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Coman RA, Coman RT, Popescu RI, Leucuta DC, Couți R, Coman I, Al Hajjar N. Multimodal Approach Combining Thulium Laser Vaporization, Bipolar Transurethral Resection of the Prostate, and Bipolar Plasma Vaporization versus Bipolar Transurethral Resection of the Prostate: A Matched-Pair Analysis. J Clin Med 2024; 13:4863. [PMID: 39201005 PMCID: PMC11355674 DOI: 10.3390/jcm13164863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (-0.3 versus -0.6, p < 0.001) and median sodium drop (-0.3 versus -0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique.
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Affiliation(s)
- Roxana Andra Coman
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.C.)
- Department of Urology, Endoplus Clinic, 400165 Cluj-Napoca, Romania
| | - Radu Tudor Coman
- Department of Epidemiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Răzvan-Ionuț Popescu
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 061344 Bucharest, Romania
| | - Daniel Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Răzvan Couți
- Bistrita County Emergency Hospital, 420016 Bistrita, Romania
| | - Ioan Coman
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.C.)
- Department of Urology, Endoplus Clinic, 400165 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Surgery, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400394 Cluj-Napoca, Romania
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Smith AF, Lendhey M, Winfield J, Mahoney JM, Bucklen BS, Carlson JB. A feasibility cadaver study for placing screws in various pelvic osseous fracture pathways using a robotic arm. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1457-1463. [PMID: 38240824 DOI: 10.1007/s00590-023-03821-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/20/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The use of a robotic system for the placement of pedicle screws in spine surgeries is well documented in the literature. However, there is only a single report in the United States describing the use of a robotic system to place two screws in osseous fixation pathways (OFPs) commonly used in the treatment of pelvic and acetabular fractures in a simulated bone model. The purpose of this study was to demonstrate the use of a robotic system to place screws in multiple, clinically relevant OFPs in a cadaveric model and to quantitatively measure accuracy of screw placement relative to the preoperative plan. METHODS A single cadaveric specimen was obtained for the purpose of this study. All surrounding soft tissues were left intact. Screws were placed in OFPs, namely iliosacral (IS), trans-sacral (TS), Lateral Compression-II (LC-II), antegrade anterior column (AC) and antegrade posterior column (PC) of the right hemipelvis using standard, fluoroscopically assisted percutaneous or mini-open technique. Following the placement of screws into the right hemipelvis using standard techniques, screws were planned and placed in the same OFPs of the contralateral hemipelvis using the commercially available ExcelsiusGPS® robotic system (Globus Medical Inc., Audubon, PA). After robotic-assisted screw placement, a post-procedure CT scan was obtained to evaluate actual screw placement against the pre-procedure plan. A custom-made image analysis program was devised to measure screw tip/tail offset and angular offset on axial and sagittal planes. RESULTS For different OFPs, the mean tip offset, tail offset and angular offsets were 1.6 ± 0.9 mm (Range 0.0-3.6 mm), 1.4 ± 0.4 mm (Range 0.3-2.5 mm) and 1.1 ± 0.4° (Range 0.5-2.1), respectively. CONCLUSION In this feasibility study, surgeons were able to place screws into the clinically relevant fracture pathways of the pelvis using ExcelsiusGPS® for robotic-assisted surgery. The measured accuracy was encouraging; however, further investigation is needed to demonstrate that robotic-assisted surgery can be used to successfully place the screws in the bony corridors of the pelvis to treat traumatic pelvic injuries.
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Affiliation(s)
- Austin F Smith
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | - Matin Lendhey
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Jalen Winfield
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA.
- Biomechanics Research, Globus Medical, Inc., 2560 General Armistead Ave, Audubon, PA, 19403, USA.
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Jon B Carlson
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
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Lin TC, Hou CP, Hsu YC, Chen Y, Yu KJ, Shao IH, Hsieh ML. Can the Sandwich Method Be an Alternative Treatment Choice for BPH Patients With Large Prostates? Urology 2023; 176:137-142. [PMID: 36963671 DOI: 10.1016/j.urology.2023.02.043] [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: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of the sandwich method with GreenLight photoselective vaporization (GLPVP) and bipolar transurethral resection (B-TURP) with those of the enucleation method in patients with BPH and a prostate volume ≥ 80 g. METHODS Patients with BPH who underwent either the sandwich method with GLPVP and B-TURP or the enucleation method between 2014 and 2021 were included in the analysis. The primary outcome was the comparison of uroflowmetry results between the 2 groups. Safety analysis of the complication rates was also compared. RESULTS The cohort included 55 patients in the sandwich group and 41 patients in the enucleation group. In the efficacy analysis, both groups showed comparable uroflowmetry results, except for a higher postoperative average flow rate in the enucleation group. Regarding perioperative parameters, the sandwich method required a longer operating time, and the enucleation group had a higher incidence of manual Foley irrigation. Both groups demonstrated similar postoperative complications. CONCLUSION The sandwich method exhibited comparable efficacy and safety to the enucleation method in patients with BPH with a prostate volume ≥ 80 g. Thus, for surgeons who are familiar with GLPVP and B-TURP, the sandwich method may be an alternative surgical approach for BPH patients with large prostates.
