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Kaye DR, Hyndman ME, Segal RL, Mettee LZ, Trock BJ, Feng Z, Su LM, Bivalacqua TJ, Pavlovich CP. Urinary Outcomes Are Significantly Affected by Nerve Sparing Quality During Radical Prostatectomy. Urology 2013; 82:1348-53. [DOI: 10.1016/j.urology.2013.06.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/01/2013] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
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Pugh J, Parekattil S, Willis D, Stifelman M, Hemal A, Su LM. Perioperative outcomes of robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma: a multi-institutional series. BJU Int 2013; 112:E295-300. [PMID: 23879914 DOI: 10.1111/bju.12163] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review a multi-institutional series of robot-assisted nephroureterectomy (RANU) for management of upper urinary tract urothelial carcinoma (UUTUC) with respect to technique and perioperative outcomes. PATIENTS AND METHODS Between May 2007 and July 2011, 43 RANU were performed at three institutions for UUTUC with review of perioperative outcomes. A three- or four-armed robotic technique was used in all cases based on surgeon preference and the entirety of all procedures was performed using the robot-assisted technique. Single and two robot-docking techniques are described. RESULTS The mean (range) operating time was 247 (128-390) min, blood loss was 131 (10-500) mL and the median (range) length of stay was 3 (2-87) days. Pathology was pTa in nine patients, pT1 in 14 patients, pT2 in three patients, pT3 in 15 patients and pT4 in two patients. Lymph node dissection was performed in 22 patients (51%) with a mean (range) lymph node count of 11 (4-23). There were six postoperative complications: bleeding requiring a blood transfusion (grade II), splenic bleeding (grade IV), two cases of pneumonia (grade II) and two cases of rhabdomyolysis (grades II and IV). Nine recurrences (six bladder, two within the retroperitoneum and one in the contralateral collecting system) have been found to date on routine surveillance with a mean follow-up of 9 months. CONCLUSIONS RANU is a feasible alternative to laparoscopic and open techniques. Particular steps of the operation including sutured closure of the cystotomy and regional lymphadenectomy are facilitated with the use of robot-assisted surgery. Long-term outcomes are necessary to assess the relative efficacy of these approaches to more established techniques; however, early perioperative outcomes appear promising.
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Pavlovich CP, Levinson AW, Su LM, Mettee LZ, Feng Z, Bivalacqua TJ, Trock BJ. Nightly vs on-demand sildenafil for penile rehabilitation after minimally invasive nerve-sparing radical prostatectomy: results of a randomized double-blind trial with placebo. BJU Int 2013; 112:844-51. [PMID: 23937708 DOI: 10.1111/bju.12253] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To clarify the role of phosphodiesterase type 5 (PDE5) inhibitors in post-prostatectomy penile rehabilitation (PPPR). To compare nightly and on-demand use of PDE5 inhibitors after nerve-sparing minimally invasive radical prostatectomy (RP). PATIENTS AND METHODS We conducted a single-institution, double-blind, randomized controlled trial of nightly vs on-demand 50-mg sildenafil citrate after nerve-sparing minimally invasive RP. A total of 100 preoperatively potent men, aged <65 years, with scores on the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) ≥26, underwent nerve-sparing surgery. The patients were randomized to either nightly sildenafil and on-demand placebo (nightly sildenafil group), or on-demand sildenafil and nightly placebo (on-demand sildenafil group; maximum on-demand dose six tablets/month) for 12 months. Patients then underwent a 1-month washout period. Validated measures of erectile function (IIEF-EF score and the Expanded Prostate Cancer Index Composite [EPIC]) were compared between treatment groups over the entire 13-month time course, using multivariable mixed linear regression models. RESULTS The treatment groups were well matched preoperatively (mean age 54.3 vs 54.6 years, baseline IIEF-EF score 29.4 vs 29.3, for the nightly vs the on-demand sildenafil groups, respectively). No significant differences were found in erectile function between treatments (nightly vs on-demand sildenafil) at any single timepoint after RP, after adjusting for potential confounding factors. When evaluated over all timepoints simultaneously, no significant effects of treatment group (nightly vs on-demand sildenafil) were found on recovery of potency, as assessed by absolute IIEF-EF scores (P = 0.765), on percentage of men returning to an IIEF-EF score >21 (P = 0.830), or on IIEF-EF score recovery to a percentage of baseline value (P = 0.778). When evaluated over all timepoints simultaneously, no significant effects of treatment group were found on secondary endpoints such as assessment of potency (including EPIC item 59 response 'erections firm enough for intercourse'), attempted intercourse frequency or confidence. CONCLUSIONS Erectile recovery up to 1 year after RP does not differ between previously potent men who use sildenafil nightly compared to on-demand. This trial does not support chronic nightly sildenafil as being any better than on-demand sildenafil for use in penile rehabilitation after nerve-sparing minimally invasive RP.
