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Alba S, Fimognari D, Crocerossa F, Ascalone L, Pullano C, Chiaravalloti F, Chiaradia F, Carbonara U, Ferro M, de Cobelli O, Pagliarulo V, Lucarelli G, Battaglia M, Damiano R, Cantiello F. Neuraxial anesthesia versus general anesthesia in patients undergoing three-dimensional laparoscopic radical prostatectomy: Preliminary results of a prospective comparative study. Asian J Urol 2022. [PMID: 37538165 PMCID: PMC10394281 DOI: 10.1016/j.ajur.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective Neuraxial anesthesia (NA) showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery. We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy (t-3DLRP) and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia (GA). Methods A prospective, double-center, double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed. A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA. Results The two group were similar in all demographic, clinical, and pathological variables. Postoperative blood gas parameters were within physiologic limits in both groups. Muscle relaxation was adequate for surgery during both NA and GA. Median length of stay was 1 day shorter for NA group than GA group (5 days vs. 6 days, p=0.05). t-3DLRP under NA had a statistically lower rate of minor complications (4.8% vs. 19.0%, p=0.03) and less postoperative pain (median numeric rating scale 3 vs. 4, p=0.01) compared to GA. No major complications were observed in both groups. Significantly more patients were willing to undergo a similar intervention under NA than GA (p=0.04). Conclusion t-3DLRP under NA is a feasible and safe procedure, with less postoperative pain and fewer minor complications than the same procedure under GA. NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.
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Lindenberg MMA, Retèl VVP, Kieffer JJM, Wijburg CC, Fossion LLMCL, van der Poel HHG, van Harten WWH. Long-term functional outcomes after robot-assisted prostatectomy compared to laparoscopic prostatectomy: Results from a national retrospective cluster study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2658-2666. [PMID: 34140189 DOI: 10.1016/j.ejso.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 06/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite multiple studies evaluating the effectiveness of Robot-Assisted Radical Prostatectomy (RARP), there is no definitive conclusion about the added value of RARP. A retrospective cluster study was conducted to evaluate long-term sexual and urinary functioning after RARP and Laparoscopic Radical Prostatectomy (LRP) based on real-world data from 12 Dutch hospitals. METHODS Data was collected from patients who underwent surgery between 2010 and 2012. A mixed effect model was used to evaluate differences between groups on urinary and sexual functioning (EPIC-26). Additionally, a regression analysis was conducted to evaluate the relationship between these functional outcomes and, among others, hospital volume. RESULTS 1370 (65.1%) patients participated, 907 underwent RARP and 463 LRP, with a median follow-up time of 7.08 years (SD = 0.98). The RARP group showed a statistically and clinically significant better urinary functioning compared to the LRP group (p = 0.002). RARP showed also a shorter procedure time (p=<0.001), reduced blood loss (p=<0.001), and a higher chance of neurovascular bundle preservation (39.8% vs 29.1%; p=<0.01). CONCLUSION RARP resulted in better long-term urinary function compared to LRP. Based on the results from this study, guidelines concerning the preferred surgery type and the position on reimbursement may change, especially when RARP proves to be cost-effective.
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Affiliation(s)
- Melanie M A Lindenberg
- Division of Psychosocial Research and Epidemiology - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Health Technology and Services Research - University of Twente, Enschede, the Netherlands
| | - Valesca V P Retèl
- Division of Psychosocial Research and Epidemiology - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Health Technology and Services Research - University of Twente, Enschede, the Netherlands
| | - Jacobien J M Kieffer
- Division of Psychosocial Research and Epidemiology - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Carl C Wijburg
- Department of Urology - Rijnstate Hospital, Arnhem, the Netherlands
| | | | | | - Wim W H van Harten
- Division of Psychosocial Research and Epidemiology - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Health Technology and Services Research - University of Twente, Enschede, the Netherlands.
