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Rapoport LM, Bezrukov EA, Tsarichenko DG, Martirosyan GA, Sukhanov RB, Krupinov GE, Slusarenco RI, Morozov AO, Avakyan SK, Sargsyan NA. [Methods for training of robot-assisted radical prostatectomy]. Khirurgiia (Mosk) 2019:89-94. [PMID: 30789615 DOI: 10.17116/hirurgia201901189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Robotic surgery is a future method of minimal invasive surgery. Robot-assisted radical prostatectomy (RARP) is a common method of surgical treatment of prostate cancer. Due to significant differences of the surgical technique of RARP compared to open or laparoscopic radical prostatectomy (LRP) new methods of training are needed. At the moment there are many opinions how to train physicians best. Which model is the most effective one remains nowadays controversial. OBJECTIVE Analyze currently available data of training methods of RARP. Determine the most effective training model and evaluate its advantages and disadvantages. Establish a standardized plan and criteria for proper training and certification of the entire surgical team. MATERIAL AND METHODS Literature review based on PubMed database, Web of Science and Scopus by keywords: robot-assisted radical prostatectomy, training of robot-assisted prostatectomy, training in robot-assisted operations, a learning curve of robot-assisted prostatectomy, virtual reality simulators (VR-simulators) in surgery. RESULTS According to the literature in average 18 to 45 procedures are required for a surgeon to achieve the plateau of the learning curve of the RARP. Parallel training, pre-operative warm-up and the use of virtual reality simulators (VR-simulators) can significantly increase the learning curve. There are many described models of RARP training. CONCLUSIONS The absence of accepted criteria of evaluation of the learning curve does not allow to use this parameter as a guide for the surgeon's experience. Proper training of robotic surgeons is necessary and requires new methods of training. There are different types of training programs. In our opinion the most effective training program is when a surgeon observes the performance of tasks or any steps of operation on the VR-simulator, then he performs them and analyzes mistakes by video recording. Then the surgeon observes real operations and performs some steps of the operation which are already leant on the simulator under supervision of the mentor and analyzes mistakes by video recording. Thus, mastering first the simple stages under supervision of a mentor, the surgeon effectively adopts the surgical experience from him. It is necessary to train not only the surgeons but also the entire surgical team.
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Affiliation(s)
- L M Rapoport
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - E A Bezrukov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - D G Tsarichenko
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - G A Martirosyan
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - R B Sukhanov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - G E Krupinov
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - R I Slusarenco
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - A O Morozov
- Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - S K Avakyan
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - N A Sargsyan
- University clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Liu XX, Pan HF, Jiang ZW, Zhang S, Wang ZM, Chen P, Zhao Y, Wang G, Zhao K, Li JS. "Fast-track" and "Minimally Invasive" Surgery for Gastric Cancer. Chin Med J (Engl) 2017; 129:2294-300. [PMID: 27647187 PMCID: PMC5040014 DOI: 10.4103/0366-6999.190659] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Enhanced recovery after surgery (ERAS) protocols or fast-track (FT) programs enable a shorter hospital stay and lower complication rate. Minimally invasive surgery (MIS) is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries. However, little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer. The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone. Methods: We summarized an 11-year experience on gastric cancer patients undergoing elective laparotomy or minimally invasive gastric resection in standard cares (SC) or FT programs during January 2004 to December 2014. A total of 984 patients were enrolled and assigned into four groups: open gastrectomies (OG) with SC (OG + SC group, n = 167); OG with FT programs (OG + FT group, n = 277); laparoscopic gastrectomies (LG) with FT programs (LG + FT group, n = 248); and robot-assisted gastrectomies (RG) with FT programs (RG + FT group, n = 292). Patients’ data were collected to evaluate the clinical outcome. The primary end point was the length of postoperative hospital stay. Results: The OG + SC group showed the longest postoperative hospital stay (mean: 12.3 days, median: 11 days, interquartile range [IQR]: 6–16 days), while OG + FT, LG + FT, and RG + FT groups recovered faster (mean: 7.4, 6.4, and 6.6 days, median: 6, 6, and 6 days, IQR: 3–9, 4–8, and 3–9 days, respectively, all P < 0.001). The postoperative rehabilitation parameters such as flatus time after surgery (4.7 ± 0.9, 3.1 ± 0.8, 3.0 ± 0.9, and 3.1 ± 0.9 days) followed the same manner. After 30 postoperative days’ follow-up, the total incidence of complications was 9.6% in OG + SC group, 10.1% in OG + FT group, 8.1% in LG + FT group, and 10.3% in RG + FT group. The complications showed no significant differences between the four groups (all P > 0.05). Conclusions: ERAS protocols alone could significantly bring fast recovery after surgery regardless of the surgical technique. MIS further reduces postoperative hospital stay. It is safe and effective to apply ERAS protocols combined with MIS for gastric cancer.
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Affiliation(s)
- Xin-Xin Liu
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002; Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, Jiangsu 225001, China
| | - Hua-Feng Pan
- Department of General Surgery, The First People's Hospital of Yangzhou, Clinical Medical School, Yangzhou University, Yangzhou, Jiangsu 225001, China
| | - Zhi-Wei Jiang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Shu Zhang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Zhi-Ming Wang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Ping Chen
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, Jiangsu 225001, China
| | - Yan Zhao
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, Jiangsu 225001, China
| | - Gang Wang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Kun Zhao
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jie-Shou Li
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu 210002, China
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Abstract
Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.