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Fleming IN, Kut C, Macura KJ, Su LM, Rivaz H, Schneider CM, Hamper U, Lotan T, Taylor R, Hager G, Boctor E. Ultrasound elastography as a tool for imaging guidance during prostatectomy: initial experience. Med Sci Monit 2013; 18:CR635-42. [PMID: 23111738 PMCID: PMC3560608 DOI: 10.12659/msm.883540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND During laparoscopic or robotic assisted laparoscopic prostatectomy, the surgeon lacks tactile feedback which can help him tailor the size of the excision. Ultrasound elastography (USE) is an emerging imaging technology which maps the stiffness of tissue. In the paper we are evaluating USE as a palpation equivalent tool for intraoperative image guided robotic assisted laparoscopic prostatectomy. MATERIAL/METHODS Two studies were performed: 1) A laparoscopic ultrasound probe was used in a comparative study of manual palpation versus USE in detecting tumor surrogates in synthetic and ex-vivo tissue phantoms; N=25 participants (students) were asked to provide the presence, size and depth of these simulated lesions, and 2) A standard ultrasound probe was used for the evaluation of USE on ex-vivo human prostate specimens (N=10 lesions in N=6 specimens) to differentiate hard versus soft lesions with pathology correlation. Results were validated by pathology findings, and also by in-vivo and ex-vivo MR imaging correlation. RESULTS In the comparative study, USE displayed higher accuracy and specificity in tumor detection (sensitivity=84%, specificity=74%). Tumor diameters and depths were better estimated using USE versus with manual palpation. USE also proved consistent in identification of lesions in ex-vivo prostate specimens; hard and soft, malignant and benign, central and peripheral. CONCLUSIONS USE is a strong candidate for assisting surgeons by providing palpation equivalent evaluation of the tumor location, boundaries and extra-capsular extension. The results encourage us to pursue further testing in the robotic laparoscopic environment.
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Munver R, Abaza R, Andrews P, Badani K, Bergman A, Castle E, Dallas K, Decotiis K, Del Pizzo J, Derweesh I, Eggener S, Eun D, Figenshau RS, Ghavamian R, Golan S, Golijanin D, Hemal A, Irwin B, Jain S, Johnson D, Joseph J, Kadlec A, Lallas C, Lee B, L'Esperance J, Link R, Mottrie A, Nelsen C, Nunez R, Palese M, Pareek G, Patel A, Peterson J, Phillips J, Png KS, Quek M, Rashid H, Raynor M, Razmaria A, Shalhav A, Small A, Su LM, Sundaram C, Thiel D, Trabulsi E, Venkatesh R, Weizer A, Woods M, Wu G, Yates J. 848 ROBOT-ASSISTED PARTIAL NEPHRECTOMY IN 2500+ CONSECUTIVE CASES: A FIVE YEAR MULTI-INSTITUTIONAL EXPERIENCE FROM THE ROBOT-ASSISTED PARTIAL NEPHRECTOMY INTEGRATED DATABASE (RAPID) STUDY GROUP. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Munver R, Abaza R, Andrews P, Badani K, Bergman A, Castle E, Dallas K, Decotiis K, Del Pizzo J, Derweesh I, Eggener S, Eun D, Figenshau RS, Ghavamian R, Golan S, Golijanin D, Hemal A, Irwin B, Jain S, Johnson D, Joseph J, Kadlec A, Lallas C, Lee B, L'Esperance J, Link R, Mottrie A, Nelsen C, Nunez R, Palese M, Pareek G, Patel A, Peterson J, Phillips J, Png KS, Quek M, Rashid H, Raynor M, Razmaria A, Shalhav A, Small A, Su LM, Sundaram C, Thiel D, Trabulsi E, Venkatesh R, Weizer A, Woods M, Wu G, Yates J. 1317 INCIDENCE AND CRITICAL ANALYSIS OF POSITIVE MARGINS FOLLOWING PARTIAL NEPHRECTOMY: RESULTS FROM THE ROBOT-ASSISTED PARTIAL NEPHRECTOMY INTEGRATED DATABASE (RAPID) STUDY GROUP. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Robb A, Kopper R, Ambani R, Qayyum F, Lind D, Su LM, Lok B. Leveraging virtual humans to effectively prepare learners for stressful interpersonal experiences. