accepted: 07/04/2007] [Indexed: 01/03/2023]
Abstract
BACKGROUND Robotic-assisted minimally invasive urologic surgery was developed to minimise surgical trauma resulting in quicker recovery. It has many potential benefits for patients with localised prostate cancer over traditional surgical techniques without taking a risk with the oncological result. OBJECTIVES To report the specific surgical outcomes for the first Australian cohort of patients with localised prostate cancer that had undergone robotic-assisted radical prostatectomy (RARP) surgery. The outcomes represent the acute (in-hospital) recovery phase and include pain, length of stay (LOS), urinary catheter management and wound management. METHODS Prospective descriptive survey of 214 consecutive patients admitted to a large metropolitan private hospital in Melbourne, Australia between December 2003 and June 2005. Patients had undergone RARP surgery for localised prostate cancer. Data were collected from the medical records and through interview at the time of discharge. Descriptive statistics were used to describe the frequency and proportion of outcomes. Patient characteristics were tabulated using cross tabulation frequency distribution and measures of central tendency. RESULTS The findings from this study are highly encouraging when compared to outcomes associated with traditional surgical techniques. Transurethral catheter duration (median 7 days (IQ range 2)) and LOS (median 3 days (IQ range 2)) were considerably reduced. While operation time (median 3.30 h (IQ range 1.07)) was marginally reduced we would expect a further reduction as the surgical team becomes more skilled. CONCLUSION The findings from this study contribute to building a comprehensive picture of patient outcomes in the acute (in-hospital) recovery phase for a cohort of Australian patients who have undergone RARP surgery for localised prostate cancer. As such, these findings will provide valuable information with which to plan care for patients' who undergo robotic-assisted surgery.
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Affiliation(s)
- Rosemary Watts
- Centre for Clinical Nursing Research, Epworth Hospital/Deakin University, 89 Bridge Road, Melbourne, Vic. 3121, Australia.
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15
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Abstract
Robotic-assisted laparoscopic prostatectomy (RALP) has emerged as an important treatment option for localized prostate cancer. As such, methods to improve instrumentation, technique, outcomes, and cost require continued investigation. For example, a recently introduced four-armed robotic system has limited the need for bedside assistants, while an enhanced understanding of pelvic anatomy as visualized robotically has led to valuable modifications in operative technique. Increased surgeon experience has decreased perioperative morbidity, and has resulted in short-term pathologic and functional outcomes that compare favorably with open radical prostatectomy. Meanwhile, quality-of-life studies using validated instruments are helping to define the time course of patient recovery. Nevertheless, costs associated with robotic surgery remain daunting. As the follow-up of patients treated with RALP matures, future studies, ideally with a prospective, randomized design, will be needed to establish the long-term oncologic efficacy of the procedure and to evaluate the overall advantages of RALP compared with open surgery.
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Mendiola FP, Zorn KC, Mikhail AA, Lin S, Orvieto MA, Zagaja GP, Shalhav AL. Urinary and sexual function outcomes among different age groups after robot-assisted laparoscopic prostatectomy. J Endourol 2008; 22:519-24. [PMID: 18355146 DOI: 10.1089/end.2006.9845] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We present an age-stratified prospective assessment of urinary and sexual function of 300 patients after robot-assisted laparoscopic prostatectomy (RALP). MATERIALS AND METHODS Subjective assessment data of continence and potency were collected for different age groups (<50, 50-59, and > or =60 years old) preoperatively, and at 1, 3, 6, and 12 months after RALP. Health-related quality of life questionnaires evaluated return of baseline urinary and sexual function at the same time intervals. RESULTS The three age groups included 21, 129, and 150 patients (aged <50, 50-59, and >60 years old, respectively). Using Kaplan-Meier curves, younger men achieved subjective continence significantly earlier than older age groups when age groups were compared using a 60-year-old cut-off point (P = 0.02). However, subjective continence was noted to be equal among all age groups after 1 year of follow-up. Time to recovery of subjective potency among age groups shows a significant difference in favor of the younger age group (P = 0.01) Objective urinary function is equal between age groups at all time points, while objective sexual function assessment showed a trend toward better results in the younger age group. CONCLUSIONS Younger men will likely have an earlier return of continence and potency compared to older men after RALP. However, continence outcomes were noted to be equal among age groups after I year of follow-up, while younger men continue to report superior potency outcomes compared to older men over the first postoperative year. Such findings are valuable in counseling older men undergoing this procedure.