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Karaveli A, Kavakli AS, Cakin O, Aykal G, Yildiz A, Ates M. Comparison of plasma neutrophil gelatinase-associated lipocalin (NGAL) levels after robot-assisted laparoscopic and retropubic radical prostatectomy: an observational study. Braz J Anesthesiol 2021; 72:21-28. [PMID: 33819496 PMCID: PMC9373087 DOI: 10.1016/j.bjane.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/28/2021] [Accepted: 03/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background and objectives Patients undergoing radical prostatectomy are at increased risk of Acute Kidney Injury (AKI) because of intraoperative bleeding, obstructive uropathy, and older age. Neutrophil Gelatinase-Associated Lipocalin (NGAL) may become important for diagnosis of postoperative AKI after urogenital oncosurgery. The objective of this study was to evaluate and compare the efficacy of NGAL as a predictor of AKI diagnosis in patients who underwent Retropubic Radical Prostatectomy (RRP) and Robot-Assisted Laparoscopic Prostatectomy (RALP) for prostate cancer. Methods We included 66 patients who underwent RRP (n = 32) or RALP (n = 34) in this prospective, comparative, nonrandomized study. Patients’ demographic data, duration of surgery and anesthesia, amount of blood products, vasopressor therapy, intraoperative blood loss, fluid administration, length of hospital stay, creatinine, and plasma NGAL levels were recorded. Results Intraoperative blood loss, crystalloid fluid administration, and length of hospital stay were significantly shorter in RALP. There was no statistically significant difference between the groups in terms of intraoperative blood transfusion. Postoperative creatinine and plasma NGAL levels were increased in both groups. The 6-h NGAL levels were higher in RRP (p = 0.026). The incidence of AKI was 28.12% in RRP and 26.05% in RALP, respectively. The NGAL level at 6 hours was more sensitive in the early diagnosis of AKI in RALP. Conclusion Although postoperative serum NGAL levels were increased in both RRP and RALP, the 6-h NGAL levels were higher in RRP. RALP was associated with fewer intraoperative blood loss and fluid administration, and shorter length of hospital stay.
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Affiliation(s)
- Arzu Karaveli
- University of Health Sciences, Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey.
| | - Ali Sait Kavakli
- University of Health Sciences, Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Ozlem Cakin
- University of Health Sciences, Antalya Training and Research Hospital, Department of ICU, Antalya, Turkey
| | - Guzin Aykal
- University of Health Sciences, Antalya Training and Research Hospital, Department of Biochemistry, Antalya, Turkey
| | - Ali Yildiz
- University of Health Sciences, Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Mutlu Ates
- University of Health Sciences, Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
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Cochetti G, Del Zingaro M, Ciarletti S, Paladini A, Felici G, Stivalini D, Cellini V, Mearini E. New Evolution of Robotic Radical Prostatectomy: A Single Center Experience with PERUSIA Technique. APPLIED SCIENCES 2021; 11:1513. [DOI: 10.3390/app11041513] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Radical prostatectomy (RP) is the standard surgical treatment of organ-confined prostate cancer in patients with a life expectancy of at least 10 years. In a recent prospective study, we described the PERUSIA (Posterior, Extraperitoneal, Robotic, Under Santorini, Intrafascial, Anterograde) technique, which is an extraperitoneal full nerve sparing robotic RP, showing its feasibility and safety. The aim of this retrospective study was to evaluate the peri-operative, oncologic, and functional outcomes of the PERUSIA technique. We retrospectively analyzed the data of 454 robotic-assisted radical prostatectomies (RARP) performed using the PERUSIA technique from January 2012 to October 2019. We evaluated perioperative outcomes (operative time, estimated blood loss, catheterization time, complication rate, length of stay), oncological (positive surgical margins and biochemical recurrence), and functional outcomes in terms of urinary continence and sexual potency. The overall complication rate was 16%, positive surgical margins were 8.1%, and biochemical recurrence occurred in 8.6% at median follow-up of 47 months. Urinary continence was achieved in 69% of cases the day after the removal of the catheter, in 92% at 3 months, and in 97% at 12 months after surgery. The average rate of sexual potency was 72% and 82% respectively 3 and 12 months after surgery. Our findings show that the PERUSIA technique is a safe extraperitoneal approach to perform a full nerve sparing technique providing exciting functional outcomes.