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2013; 19:662-670. [PMID: 23428451 DOI: 10.1109/tvcg.2013.35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Stressful interpersonal experiences can be difficult to prepare for. Virtual humans may be leveraged to allow learners to safely gain exposure to stressful interpersonal experiences. In this paper we present a between-subjects study exploring how the presence of a virtual human affected learners while practicing a stressful interpersonal experience. Twenty-six fourth-year medical students practiced performing a prostate exam on a prostate exam simulator. Participants in the experimental condition examined a simulator augmented with a virtual human. Other participants examined a standard unaugmented simulator. Participants reactions were assessed using self-reported, behavioral, and physiological metrics. Participants who examined the virtual human experienced significantly more stress, measured via skin conductance. Participants stress was correlated with previous experience performing real prostate exams; participants who had performed more real prostate exams were more likely to experience stress while examining the virtual human. Participants who examined the virtual human showed signs of greater engagement; non-stressed participants performed better prostate exams while stressed participants treated the virtual human more realistically. Results indicated that stress evoked by virtual humans is linked to similar previous real-world stressful experiences, implying that learners real-world experience must be taken into account when using virtual humans to prepare them for stressful interpersonal experiences.
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Eruslanov E, Stoffs T, Kim WJ, Daurkin I, Gilbert SM, Su LM, Vieweg J, Daaka Y, Kusmartsev S. Expansion of CCR8(+) inflammatory myeloid cells in cancer patients with urothelial and renal carcinomas. Clin Cancer Res 2013; 19:1670-80. [PMID: 23363815 DOI: 10.1158/1078-0432.ccr-12-2091] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Chemokines are involved in cancer-related inflammation and malignant progression. In this study, we evaluated expression of CCR8 and its natural cognate ligand CCL1 in patients with urothelial carcinomas of bladder and renal cell carcinomas. EXPERIMENTAL DESIGN We examined CCR8 expression in peripheral blood and tumor tissues from patients with bladder and renal carcinomas. CCR8-positive myeloid cells were isolated from cancer tissues with magnetic beads and tested in vitro for cytokine production and ability to modulate T-cell function. RESULTS We show that monocytic and granulocytic myeloid cell subsets in peripheral blood of patients with cancer with urothelial and renal carcinomas display increased expression of chemokine receptor CCR8. Upregulated expression of CCR8 is also detected within human cancer tissues and primarily limited to tumor-associated macrophages. When isolated, CD11b(+)CCR8(+) cell subset produces the highest levels of proinflammatory and proangiogenic factors among intratumoral CD11b myeloid cells. Tumor-infiltrating CD11b(+)CCR8(+) cells selectively display activated Stat3 and are capable of inducing FoxP3 expression in autologous T lymphocytes. Primary human tumors produce substantial amounts of the natural CCR8 ligand CCL1. CONCLUSIONS This study provides the first evidence that CCR8(+) myeloid cell subset is expanded in patients with cancer. Elevated secretion of CCL1 by tumors and increased presence of CCR8(+) myeloid cells in peripheral blood and cancer tissues indicate that CCL1/CCR8 axis is a component of cancer-related inflammation and may contribute to immune evasion. Obtained results also implicate that blockade of CCR8 signals may provide an attractive strategy for therapeutic intervention in human urothelial and renal cancers.