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Abstract
Given the lack of unequivocal survival data clearly favoring one treatment over another for localized prostate cancer, patients strongly consider quality-of-life effects when choosing treatment for this common malignancy. In the past 15 years, a sizeable body of literature assessing health-related quality-of-life (HRQOL) outcomes in localized prostate cancer has emerged. The goal of this article is to review the quality-of-life experience after treatment for localized prostate cancer. Specifically, I will briefly discuss how quality of life is measured and then review the quality of life effects of each of the commonly used treatment strategies in localized prostate cancer. Finally, I attempt to directly compare the quality-of-life effects of the various treatments to assist clinicians in advising patients with newly diagnosed localized prostate cancer.
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DeWolf WC. Editorial Comment. J Urol 2007. [DOI: 10.1016/j.juro.2007.03.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- William C. DeWolf
- Department of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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19
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Goldstraw MA, Patil K, Anderson C, Dasgupta P, Kirby RS. A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom. Prostate Cancer Prostatic Dis 2007; 10:242-9. [PMID: 17519927 DOI: 10.1038/sj.pcan.4500968] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robot-assisted laparoscopic prostatectomy (RALP) is a rapidly evolving technique for the treatment of localized prostate cancer. However, cynics point to the increasing role of market forces in the robotic revolution. As yet, Europe has not taken up RALP in large numbers and this may in part relate to the high level of expertise in laparoscopy previously gained. Furthermore, setting up a robotic programme is a major undertaking for many surgical units. This review discusses some of the challenges in the development of a robotic service drawn from personal experience within the United Kingdom. Furthermore, available data on RALP versus open and laparoscopic approaches are reviewed for surgical and cancer-related outcomes. Preliminary data appear to show an advantage over open prostatectomy with reduced blood loss, decreased pain and early mobilisation and shorter hospital stay. Most intra-institutional studies demonstrate better postoperative continence and potency with RALP; however, this needs to be viewed in the context of a paucity of randomized data available in the literature. There is no definitive data to show an advantage over standard laparoscopic surgery, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging: with continued experience, the hope is that results will continue to improve.
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Affiliation(s)
- M A Goldstraw
- Department of Urology, The Royal Marsden Hospital, London, UK.
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Zorn KC, Mendiola FP, Rapp DE, Mikhail AA, Lin S, Orvieto MA, Zagaja GP, Shalhav AL. Age-stratified outcomes after robotic-assisted laparoscopic radical prostatectomy. J Robot Surg 2007; 1:125-32. [PMID: 25484948 PMCID: PMC4247449 DOI: 10.1007/s11701-007-0009-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 01/08/2007] [Indexed: 12/01/2022]
Abstract
We sought to evaluate post-operative return of urinary and sexual function in men undergoing robotic-assisted laparoscopic radical prostatectomy (RLRP). Prospective assessment of urinary continence and sexual function was performed in patients undergoing RLRP. Subjective assessment involved the use of the validated RAND-36 Item Health Survey/UCLA Prostate Cancer Index questionnaire. Questionnaires were completed pre-operatively and at 1, 3, 6 and 12 months post-operatively. Subset analyses were performed to assess the effect of age on functional outcomes. A total of 338 consecutive patients underwent RLRP between February 2003 and August 2005. Included patients for evaluation comprised of 21, 129, and 150 patients, aged <50, 50–59, and ≥60 years old, respectively. Kaplan–Meier curve analysis demonstrated that younger men (<60 years) achieved subjective continence significantly earlier than older age group (≥60 years) (P = 0.02). Continence rates, however, equalized among all age groups at 1 year follow-up. Younger men (<50 years) also demonstrated a quicker and greater return of sexual function (P = 0.01), which persisted through assessment at 1 year post-operatively. Our results suggest that younger men may have an earlier return of continence and potency when compared to men > 60 years. Despite this finding, continence outcomes appear to be equal among age groups after 1 year of follow-up. Moreover, men < 60 years continue to report superior potency outcomes compared to men > 60 years at 1 year post-operatively. Such findings are valuable in counseling patients undergoing RLRP.