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Improvement in early continence after introduction of periurethral suspension stitch in robotic prostatectomy. J Robot Surg 2020; 15:679-686. [PMID: 33057938 PMCID: PMC8423698 DOI: 10.1007/s11701-020-01156-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022]
Abstract
Early urinary incontinence remains a major source of morbidity for patients undergoing robotic prostatectomy. The purpose of the study was to determine whether the introduction of a suspension stitch would improve early urinary continence rates in patients undergoing robotic prostatectomy for localized prostate cancer at our department. We retrospectively reviewed patients undergoing robotic prostatectomy with either suspension (n = 119) or figure-of-eight (n = 48) stitching of the dorsal venous complex. The patients submitted EPIC-26 questionnaires before surgery and after 3 and 18 months, respectively. Logistic regression analysis was run to determine the effect of the suspension stitch, nerve-sparing, posterior reconstruction, prostate volume, age and body mass index on early continence rate. The odds ratio of experiencing urinary leaks was 2.1 times higher (95% CI 1.0–4.3) in the figure-of-eight stitch group compared to the suspension stitch group 3 months after surgery (p < 0.05). The early urinary continence rate was 61.3% in the suspension stitch group compared to 35.4% in the figure-of-eight stitch group (p < 0.005). There were no differences between the groups 18 months post-prostatectomy (90.7% in the suspension stitch group versus 81.4% in the non-suspension stitch group, p = 0.1). Ordinal regression analysis identified the suspension stitch, bilateral nerve-sparing and body mass index as independent predictors of urinary continence at 3 months. The association between urinary continence and either unilateral nerve-sparing, posterior reconstruction, prostate volume or age did not reach statistical significance. Our results suggest that the suspension stitch improved early urinary continence following robotic prostatectomy.
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Kang HW, Yun SJ, Chung JI, Choi H, Kim JH, Yu HS, Ha YS, Cho IC, Kim HJ, Chung HC, Koh JS, Kim WJ, Park JH, Lee JY, Kim SY. National practice patterns and direct medical costs for prostate cancer in Korea across a 10 year period: a nationwide population-based study using a national health insurance database. BMC Health Serv Res 2019; 19:408. [PMID: 31234845 PMCID: PMC6591932 DOI: 10.1186/s12913-019-4218-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 06/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A complete enumeration study was conducted to evaluate trends in national practice patterns and direct medical costs for prostate cancer (PCa) in Korea over a 10-year retrospective period using data from the Korean National Health Insurance Service. METHODS Reimbursement records for 874,924 patients diagnosed between 2002 and 2014 with primary PCa according to the International Classification of Disease (ICD) 10th revision code C61 were accessed. To assess direct medical costs for patients newly diagnosed after 2005, data from 68,596 patients managed between January 2005 and 31 December 2014 were evaluated. RESULTS From 2005 to 2014, the total number of PCa patients showed a 2.6-fold increase. Surgery and androgen deprivation therapy were the most common first-line treatment, alone or within the context of combined therapy. Surgery as a monotherapy was performed in 23.5% of patients in 2005, and in 39.4% of patients in 2014. From 2008, the rate of robot-assisted RP rose sharply, showing a similar rate to open RP in 2014. Average total treatment costs in the 12 months post-diagnosis were around 10 million Korean won. Average annual treatment costs thereafter were around 5 million Korean won. Out-of-pocket expenditure was highest in the first year post-diagnosis, and ranged from 12 to 17% thereafter. CONCLUSIONS Between 2005 and 2014, a substantial change was observed in the national practice pattern for PCa in Korea. The present data provide a reliable overview of treatment patterns and medical costs for PCa in Korea.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seok-Joong Yun
- Department of Urology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jae Il Chung
- Department of Urology, Inje University Busan Paik Hospital, Busan, Korea
| | - Hoon Choi
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Seoul, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - In-Chang Cho
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Hyung Joon Kim
- Department of Urology, Konyang University College of Medicine, Daejeon, Korea
| | - Hyun Chul Chung
- Department of Urology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jun Sung Koh
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Jong-Hyock Park
- Department of Preventive Medicine/ Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
| | - So-Young Kim
- Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.
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Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy. Eur Urol Focus 2019; 5:389-398. [DOI: 10.1016/j.euf.2017.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 11/21/2022]
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Dirie NI, Pokhrel G, Guan W, Mumin MA, Yang J, Masau JF, Hu H, Wang S. Is Retzius-sparing robot-assisted radical prostatectomy associated with better functional and oncological outcomes? Literature review and meta-analysis. Asian J Urol 2018; 6:174-182. [PMID: 31061804 PMCID: PMC6488752 DOI: 10.1016/j.ajur.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/29/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the efficiency, safety and clinical outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in comparison with the standard RARP. Methods A systematic search from Web of Science, PubMed, EMBase, Cochrane Library and Google Scholar was performed using the terms “Retzius-sparing”, “Bocciardi approach” and “robot-assisted radical prostatectomy”. Video articles and abstract papers for academic conferences were excluded. Meta-analysis of interested outcomes such as positive surgical margins (PSMs) and continence recovery was undertaken. A comprehensive literature review of all studies regarding Retzius-sparing (RS) approach was conducted and summarized. Results From 2010 to 2017, 11 original articles about RS-RARP approach were retrieved. Of that, only four studies comparing the RS-RARP approach to the conventional RARP were comparable for meta-analysis. Faster overall continence recovery within 1 month after the surgery was noted in the RS group (61% vs. 43%; p = 0.004). PSMs of pT2 and pT3 stages were not significantly different between the groups (10.0% vs. 7.4%; p = 0.39 and 13.1% vs. 9.5%, p = 0.56, respectively). Of all the studies, only one reported sexual recovery outcomes after RS treatment in which 40% of the participants achieved sexual intercourse within the first month. Conclusion Though more technically demanding than the conventional RARP, the RS technique is a safe and feasible approach. This meta-analysis and literature review indicates that RS technique, as opposed to the conventional approach, is associated with a faster continence recovery while PSMs were comparable between the two groups. The limitations of observational studies and the small data in our meta-analysis may prevent an ultimate conclusion. Future well-designed RCTs are needed to validate and confirm our findings.