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Affiliation(s)
- Tsu-Chen Lin
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Pang Hou
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Yu-Chao Hsu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu Chen
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Wagaskar VG, Zaytoun O, Kale P, Pedraza A, Haines K, Tewari A. Robot-assisted simple prostatectomy for prostates greater than 100 g. World J Urol 2023; 41:1169-1174. [PMID: 36929409 DOI: 10.1007/s00345-023-04326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/30/2022] [Indexed: 03/18/2023] Open
Abstract
PURPOSE Efforts are ongoing to treat severe benign prostatic hyperplasia as traditional endoscopic treatment options are often difficult to perform and associated with significant complications. This manuscript highlights our initial experience of robot-assisted simple prostatectomy [RASP] with minimum a year follow-up. We also compared our outcomes with published literature. METHODS After an Institution Review Board approval, we gathered data of 50 cases of RASP between Jan 2014 and May 2021. Patients with prostate volume > 100 cc [calculated from magnetic resonance imaging (MRI)] and prostate biopsy confirmed benign prostate were candidates for RASP. Patients underwent RASP via transperitoneal route either by suprapubic or trans-vesical approach. Preoperative demographics, peri-operative parameters and post-operative parameters such as hospital stay, catheter removal, urinary continence and uroflow were recorded in standard database and presented as descriptive statistics. RESULTS Patients presented with a baseline median International Prostate Symptom Score (IPSS) of 23 (inter-quartile range (IQR) 21,25) and a median PSA of 7.7 ng/ml (IQR 6.4,8.7). Median preoperative prostate volume was 167 ml (IQR, 136,198 ml). Median console time was 118 min, and median estimated blood loss was 148 ml (IQR 130, 167 ml). None of our cohort needed intraoperative transfusion, conversion to open surgery or developed any complications. Median time to Foley removal was 10 days (IQR 8,12). Significant drop in the IPSS score and improvement in Qmax was noted over the period of follow-up. CONCLUSION RASP is associated with considerable improvements in urinary symptoms. However, comparative studies with endoscopic treatment options of large prostatic adenomas are warranted and ideally include cost analysis of different procedures.
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Affiliation(s)
- Vinayak G Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA.,Department of Urology, Alexandria, Egypt
| | - Priyanka Kale
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Adriana Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA
| | - Kenneth Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, 10029, USA
| | - Ash Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1425 Madison Avenue, New York, NY, 10029, USA.
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John H, Burkhardt O, Tutal M, Padevit C, Foerster B. Extraperitoneal Extravesical Robot-Assisted Simple Prostatectomy (EE-RASP) with Intraprostatic Urethral Reconstruction. UROLOGY VIDEO JOURNAL 2023. [DOI: 10.1016/j.urolvj.2023.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Endoscopic Enucleation of the Prostate Is Better than Robot-assisted Simple Prostatectomy. Eur Urol Focus 2022; 8:365-367. [PMID: 35396196 DOI: 10.1016/j.euf.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
In 2022, endoscopic enucleation of the prostate (EEP) is the treatment of choice for benign prostatic obstruction (BPO) for glands >80 ml and is a valid alternative for patients with bleeding disorders. Unlike robot-assisted radical prostatectomy, EEP has no additional access-related trauma and can be performed using the same instruments as for bipolar enucleoresection. With favorable costs, EEP can serve as a global solution for BPO treatment.
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Atan A. Letter to the Editor for the paper entitled From open simple to robotic-assisted simple prostatectomy (RASP) for large benign prostate hyperplasia: the time has come. World J Urol 2022; 40:1069-1070. [PMID: 33755761 DOI: 10.1007/s00345-021-03652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ali Atan
- Department of Urology, Gazi University, School of Medicine, Ankara, Turkey.
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Grobet-Jeandin E, Pinar U, Rouprêt M. The place of robotic-assisted laparoscopy for BPO surgical management in 2021. Curr Opin Urol 2021; 31:438-443. [PMID: 34231542 DOI: 10.1097/mou.0000000000000916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Robot-assisted laparoscopic simple prostatectomy (RASP) is being used increasingly for the surgical treatment of benign prostatic obstruction (BPO). Our purpose is to review the main outcomes of RASP for the management of BPO. RECENT FINDINGS A computerised bibliographic search of Medline was performed for articles that included detailed results of RASP, published over the past 2 years. Although RASP seems to be associated with better perioperative and functional outcomes, this procedure remains expensive when compared to open or endoscopic surgery. However, considering the enhanced safety of RASP compared to open simple prostatectomy and its favourable learning-curve when compared to endoscopic laser enucleation, RASP seems to be a good and effective option in centres with extended robotic expertise. Single-port robotic surgery appeared to be safe and effective in two preliminary studies. Other studies reported interesting and improved results for the preservation of ejaculatory function. SUMMARY Many RASP techniques have been developed, with the common goal of improving the quality of life of patients. Although the cost of RASP is higher than open surgery, the perioperative benefits of the robotic approach make RASP a favourable option in centres with extended robotic expertise.
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Affiliation(s)
- Elisabeth Grobet-Jeandin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Paris, France
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Paris, France
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Herrmann TRW, Misrai V, Sancha FG, Bach T. TURPxit or not: contemporary management options for benign prostatic obstruction. World J Urol 2021; 39:2251-2254. [PMID: 34283282 PMCID: PMC8332635 DOI: 10.1007/s00345-021-03780-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Thomas R. W. Herrmann
- Urology Spital Thurgau AG, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
- Hannover Medical Scholl MHH, Carl Neuberg Str. 1, 30625 Hannover, Germany
- Stellenbosch University Western Cape, Stellenbosch, South Africa
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, Toulouse, France
| | - Fernando Gómez Sancha
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Ventisquero de la Condesa 42, 28035 Madrid, Spain
- Urology Department, Hill Clinic, Sofia, Bulgaria
| | - Thorsten Bach
- Department of Urology, AsklepiosWestklinikumHamburg, Suurheid 20, 22559 Hamburg, Germany
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