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Affiliation(s)
- Kevin C Zorn
- Section of Urology, Department of Surgery, University of Chicago, 5841 S. Maryland Ave. MC6038 J-653, Chicago, IL 60637 USA
| | - Frederick P Mendiola
- Section of Urology, Department of Surgery, University of Chicago, 5841 S. Maryland Ave. MC6038 J-653, Chicago, IL 60637 USA
| | - David E Rapp
- Section of Urology, Department of Surgery, University of Chicago, 5841 S. Maryland Ave. MC6038 J-653, Chicago, IL 60637 USA
| | - Albert A Mikhail
- Section of Urology, Department of Surgery, University of Chicago, 5841 S. Maryland Ave. MC6038 J-653, Chicago, IL 60637 USA
| | - Shang Lin
- Department of Health Studies/Statistics, University of Chicago, Chicago, IL USA
| | - Marcelo A Orvieto
- Section of Urology, Department of Surgery, University of Chicago, 5841 S. Maryland Ave. MC6038 J-653, Chicago, IL 60637 USA
| | - Gregory P Zagaja
- Section of Urology, Department of Surgery, University of Chicago, 5841 S. Maryland Ave. MC6038 J-653, Chicago, IL 60637 USA
| | - Arieh L Shalhav
- Section of Urology, Department of Surgery, University of Chicago, 5841 S. Maryland Ave. MC6038 J-653, Chicago, IL 60637 USA
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Cansino Alcaide JR, Alvarez Maestro M, Castillo Cabrera PM, Martínez-Piñeiro Lorenzo L, Tabernero Prieto A, De la Peña Barthel JJ. [Analysis of a laparoscopic radical prostatectomy program with 544 cases]. Actas Urol Esp 2006; 30:517-30. [PMID: 16884105 DOI: 10.1016/s0210-4806(06)73491-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This article reviews the latest publications that refer to Laparoscopic Radical Prostatectomy (LRP) up to 2005, and describes our series of patients for this type of surgery. MATERIALS AND METHODS After a search of the Internet and consulting journals of renowned prestige, we selected articles that refer to this technique and we summarise the latest developments in LRP. We also present our series of patients. RESULTS In view of the good oncologic and functional results obtained with LRP, and the possibility of performing hernioplasty as in open surgery, this technique provides a high quality service for patients. CONCLUSIONS Due to the advances in the safety and quality of this technique, such as the use of robots, 3 CCD cameras, and the surgeon's experience, LRP should be offered to our patients, if it is within our means.
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Roy SD, Philip J. Re: Galosi et al. Tolerability of prostate transrectal biopsies using gel and local anesthetics: results of a randomized clinical trial. J Endourol 2005;19:738-743. J Endourol 2006; 20:530. [PMID: 16859473 DOI: 10.1089/end.2006.20.530.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Skrepetis K, Doumas K. Re: Goel et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol 2005;19:54-57. J Endourol 2006; 20:530-1. [PMID: 16859474 DOI: 10.1089/end.2006.20.530.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Gettman MT, Blute ML. Critical comparison of laparoscopic, robotic, and open radical prostatectomy: techniques, outcomes, and cost. Curr Urol Rep 2006; 7:193-9. [PMID: 16770855 DOI: 10.1007/s11934-006-0021-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Radical prostatectomy has maintained paramount importance in prostate cancer management. Emerging alternative treatments are laparoscopic and robotic prostatectomy. Technical modifications have improved radical prostatectomy outcomes, yet surgery remains difficult to perform regardless of approach. Contemporary series have shown comparable outcomes with operative time, transfusion rates, analgesia, and length of catheterization. Open radical prostatectomy provides excellent long-term oncologic control, but sparse short-term data are available for laparoscopic and robotic prostatectomy. Favorable outcomes also have been reported for urinary control and sexual function, regardless of approach. Additional prospective data collection is needed to evaluate if minimally invasive approaches provide distinct advantages over open surgery.
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Affiliation(s)
- Matthew T Gettman
- Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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25
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O'Malley PJ, Van Appledorn S, Bouchier-Hayes DM, Crowe H, Costello AJ. Robotic radical prostatectomy in Australia: initial experience. World J Urol 2006; 24:165-70. [PMID: 16552598 DOI: 10.1007/s00345-006-0064-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 03/06/2006] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study is to describe the initial experience of robotic-assisted radical prostatectomy (RARP) in Australia. Since the installation of the daVinci system at the Australian Institute for Robotic Surgery, Epworth Hospital, Melbourne in December 2003, 275 robotic-assisted radical prostatectomies have been performed by two surgeons. A prospective database is compiled for each procedure including patient, operative and outcome details. We report on the initial learning curve, surgical technique and modifications, anaesthetic considerations and surgical results comparative to open radical prostatectomy in a single surgeons experience along with margin positivity rates for the first 200 cases of RARP. RARP is the single most frequent adaptation of robotic-assisted surgery with promising initial results. Increasing availability of this modality will inevitably give rise to further adaptations. We present the initial Australian experience.