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Clubb A, Grossman A, Dahm P, Su LM. 579 CORRELATION OF R.E.N.A.L. NEPHROMETRY SCORE AND PERIOPERATIVE AND RENAL FUNCTIONAL OUTCOMES FOLLOWING ROBOT-ASSISTED PARTIAL NEPHRECTOMY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wen Y, Su LM, Qin WC, He J, Fu L, Zhang XJ, Zhao YH. Linear and non-linear relationships between soil sorption and hydrophobicity. SAR AND QSAR IN ENVIRONMENTAL RESEARCH 2012; 23:111-123. [PMID: 22150068 DOI: 10.1080/1062936x.2011.636761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The relationship between log K (oc) and log P was examined by use of a large dataset. For most of the hydrophobic compounds (e.g. 0.5 < log P < 7.5), the organic carbon content plays a dominant role in soil sorption and the sorption coefficient is linearly related to the octanol/water partition coefficient. For hydrophilic compounds (e.g. log P < 0.5), hydrophobic sorption becomes less significant. The hydrophilic contribution to sorption is equal to, or higher than, the hydrophobic contribution to sorption, resulting in the observed K (oc) values being higher than those predicted from their log P values. For highly hydrophobic compounds (e.g. log P > 7.5), log K (oc) decreases with increasing hydrophobicity because of a lack of chemical availability due to low solubility. A linear solvation energy relationship shows that the sorption potential increases with increasing molecular size by increasing the dispersion interactions between the chemical and soil organic phase. The sorption potential decreases with increase in the basicity of hydrophobic compounds by increasing the H-bonding of chemicals with water. Principal component analysis shows that the octanol/water system is the closest system, but not an ideal surrogate, to describe the soil sorption for hydrophobic compounds as compared with other solvent/water partition systems.
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Daurkin I, Eruslanov E, Stoffs T, Perrin GQ, Algood C, Gilbert SM, Rosser CJ, Su LM, Vieweg J, Kusmartsev S. Tumor-associated macrophages mediate immunosuppression in the renal cancer microenvironment by activating the 15-lipoxygenase-2 pathway. Cancer Res 2011; 71:6400-9. [PMID: 21900394 DOI: 10.1158/0008-5472.can-11-1261] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal cell carcinoma (RCC), the most common human kidney cancer, is frequently infiltrated with tumor-associated macrophages (TAM) that can promote malignant progression. Here, we show that TAMs isolated from human RCC produce substantial amounts of the proinflammatory chemokine CCL2 and immunosuppressive cytokine IL-10, in addition to enhanced eicosanoid production via an activated 15-lipoxygenase-2 (15-LOX2) pathway. TAMs isolated from RCC tumors had a high 15-LOX2 expression and secreted substantial amounts of 15(S)-hydroxyeicosatetraenoic acid, its major bioactive lipid product. Inhibition of lipoxygenase activity significantly reduced production of CCL2 and IL-10 by RCC TAMs. In addition, TAMs isolated from RCC were capable of inducing in T lymphocytes, the pivotal T regulatory cell transcription factor forkhead box P3 (FOXP3), and the inhibitory cytotoxic T-lymphocyte antigen 4 (CTLA-4) coreceptor. However, this TAM-mediated induction of FOXP3 and CTLA-4 in T cells was independent of lipoxygenase and could not be reversed by inhibiting lipoxygenase activity. Collectively, our results show that TAMs, often present in RCCs, display enhanced 15-LOX2 activity that contributes to RCC-related inflammation, immunosuppression, and malignant progression. Furthermore, we show that TAMs mediate the development of immune tolerance through both 15-LOX2-dependent and 15-LOX2-independent pathways. We propose that manipulating LOX-dependent arachidonic acid metabolism in the tumor microenvironment could offer new strategies to block cancer-related inflammation and immune escape in patients with RCC.