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Affiliation(s)
- Najib Isse Dirie
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mukhtar Adan Mumin
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jackson Ferdinand Masau
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Corresponding author.
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Abstract
PURPOSE OF REVIEW Robotic-assisted radical prostatectomy has been rapidly adopted and is now the standard of care in the surgical management of prostate cancer. Since the initial description in 2001, the technique has evolved to optimize oncological functional outcomes. Herein, we review key techniques for the robotic-assisted radical prostatectomy. RECENT FINDINGS With the current influx of new technology such as focal therapy, stereotactic body radiation therapy and prostate-sparing treatments, there is greater emphasis on maximizing outcomes of robotic-assisted radical prostatectomy. The evidence-based techniques of optimizing oncological outcomes including the lymph node dissection and improving cancer control through minimizing positive surgical margins are reviewed. Improvements in functional recovery has also been seen with technical modifications such as nerve sparing, preservation of the urethral support structures and the bladder neck and the urethra-vesical reconstruction. SUMMARY Robotic prostatectomy has demonstrated adequate long-term oncologic success and satisfactory functional recovery. As technology and techniques in robotic-assisted surgery evolve, surgeons will continue to optimize techniques to maximize functional outcome recovery and cancer control. Further studies are actively being conducted to provide level one evidence in multiple aspects of the robotic-assisted radical prostatectomy.
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Lipman D, Pieters BR, De Reijke TM. Improving postoperative radiotherapy following radical prostatectomy. Expert Rev Anticancer Ther 2017; 17:925-937. [PMID: 28787182 DOI: 10.1080/14737140.2017.1364994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Prostate cancer has one of the highest incidences in the world, with good curative treatment options like radiotherapy and radical prostatectomy. Unfortunately, about 30% of the patients initially treated with curative intent will develop a recurrence and need adjuvant treatment. Five randomized trials covered the role of postoperative radiotherapy after radical prostatectomy, but there is still a lot of debate about which patients should receive postoperative radiotherapy. Areas covered: This review will give an overview on the available literature concerning post-operative radiotherapy following radical prostatectomy with an emphasis on the five randomized trials. Also, new imaging techniques like prostate-specific membrane antigen positron emission tomography (PSMA-PET) and multiparametric magnetic resonance imaging (mp-MRI) and the development of biomarkers like genomic classifiers will be discussed in the search for an improved selection of patients who will benefit from postoperative radiotherapy following radical prostatectomy. With new treatment techniques like Intensity Modulated Radiotherapy, toxicity profiles will be kept low. Expert commentary: Patients with biochemical recurrence following radical prostatectomy with an early rise in prostate-specific antigen (PSA) will benefit most from postoperative radiotherapy. In this way, patients with only high risk pathological features can avoid unnecessary treatment and toxicity, and early intervention in progressing patients would not compromise the outcome.