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Affiliation(s)
- P J O'Malley
- Department of Urology 3S, Royal Melbourne Hospital, Grattan Street, 3050, Parkville, VIC, Australia.
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Kaufman MR, Smith JA, Baumgartner RG, Wells N, Chang SS, Herrell SD, Cookson MS. Positive influence of robotically assisted laparoscopic prostatectomy on the collaborative-care pathway for open radical prostatectomy. BJU Int 2006; 97:473-5. [PMID: 16469010 DOI: 10.1111/j.1464-410x.2005.05993.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define changes in the clinical pathway for open radical retropubic prostatectomy (RRP) and to determine their impact on patient care under the indirect influence of minimally invasive prostatectomy after implementing robotically assisted laparoscopic prostatectomy (RALP) at our institution and modifying the collaborative-care pathway. PATIENTS AND METHODS We retrospectively reviewed the Vanderbilt Prostate Database since the initiation of RALP in May 2003, evaluating those patients who had open RRP. Data were analysed in three consecutive 5-month blocks to determine incremental changes in protocol and outcomes, including complications and re-admissions. RESULTS Between May 2003 and August 2004, 196 patients had RALP and 183 had RRP. After May 2003, there was a progressive reduction for open RRP in the length of stay from 1.6 to 1.3 days. Analysis also showed an elimination of patient-controlled analgesia, a rapid diet advancement, and drain removal at the surgeon's discretion. There were no major complications after surgery, and three minor complications (1.6%). The rate of re-admission after open RRP was low throughout the study period (seven patients, 3.8%), and did not increase progressively. CONCLUSIONS The management after open RRP was modified substantially after implementing RALP, with the two clinical pathways now similar. Despite these modifications in the treatment of patients having open RRP there was no increase in morbidity or compromise in patient outcome. Indeed, this study shows the feasibility and safety of a 1-day length of stay for open RRP.
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Affiliation(s)
- Melissa R Kaufman
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA
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27
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Philip J, McCabe JE, Roy SD, Samsudin A, Campbell IM, Javlé P. Site of local anaesthesia in transrectal ultrasonography-guided 12-core prostate biopsy: does it make a difference? BJU Int 2006; 97:263-5. [PMID: 16430625 DOI: 10.1111/j.1464-410x.2006.05957.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To prospectively compare the efficacy of bi-basal vs bi-apical periprostatic nerve block (PPNB) during 12-core prostate biopsy guided by transrectal ultrasonography (TRUS), and to evaluate the pain experienced on inserting the probe compared to the biopsy procedure, as PPNB with lignocaine local anaesthesia has been used for over a decade for minimizing pain during prostatic biopsy. PATIENTS AND METHODS In all, 143 men who were to have a TRUS-guided prostate biopsy were systematically randomized to two groups, to receive PPNB at the apex or base. A 10-cm visual analogue score was used to record the pain experienced during probe insertion, the biopsy and just before to leaving the department . RESULTS The mean pain score on biopsy in the apical group was similar to that of the basal group (apex 1.9, base 1.6, P = 0.36). Probe introduction produced a significantly higher pain score (probe 2.2, biopsy 1.7, P < 0.001) than at the biopsy. CONCLUSIONS Patients who experienced greater pain with the introduction of the probe also reported more pain with the biopsy procedure. The site of local anaesthetic before prostatic biopsy showed no significant difference in pain scores. Older men tolerated the procedure better. Analgesia after PPNB at near either the apex or base appears equal, regardless of the site of injection. We suggest that topical perianal anaesthetic agents could significantly reduce not only pain perception, but also improve tolerance.
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Affiliation(s)
- Joe Philip
- Department of Urology, Leighton Hospital, Crewe, UK.