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Willis DL, Gonzalgo ML, Brotzman M, Feng Z, Trock B, Su LM. Comparison of outcomes between pure laparoscopic vs robot-assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes. BJU Int 2011. [PMID: 21933328 DOI: 10.1111/j.1464-410x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare perioperative, oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP) with emphasis on health-related quality of life (HRQOL) data as few studies exist. PATIENTS AND METHODS Patients underwent RALP or LRP by a single, fellowship trained surgeon with a standard clinical care pathway. HRQOL data using the Expanded Prostate Cancer Index Composite (EPIC) were collected at 0, 3, 6 and 12 months after 175 consecutive LRP and 174 RALP procedures. Urinary and sexual function outcomes were compared using two methods: (1) EPIC summary/subscale analyses described as percent return to baseline function and (2) traditional single-question analysis. RESULTS The two groups were statistically similar with respect to demographics, clinical stage, perioperative outcomes, stage-specific surgical margin rates, and baseline urinary and sexual function scores. There was no statistical difference in postoperative urinary function between RALP and LRP using EPIC or single-question analyses at 3, 6 and 12 months. EPIC questionnaire data showed a greater return to baseline sexual function over time (mixed model analysis) in RALP than in LRP patients who had a bilateral nerve sparing procedure (Sexual Summary Score, P= 0.005; Sexual Function and Bother Subscales, P= 0.007). Using EPIC, RALP patients receiving a bilateral nerve sparing procedure showed improved percent return to baseline potency at 3 and 6 months (P < 0.025) compared with LRP patients, but had similar outcomes at 12 months (73.7% vs 66.2%, P= 0.3). Single-question analysis suggested improved potency after RALP compared with LRP, with a greater percentage of RALP patients reporting successful sexual intercourse in the past 4 weeks (87.5% vs 66.7% at 12 months, P= 0.06). CONCLUSIONS When comparing surgical techniques, RALP and LRP groups showed statistically similar postoperative urinary function outcomes. RALP patients had an earlier return of sexual function when compared with LRP patients after a bilateral nerve sparing procedure.
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Willis DL, Gonzalgo ML, Brotzman M, Feng Z, Trock B, Su LM. Comparison of outcomes between pure laparoscopic vs robot-assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes. BJU Int 2011; 109:898-905. [DOI: 10.1111/j.1464-410x.2011.10551.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Viprakasit DP, Derweesh I, Wong C, Su LM, Stroup SP, Bazzi W, Strom KH, Herrell SD. Selective Renal Parenchymal Clamping in Robot-Assisted Laparoscopic Partial Nephrectomy: A Multi-Institutional Experience. J Endourol 2011; 25:1487-91. [DOI: 10.1089/end.2010.0667] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Abstract
BACKGROUND AND OBJECTIVES Inadvertent bladder injury is a potential complication of various urological and pelvic surgeries. Bladder injury can also be a complication of natural orifice transluminal endoscopic surgery (NOTES). The aim of this study was to test the feasibility of a NOTES approach to repair bladder lacerations in a blinded porcine study. METHODS Intentional bladder lacerations were made to mimic accidental injury during NOTES in 7 pigs. In 3 animals, the site of bladder injury was identified and repaired by a blinded endoscopist. Bladder laceration and transluminal access sites were closed with Endoclips. Leak test was performed to confirm adequate closure. Survival animals were monitored postoperatively and surgical sites were inspected for abscess, bleeding, or damage to surrounding structures at necropsy. RESULTS Complete endoscopic closure of bladder injuries was achieved in all 7 animals with a negative leak test. The site of laceration was successfully identified by the blinded endoscopist and repaired in all 3 animals in which it was attempted. Survival animals had an uneventful postoperative course without any complications. CONCLUSION This blinded feasibility study shows that urinary bladder injury occurring during NOTES can be successfully managed via a NOTES approach using currently available endoscopic accessories.
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Whiting B, Su LM, Yamamoto A. V1029 OFF CLAMP ROBOTIC HEMINEPHRECTOMY: THE SIMON LAPAROSCOPIC RENAL POLE CLAMP. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pugh J, Grossman A, Parekattil S, Su LM. V864 ROBOTIC SURGICAL MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ward NT, Parsons JK, Levinson AW, Bagga HS, Mettee LZ, Su LM, Pavlovich CP. Prostate size is not associated with recovery of sexual function after minimally invasive radical prostatectomy. Urology 2010; 77:952-6. [PMID: 21195466 DOI: 10.1016/j.urology.2010.09.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 08/02/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the association of prostate weight with recovery of sexual function after minimally invasive radical prostatectomy. METHODS Between April 2001 and September 2007, two surgeons performed 856 consecutive laparoscopic radical prostatectomies for clinically localized prostate cancer. Patients were stratified into three groups by prostate weight: <35 g, 35-70 g, and >70 g. Sexual and urinary outcomes were assessed prospectively using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. Patients who underwent nerve sparing (unilateral or bilateral) with complete preoperative EPIC data, a minimum preoperative Sexual Health Inventory for Men score ≥21, and a minimum of 3 months of complete postoperative EPIC data were included in the analysis. RESULTS Of the cohort of 856 men, 324 (38%) had complete, evaluable data and met the inclusion criteria for this study. Preoperatively, there were no significant differences by prostate weight in the EPIC sexual function or bother subscale scores or the proportion of patients participating in sexual intercourse. Postoperatively, we observed statistically similar returns to baseline EPIC sexual function and bother subscale scores and participation in sexual intercourse across all gland weight groups at all time points. EPIC sexual domain scores and the proportions of patients participating in sexual intercourse continued to increase up to 24 months postoperatively, but no group returned to preoperative function at any sampling point. CONCLUSIONS Prostate size is not associated with postoperative recovery of sexual function in men undergoing minimally invasive radical prostatectomy.