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Affiliation(s)
- D Lipman
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - B R Pieters
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - Theo M De Reijke
- b Department of Urology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
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Li M, Konstantinova J, Xu G, He B, Aminzadeh V, Xie J, Wurdemann H, Althoefer K. Evaluation of stiffness feedback for hard nodule identification on a phantom silicone model. PLoS One 2017; 12:e0172703. [PMID: 28248996 PMCID: PMC5383005 DOI: 10.1371/journal.pone.0172703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/08/2017] [Indexed: 11/18/2022] Open
Abstract
Haptic information in robotic surgery can significantly improve clinical outcomes and help detect hard soft-tissue inclusions that indicate potential abnormalities. Visual representation of tissue stiffness information is a cost-effective technique. Meanwhile, direct force feedback, although considerably more expensive than visual representation, is an intuitive method of conveying information regarding tissue stiffness to surgeons. In this study, real-time visual stiffness feedback by sliding indentation palpation is proposed, validated, and compared with force feedback involving human subjects. In an experimental tele-manipulation environment, a dynamically updated color map depicting the stiffness of probed soft tissue is presented via a graphical interface. The force feedback is provided, aided by a master haptic device. The haptic device uses data acquired from an F/T sensor attached to the end-effector of a tele-manipulated robot. Hard nodule detection performance is evaluated for 2 modes (force feedback and visual stiffness feedback) of stiffness feedback on an artificial organ containing buried stiff nodules. From this artificial organ, a virtual-environment tissue model is generated based on sliding indentation measurements. Employing this virtual-environment tissue model, we compare the performance of human participants in distinguishing differently sized hard nodules by force feedback and visual stiffness feedback. Results indicate that the proposed distributed visual representation of tissue stiffness can be used effectively for hard nodule identification. The representation can also be used as a sufficient substitute for force feedback in tissue palpation.
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Affiliation(s)
- Min Li
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jelizaveta Konstantinova
- School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom
| | - Guanghua Xu
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Bo He
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | | | - Jun Xie
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Helge Wurdemann
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Kaspar Althoefer
- Faculty of Science & Engineering, Queen Mary University of London, London, United Kingdom
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Alenizi AM, Valdivieso R, Rajih E, Meskawi M, Toarta C, Bienz M, Azizi M, Hueber PA, Lavigueur-Blouin H, Trudeau V, Trinh QD, El-Hakim A, Zorn KC. Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): A single surgeon's experience. Can Urol Assoc J 2015; 9:E417-22. [PMID: 26279709 DOI: 10.5489/cuaj.2805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION We evaluated the average time required to complete individual steps of robotic-assisted radical prostatectomy (RARP) by an expert RARP surgeon. The intent is to help establish a time-based benchmark to aim for during apprenticeship. In addition, we aimed to evaluate preoperative patient factors, which could prolong the operative time of these individual steps. METHODS We retrospectively identified 247 patients who underwent RARP, performed by an experienced robotic surgeon at our institution. Baseline patient characteristics and the duration of each step were recorded. Multivariate analysis was performed to predict factors of prolonged individual steps. RESULTS In multivariable analysis, obesity was a significant predictor of prolonged operative time of: docking (odds ratio [OR] 1.96), urethral division (OR 3.13), and vesico-urethral anastomosis (VUA) (OR 2.63). Prostate volume was also a significant predictor of longer operative time in dorsal vein complex ligation (OR 1.02), bladder neck division (OR 1.03), pedicle control (OR 1.04), urethral division (OR 1.02), and VUA (OR 1.03). A prolonged bladder neck division was predicted by the presence of a median lobe (OR 5.03). Only obesity (OR 2.56) and prostate volume (OR 1.04) were predictors of a longer overall operative time. CONCLUSIONS Obesity and prostate volume are powerful predictors of longer overall operative time. Furthermore, both can predict prolonged time of several individual RARP steps. The presence of a median lobe is a strong predictor of a longer bladder neck division. These factors should be taken into consideration during RARP training.
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Affiliation(s)
- Abdullah M Alenizi
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC; ; Division of Robotic Urology, Hôpital Sacré Cœur de Montréal, QC
| | - Roger Valdivieso
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC
| | - Emad Rajih
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC; ; Division of Robotic Urology, Hôpital Sacré Cœur de Montréal, QC
| | - Malek Meskawi
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC
| | - Cristian Toarta
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC
| | - Marc Bienz
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC
| | - Mounsif Azizi
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC
| | | | | | - Vincent Trudeau
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Assaad El-Hakim
- Division of Robotic Urology, Hôpital Sacré Cœur de Montréal, QC
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, QC
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Li M, Liu H, Jiang A, Seneviratne LD, Dasgupta P, Althoefer K, Wurdemann H. Intra-operative tumour localisation in robot-assisted minimally invasive surgery: A review. Proc Inst Mech Eng H 2014; 228:509-522. [PMID: 24807165 DOI: 10.1177/0954411914533679] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Robot-assisted minimally invasive surgery has many advantages compared to conventional open surgery and also certain drawbacks: it causes less operative trauma and faster recovery times but does not allow for direct tumour palpation as is the case in open surgery. This article reviews state-of-the-art intra-operative tumour localisation methods used in robot-assisted minimally invasive surgery and in particular methods that employ force-based sensing, tactile-based sensing, and medical imaging techniques. The limitations and challenges of these methods are discussed and future research directions are proposed.