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Herrell SD, Smith JA. Robotic-assisted laparoscopic prostatectomy: What is the learning curve? Urology 2005; 66:105-7. [PMID: 16194715 DOI: 10.1016/j.urology.2005.06.084] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 06/23/2005] [Indexed: 11/17/2022]
Abstract
Although equipment for performance of robotic-assisted laparoscopic prostatectomy (RALP) is becoming more widely available, few surgeons have acquired the skill and experience necessary to master RALP. A significant issue has been the requisite training and experience (ie, the "learning curve") necessary for a qualified surgeon to become an expert at RALP. The senior author (J.A.S.) has experience with > 2500 radical retropubic prostatectomy (RRP) and > 350 RALP procedures. He assessed his learning curve in achieving expertise with RALP. Because there are no objective measures to define expertise with RALP, achievement of expert status depends on the surgeon's comfort, experience, and results with alternative approaches. Surgeons with extensive experience with open approaches may "set the bar" higher for the learning curve because of expectations. RALP results comparable to those obtained routinely with RRP were not achieved until after > or = 150 procedures. Surgeon comfort and confidence comparable to that with RRP did not occur until after 250 RALP procedures. Defining the learning curve for RALP as the point at which a surgeon could provide outcomes comparable to those obtainable with alternative surgical approaches means that the point varies, depending on the experience and expertise of the surgeon. Surgeons whose sole or dominant experience is with laparoscopic or robotic approaches may have a different perception of the learning curve compared with an experienced open surgeon.
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Affiliation(s)
- S Duke Herrell
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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30
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LiteratureWatch. J Endourol 2005; 19:1045-62. [PMID: 16253079 DOI: 10.1089/end.2005.19.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Costello AJ, Corcoran NM, Van Appledorn S. Revisiting the role of radical surgery in early stage prostate cancer. Med J Aust 2005; 183:286-7. [PMID: 16167865 DOI: 10.5694/j.1326-5377.2005.tb07055.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 08/15/2005] [Indexed: 11/17/2022]
Abstract
Is it time to walk the line between overtreating indolent disease and undertreating aggressive disease?
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Costello AJ, Haxhimolla H, Crowe H, Peters JS. Installation of telerobotic surgery and initial experience with telerobotic radical prostatectomy. BJU Int 2005; 96:34-8. [PMID: 15963116 DOI: 10.1111/j.1464-410x.2005.05562.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the ability of untrained laparoscopic surgeons to learn and implement laparoscopic telerobotic radical prostatectomy (TRP) using the daVinci Surgical System (Intuitive Surgical, CA), and assess the education, safety and efficacy issues when instituting this system. PATIENTS AND METHODS Between December 2003 and October 2004, 122 consecutive TRPs were performed by two surgeons for clinically localized prostate cancer. The individual robotic surgeon was assisted at the bedside by another surgeon. The TRP was performed robotically by the surgeon at the remote console unit. Perioperative data and pathological results were recorded. The two surgeons spent 1 week in a skills laboratory using a porcine model of laparoscopic TRP, and then cadaveric robotic prostatectomy. The first six cases were mentored by an experienced telerobotic surgeon. RESULTS The TRP was conducted by two surgeons with no previous laparoscopic experience. There were no conversions to open surgery. Assessing the complications, postoperative continence, operating time and transfusion rates showed equivalent efficacy and safety to open and pure laparoscopic methods. CONCLUSION TRP represents a novel computer-based surgical approach to prostate cancer, which offers the benefits of minimally invasive surgery without the extensive experience associated with the laparoscopic method. It remains to be seen whether the robotic approach can deliver better outcomes in continence and potency over time.
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Affiliation(s)
- Anthony J Costello
- Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
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Joseph JV, Vicente I, Madeb R, Erturk E, Patel HRH. Robot-assisted vs pure laparoscopic radical prostatectomy: are there any differences? BJU Int 2005; 96:39-42. [PMID: 15963117 DOI: 10.1111/j.1464-410x.2005.05563.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare our experience of pure laparoscopic radical prostatectomy (LRP) with robot-assisted radical prostatectomy (RAP). PATIENTS AND METHODS The two techniques were compared retrospectively in 100 patients with localized prostate cancer who had LRP or RAP (50 each). Both groups were similar in age, serum prostate-specific antigen level, Gleason score and clinical stage. Their charts were reviewed, collating intraoperative data and early functional outcome. RESULTS The mean surgical time for LRP and RAP was 235 and 202 min (P > 0.05) and mean (95% confidence interval) blood loss 299 (40) and 206 (63) mL (P = 0.014), with no transfusions in either group. The positive margin rate did not differ significantly (14% LRP and 12% RAP) and there was no biochemical recurrence in either group. Early functional outcomes were similar. CONCLUSIONS Both LRP and RAP are technically demanding, but feasible, with the patient clearly benefiting. There were no major surgical differences between the techniques, but RAP is more costly.
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Affiliation(s)
- Jean V Joseph
- Section of Laparoscopic and Robotic Surgery, Department of Urology, University of Rochester Medical Center, Rochester, New York 14642-8656, USA.
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