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Levinson AW, Lavery HJ, Ward NT, Su LM, Pavlovich CP. Is a return to baseline sexual function possible? An analysis of sexual function outcomes following laparoscopic radical prostatectomy. World J Urol 2010; 29:29-34. [DOI: 10.1007/s00345-010-0616-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 11/09/2010] [Indexed: 11/25/2022] Open
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Magheli A, Gonzalgo ML, Su LM, Guzzo TJ, Netto G, Humphreys EB, Han M, Partin AW, Pavlovich CP. Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. BJU Int 2010; 107:1956-62. [PMID: 21044243 DOI: 10.1111/j.1464-410x.2010.09795.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE • To investigate a single institution experience with radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) with respect to pathological and biochemical outcomes. PATIENTS AND METHODS • A group of 522 consecutive patients who underwent RARP between 2003 and 2008 were matched by propensity scoring on the basis of patient age, race, preoperative prostate-specific antigen (PSA), biopsy Gleason score and clinical stage with an equal number of patients who underwent LRP and RRP at our institution. • Pathological and biochemical outcomes of the three cohorts were examined. RESULTS • Overall positive surgical margin rates were lower among patients who underwent RRP (14.4%) and LRP (13.0%) compared to patients who underwent RARP (19.5%) (P= 0.010). There were no statistically significant differences in positive margin rates between the three surgical techniques for pT2 disease (P= 0.264). • In multivariate logistic regression analysis, surgical technique (P= 0.016), biopsy Gleason score (P < 0.001) and preoperative PSA (P < 0.001) were predictors of positive surgical margins. • Kaplan-Meier analysis did not show any statistically significant differences with respect to biochemical recurrence for the three surgical groups. CONCLUSIONS • RRP, LRP and RARP represent effective surgical approaches for the treatment for clinically localized prostate cancer. A higher overall positive SM rate was observed for the RARP group compared to RRP and LRP; however, there was no difference with respect to biochemical recurrence-free survival between groups. • Further prospective studies are warranted to determine whether any particular technique is superior with regard to long-term clinical outcomes.
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Secin FP, Savage C, Abbou C, de La Taille A, Salomon L, Rassweiler J, Hruza M, Rozet F, Cathelineau X, Janetschek G, Nassar F, Turk I, Vanni AJ, Gill IS, Koenig P, Kaouk JH, Martinez Pineiro L, Pansadoro V, Emiliozzi P, Bjartell A, Jiborn T, Eden C, Richards AJ, Van Velthoven R, Stolzenburg JU, Rabenalt R, Su LM, Pavlovich CP, Levinson AW, Touijer KA, Vickers A, Guillonneau B. The learning curve for laparoscopic radical prostatectomy: an international multicenter study. J Urol 2010; 184:2291-6. [PMID: 20952022 DOI: 10.1016/j.juro.2010.08.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE It is not yet possible to estimate the number of cases required for a beginner to become expert in laparoscopic radical prostatectomy. We estimated the learning curve of laparoscopic radical prostatectomy for positive surgical margins compared to a published learning curve for open radical prostatectomy. MATERIALS AND METHODS We reviewed records from 8,544 consecutive patients with prostate cancer treated laparoscopically by 51 surgeons at 14 academic institutions in Europe and the United States. The probability of a positive surgical margin was calculated as a function of surgeon experience with adjustment for pathological stage, Gleason score and prostate specific antigen. A second model incorporated prior experience with open radical prostatectomy and surgeon generation. RESULTS Positive surgical margins occurred in 1,862 patients (22%). There was an apparent improvement in surgical margin rates up to a plateau at 200 to 250 surgeries. Changes in margin rates once this plateau was reached were relatively minimal relative to the CIs. The absolute risk difference for 10 vs 250 prior surgeries was 4.8% (95% CI 1.5, 8.5). Neither surgeon generation nor prior open radical prostatectomy experience was statistically significant when added to the model. The rate of decrease in positive surgical margins was more rapid in the open vs laparoscopic learning curve. CONCLUSIONS The learning curve for surgical margins after laparoscopic radical prostatectomy plateaus at approximately 200 to 250 cases. Prior open experience and surgeon generation do not improve the margin rate, suggesting that the rate is primarily a function of specifically laparoscopic training and experience.