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Affiliation(s)
- Min Li
- Department of Informatics, King's College London, London, UK
| | - Hongbin Liu
- Department of Informatics, King's College London, London, UK
| | - Allen Jiang
- Department of Informatics, King's College London, London, UK
| | - Lakmal D Seneviratne
- Department of Informatics, King's College London, London, UK College of Engineering, Khalifa University of Science, Technology & Research, Abu Dhabi, UAE
| | - Prokar Dasgupta
- Medical Research Council (MRC) Centre for Transplantation, Guy's Hospital, London, UK
| | | | - Helge Wurdemann
- Department of Informatics, King's College London, London, UK
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Harty NJ, Kozinn SI, Canes D, Sorcini A, Moinzadeh A. Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy. Int Braz J Urol 2014; 39:639-46; discussion 647-8. [PMID: 24267107 DOI: 10.1590/s1677-5538.ibju.2013.05.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 08/28/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We compared positive surgical margin (PSM) rates for patients with high risk prostate cancer (HRCaP) who underwent open radical retropubic (RRP), robotic (RALP), and laparoscopic (LRP) prostatectomy at a single institution. MATERIALS AND METHODS We performed a retrospective review of our prospectively maintained IRB approved database identifying prostate cancer patients who underwent RRP, RALP, or LRP between January 2000 and March 2010. Patients were considered to have HRCaP if they had biopsy or final pathologic Gleason score ≥ 8, or preoperative PSA ≥ 20, or pathologic stage ≥ T3a. A positive surgical margin (PSM) was defined by the presence of tumor at the inked surface of the specimen. Patients who received neoadjuvant hormonal therapy and those who underwent a perineal prostatectomy were excluded from the study. RESULTS Of the 445 patients in this study, surgical technique for prostatectomy included RRP (n = 153), RALP (n = 152), and LRP (n = 140). PSM rate for the three groups were not different: 52.9% RRP, 50% RALP, and 41.4% LRP, (p = 0.13). The PSM rate did not differ when comparing RRP to a combined group of RALP and LRP (p = 0.16). Among patients with a PSM, there was no statistical difference between the three groups in terms of the number of patients with a pathologic stage of T3 or higher (p = 0.83). On univariate analysis, a higher preoperative PSA value was associated with a positive margin (p = 0.04). CONCLUSION In this HRCaP series, the PSM rate did not differ based on the surgical approach. On univariate analysis, patients with a higher preoperative PSA value were more likely to have a PSM.
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Superior Quality of Life and Improved Surgical Margins Are Achievable with Robotic Radical Prostatectomy After a Long Learning Curve: A Prospective Single-surgeon Study of 1552 Consecutive Cases. Eur Urol 2014; 65:521-31. [DOI: 10.1016/j.eururo.2013.10.030] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/21/2013] [Indexed: 11/23/2022]
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Huser AS, Müller D, Brunkhorst V, Kannisto P, Musch M, Kröpfl D, Groeben H. Simulated life-threatening emergency during robot-assisted surgery. J Endourol 2014; 28:717-21. [PMID: 24471449 DOI: 10.1089/end.2013.0762] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the increasing use of robot-assisted techniques for urologic and gynecologic surgery in patients with severe comorbidities, the risk of a critical incidence during surgery increases. Due to limited access to the patient the start of effective measures to treat a life-threatening emergency could be delayed. Therefore, we tested the management of an acute emergency in an operating room setting with a full-size simulator in six complete teams. METHODS A full-size simulator (ISTAN, Meti, CA), modified to hold five trocars, was placed in a regular operating room and connected to a robotic system. Six teams (each with three nurses, one anesthesiologist, two urologists or gynecologists) were introduced to the scenario. Subsequently, myocardial fibrillation occurred. Time to first chest compression, removal of the robot, first defibrillation, and stabilization of circulation were obtained. After 7 weeks the simulation was repeated. RESULTS The time to the start of chest compressions, removal of the robotic system, and first defibrillation were significantly improved at the second simulation. Time for restoration of stable circulation was improved from 417 ± 125 seconds to 224 ± 37 seconds (P=0.0054). Unexpected delays occurred during the first simulation because trocars had been removed from the patient but not from the robot, thus preventing the robot to be moved. CONCLUSION Following proper training, resuscitation can be started within seconds. A repetition of the simulation significantly improved time for all steps of resuscitation. An emergency simulation of a multidisciplinary team in a real operating room setting can be strongly recommended.
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Affiliation(s)
- Anna-Sophia Huser
- 1 Department of Anesthesia, Critical Care Medicine , and Pain Therapy, Kliniken Essen-Mitte, Essen, Germany
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Huang KH, Carter SC, Hu JC. Does robotic prostatectomy meet its promise in the management of prostate cancer? Curr Urol Rep 2014; 14:184-91. [PMID: 23564268 DOI: 10.1007/s11934-013-0327-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Following Walsh's advances in pelvic anatomy and surgical technique to minimize intraoperative peri-prostatic trauma more than 30 years ago, open retropubic radical prostatectomy (RRP) evolved to become the gold standard treatment of localized prostate cancer, with excellent long-term survival outcomes [1•]. However, RRP is performed with great heterogeneity, even among high volume surgeons, and subtle differences in surgical technique result in clinically significant differences in recovery of urinary and sexual function. Since the initial description of robotic-assisted radical prostatectomy (RARP) in 2000 [2], and U.S. Food and Drug Administration approval shortly thereafter, RARP has been rapidly adopted and has overtaken RRP as the most popular surgical approach in the management of prostate cancer in the United States [3]. However, the surgical management of prostate cancer remains controversial. This is confounded by the idolatry of new technologies and aggressive marketing versus conservatism in embracing tradition. Herein, we review the literature to compare RRP to RARP in terms of perioperative, oncologic, and quality-of-life outcomes as well as healthcare costs. This is a particularly relevant, given the absence of randomized trials and long-term (more than 10-year) follow-up for RARP biochemical recurrence-free survival.
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Affiliation(s)
- Kuo-How Huang
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd, Suite 1000, Los Angeles, CA 90024, USA
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A reference set of health utilities for long-term survivors of prostate cancer: population-based data from Ontario, Canada. Qual Life Res 2013; 22:2951-62. [PMID: 23564620 DOI: 10.1007/s11136-013-0401-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE To measure quality of life (QOL) and utilities for prostate cancer (PC) patients and determine their predictors. METHODS A population-based, community-dwelling, geographically diverse sample of long-term PC survivors in Ontario, Canada, was identified from the Ontario Cancer Registry and contacted through their referring physician. Consenting patients completed questionnaires by mail: Health Utilities Index (HUI 2/3), Patient Oriented Prostate Utility Scale PORPUS-U (utility), PORPUS-P (health profile), Functional Assessment of Cancer Therapy-Prostate (FACT-P), and Prostate Cancer Index (PCI). Clinical data were obtained from chart reviews. Regression models determined the effects of a series of variables on QOL and utility. RESULTS We received questionnaires and reviewed charts for 585 patients (mean age 72.6, 2-13 years postdiagnosis). Mean utility scores were as follows: PORPUS-U = 0.92, HUI2 = 0.85, and HUI3 = 0.78. Mean health profile scores were as follows: PORPUS-P = 71.7, PCI sexual, urinary, and bowel function = 23.7, 79.1, and 84.6, respectively (0 = worst, 100 = best), and FACT-P = 125.1 (0 = worst, 156 = best). In multiple regression analyses, comorbidity and PCI urinary, sexual, and bowel function were significant predictors of other QOL measures. With all variables, 32-50 % of the variance in utilities was explained. CONCLUSIONS Many variables affect global QOL of PC survivors; only prostate symptoms and comorbidity have independent effects. Our model allows estimation of the effects of multiple factors on utilities. These utilities for long-term outcomes of PC and its treatment are valuable for decision/cost-effectiveness models of PC treatment.