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Levinson AW, Ward NT, Sanda MG, Mettee LZ, Wei JT, Su LM, Litwin MS, Pavlovich CP. Comparison of Validated Instruments Measuring Sexual Function in Men. Urology 2010; 76:380-6. [DOI: 10.1016/j.urology.2010.04.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/12/2010] [Accepted: 04/16/2010] [Indexed: 11/16/2022]
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Qin WC, Su LM, Zhang XJ, Qin HW, Wen Y, Guo Z, Sun FT, Sheng LX, Zhao YH, Abraham MH. Toxicity of organic pollutants to seven aquatic organisms: effect of polarity and ionization. SAR AND QSAR IN ENVIRONMENTAL RESEARCH 2010; 21:389-401. [PMID: 20818578 DOI: 10.1080/1062936x.2010.501143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The toxicity of organic chemicals to Vibrio fischeri, river bacteria, algae, Daphnia magna and fishes were analysed. The results showed that the toxicity of chemicals to narcotics was dependent on hydrophobicity. A single model for both polar and non-polar narcotics was developed by inclusion of a polarity descriptor as well as the hydrophobic parameter. The highly hydrophobic polar narcotics could be treated as non-polar narcotics because their polar functional group(s) make(s) a relatively small contribution to polarity as compared with their hydrophobicity. In order to investigate the toxic mechanism of action for reactive compounds, the response-surface approach was used to develop models derived from easily calculated descriptors. The stepwise analysis selected the octanol/water partition coefficient and a polarity descriptor to parameterize bio-uptake and reactivity, respectively, for seven species. Benzoic acids can be easily absorbed into the unicellular bacteria, but this is not the case for multicellular D. magna and fish. Their toxicity to V. fischeri is much higher than that to D. magna and carp. Regression analysis was performed based on the model that we developed for ionizable compounds. Good correlations were observed by introducing the correction factor for ionizable compounds. The toxic mechanisms are discussed.
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Su LM, Zhao YH, Yuan X, Mu CF, Wang N, Yan JC. Evaluation of combined toxicity of phenols and lead to Photobacterium phosphoreum and quantitative structure-activity relationships. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2010; 84:311-314. [PMID: 20043147 DOI: 10.1007/s00128-009-9665-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 02/03/2009] [Indexed: 05/28/2023]
Abstract
The combined toxicity of lead (Pb) and nine phenols were measured. The result indicated that the combined toxicity is not only dependent on the Pb concentrations but also on the positions of substituted groups of phenols. Quantitative structure-activity relationship equations were built from the combined toxicity and physico-chemical descriptors of phenols in the different Pb concentrations. The combined toxicity was related to water solubility and the third order molecular connectivity index ((3)X) in low Pb concentration, to solute excess molar refractivity (E) and ionization constant (pKa) in medium Pb concentration and to dipolarity/polarizability (S) in high Pb concentration.
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Turpen R, Atalah H, Su LM. Technical advances in robot-assisted laparoscopic radical prostatectomy. Ther Adv Urol 2009; 1:251-8. [PMID: 21789072 PMCID: PMC3126074 DOI: 10.1177/1756287210364207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since it was introduced in 1999, the da Vinci Surgical System has become an integral tool in urologic surgery, specifically in the management of localized prostate cancer. The original technique of robot-assisted laparoscopic prostatectomy (RALP) was developed and standardized in 2000 at the Institut Mutualiste Monsouris. Since that time, the technique of RALP has undergone various modifications. The driving force behind the evolution of the RALP technique in the past decade has been based on efforts to improve upon the three main objectives of surgery, namely the 'trifecta' of cancer cure and the preservation of potency and of urinary continence. In this review, we aim to provide an update on the midterm oncologic outcomes of RALP and focus specifically on two technical modifications that have been introduced in an effort to optimize the outcomes of potency and earlier return of urinary continence.
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