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Yiou R, De Laet K, Hisano M, Salomon L, Abbou C, Lefaucheur J. Neurophysiological Testing to Assess Penile Sensory Nerve Damage After Radical Prostatectomy. J Sex Med 2012; 9:2457-66. [DOI: 10.1111/j.1743-6109.2012.02793.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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20
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Steinsvik EAS, Axcrona K, Angelsen A, Beisland C, Dahl A, Eri LM, Haug ES, Svindland A, Fosså S. Does a surgeon's annual radical prostatectomy volume predict the risk of positive surgical margins and urinary incontinence at one-year follow-up? Findings from a prospective national study. Scand J Urol 2012; 47:92-100. [PMID: 22860630 DOI: 10.3109/00365599.2012.707684] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to assess the prevalence of positive surgical margins (PSM) and urinary incontinence (UI) in relation to surgeons' annual radical prostatectomy (RP) volume. MATERIAL AND METHODS This national study prospectively assessed 521 preoperatively continent patients with prostate cancer (PCa), scheduled for RP by surgeons with high (>50), medium (20-50) or low annual volume (<20) at 14 urological departments in Norway. Patients responded to UI questions from the Expanded Composite prostate cancer index (EPIC-50) before and 1 year after RP. UI was defined as "use of pad(s)" and/or "a moderate or severe urinary leakage problem (ULP)". Preoperative prediction of PSMs and UI was explored in multivariate regression analyses with the following independent variables: surgeons' annual RP volume, type of hospital (university versus community), patient's health, sociodemographic features and PCa characteristics. RESULTS Based on histopathological reports, the overall PSM rate was 26%, with differences between the high- (18%), medium- (28%) and low-volume (44%) groups. Increasing PSM rates were predicted by surgeons belonging to the low- and medium-volume categories, prostate-specific antigen> 10 µg/l, Gleason score >7, patient age >65 years and <12 years of education. At 1-year follow-up 40% reported UI, without significant differences between the volume groups. Only 46% of those who used pad(s) experienced ULP. UI was predicted by clinical category ≥T2 and community type of hospital, but not by surgeons' annual RP volume. CONCLUSIONS. Preoperative counselling should take into account the relationship between surgeon's annual RP volume and PSM rate and the current knowledge about UI and ULP.
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Affiliation(s)
- Eivind Andreas Svaboe Steinsvik
- National Resource Center for Late Effects after Cancer Treatment, The Norwegian Radium Hospital, Oslo University Hospital, Norway.
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Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M, Guazzoni G, Menon M, Patel VR, Shariat SF, Tewari AK, Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Rosen RC, Wilson TG. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 2012; 62:382-404. [PMID: 22749851 DOI: 10.1016/j.eururo.2012.05.047] [Citation(s) in RCA: 350] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 05/22/2012] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite the large diffusion of robot-assisted radical prostatectomy (RARP), literature and data on the oncologic outcome of RARP are limited. OBJECTIVE Evaluate lymph node yield, positive surgical margins (PSMs), use of adjuvant therapy, and biochemical recurrence (BCR)-free survival following RARP and perform a cumulative analysis of all studies comparing the oncologic outcomes of RARP and retropubic radical prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). EVIDENCE ACQUISITION A systematic review of the literature was performed in August 2011, searching Medline, Embase, and Web of Science databases. A free-text protocol using the term radical prostatectomy was applied. The following limits were used: humans; gender (male); and publications dating from January 1, 2008. A cumulative analysis was conducted using Review Manager software v.4.2 (Cochrane Collaboration, Oxford, UK) and Stata 11.0 SE software (StataCorp, College Station, TX, USA). EVIDENCE SYNTHESIS We retrieved 79 papers evaluating oncologic outcomes following RARP. The mean PSM rate was 15% in all comers and 9% in pathologically localized cancers, with some tumor characteristics being the most relevant predictors of PSMs. Several surgeon-related characteristics or procedure-related issues may play a major role in PSM rates. With regard to BCR, the very few papers with a follow-up duration >5 yr demonstrated 7-yr BCR-free survival estimates of approximately 80%. Finally, all the cumulative analyses comparing RARP with RRP and comparing RARP with LRP demonstrated similar overall PSM rates (RARP vs RRP: odds ratio [OR]: 1.21; p=0.19; RARP vs LRP: OR: 1.12; p=0.47), pT2 PSM rates (RARP vs RRP: OR: 1.25; p=0.31; RARP vs LRP: OR: 0.99; p=0.97), and BCR-free survival estimates (RARP vs RRP: hazard ratio [HR]: 0.9; p=0.526; RARP vs LRP: HR: 0.5; p=0.141), regardless of the surgical approach. CONCLUSIONS PSM rates are similar following RARP, RRP, and LRP. The few data available on BCR from high-volume centers are promising, but definitive comparisons with RRP or LRP are not currently possible. Finally, significant data on cancer-specific mortality are not currently available.
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Bilgin TE, Atici S, Bozlu M, Cayan S, Tasdelen B. Reply. Urology 2011. [DOI: 10.1016/j.urology.2011.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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