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Affiliation(s)
- Allison Weaver
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Scott Steele
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
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Munawar A, Fischer G. A Surgical Robot Teleoperation Framework for Providing Haptic Feedback Incorporating Virtual Environment-Based Guidance. Front Robot AI 2016. [DOI: 10.3389/frobt.2016.00047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ceccarelli G, Codacci Pisanelli M, Patriti A, Biancafarina A. Renal cavernous hemangioma: robot-assisted partial nephrectomy with selective warm ischemia. Case report and review of the literature. G Chir 2015; 36:197-200. [PMID: 26712254 DOI: 10.11138/gchir/2015.36.5.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renal hemangioma is a relatively rare benign tumor with a wide range of clinical and radiological presentation, not easy to differentiate preoperatively from a renal cancer. Due to its benign nature complete surgical resection is the recommended therapy and is considered curative. A 73-year old male patient followed-up for a lung carcinoma and a chronic renal failure underwent a CT scan showing a 35-mm mass of the inferior pole of the left kidney. The patient underwent robot-assisted partial nephrectomy with left inferior pole selective warm ischemia. The outcome was favorable and no repercussions on the renal reserve were observed postoperatively. Histopathological characteristics of the surgical specimen were consistent with renal cavernous hemangioma. A robot-assisted operation allows the fine dissection required to carry out a bloodless nephron-sparing surgery without a complete warm ischemia. The use of robot could be noteworthy for nephron-sparing surgery in cases of concomitant chronic renal failure.
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Ihsan-Tasci A, Simsek A, Dogukan-Torer M, Sokmen D, Sahin S, Bitkin A, Tugcu V. Oncologic results, functional outcomes, and complication rates of transperitoneal robotic assisted radical prostatectomy: single centre's experience. Actas Urol Esp 2015; 39:70-7. [PMID: 24856651 DOI: 10.1016/j.acuro.2014.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/31/2013] [Accepted: 02/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND We report the operative details and short term oncologic and functional outcome of the first 334 Robotic-assisted radical prostatectomy experiences for organ confined prostate cancer METHODS From August 2009 to December 2012, details of 334 consecutive patients were retrospectively analyzed. The analyzed parameters included: preoperative, per-operative characteristics, postoperative minor and major complications, positive surgical margin continence, potency, and biochemical progression at the follow-up period. RESULTS The classical extrafascial, interfascial, intrafascial and fascia sparing radical prostatectomy were performed in 31, 41, 200, and 62 cases, respectively. The mean operation time was 213.8±90.1minutes, and the mean estimated blood loss was 116.1±58.9cc during operation. A nerve-sparing procedure was performed bilaterally in 198 (59.3%) cases and unilaterally in 126 (37.7%) cases. The catheter was removed on postoperative day 9, 1±1.9. Surgical margin was positive in 36 (10.7%) patients. The overall, pT2, pT3a and pT3b PSM rates were 8 (2.4%), 12 (3.6%), 16 (4.8%) respectively and PSM and BCR rates were not statistically different among four approach (P>.05). At the follow-up period, the continence rates were 74.4%, 80.4%, 80.5%, and 96.7% (P<.001), and previously potent patients' potency rates were 64.3%, 66.6%, 68.1%, and 74.5% (P>.05), in classic extrafascial, interfascial, intrafascial, and fascia sparing intrafascial prostatectomy, respectively. CONCLUSION RARP is a safe and feasible technique in treatment of localized prostate cancer. Fascia sparing approach has better continence rate. This results need to be supported by new prospective, randomized studies.
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Jamal K, Patel P, Sooriakumaran P. Minimally invasive surgical modalities in the management of localized prostate cancer. Expert Rev Anticancer Ther 2014; 8:957-66. [DOI: 10.1586/14737140.8.6.957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Rhee H, Paterdis J, Heathcote P. Robot-assisted laparoscopic radical prostatectomy using modular training programme in a private hospital. J Robot Surg 2013; 7:339-44. [PMID: 27001872 DOI: 10.1007/s11701-013-0395-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/23/2013] [Indexed: 11/26/2022]
Abstract
The aim of the study was to demonstrate an efficacious robotic fellowship model that balances safety of patients, time efficiency and adequate training, in a private hospital. Sixty-four patients underwent robot-assisted laparoscopic radical prostatectomy using a 13-step modular training programme in a single private institute. The patients were compared with 64 consecutive patients operated on by the mentoring surgeon immediately prior to the implementation of the programme. The main parameters analysed included console time, total operating time, blood loss, positive surgical margin rate and postoperative complications. There was a marginal difference in mean console time (92.67 vs. 90.41 min; p = 0.02). Statistical difference disappeared when comparing mean total operating time (136.09 vs. 134.14 min; p = 0.16), mean blood loss (165 vs. 172 ml; p = 0.96) and margin positivity (8 vs. 13; p = 0.34). The trainee was able to complete significant numbers of modular training steps whilst maintaining momentum of the operation from the commencement of the fellowship programme. This study demonstrates that a comprehensive modular training programme in complicated robotic procedures could be implemented without compromising patient safety or time efficiency.
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Affiliation(s)
- Handoo Rhee
- Greenslopes Private Hospital, Greenslopes, Australia.
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Baek SJ, Al-Asari S, Jeong DH, Hur H, Min BS, Baik SH, Kim NK. Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc 2013. [PMID: 23708725 DOI: 10.1007/s00464‐013‐3014‐4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Robotic surgery is increasingly used in the field of rectal cancer surgery. This study aimed to compare the short- and long-term outcomes between robotic and laparoscopic ultralow anterior resection (uLAR) and coloanal anastomosis (CAA). Between January 2007 and December 2010, a retrospective chart review was performed for all patients with low rectal cancer who underwent curative uLAR and CAA with or without intersphincteric resection using either a robotic or a laparoscopic approach. The study excluded patients with tumors invading the levator ani or external sphincter, patients with T4 cancers invading the prostate or vagina, and patients for whom an open approach was used. Patients' short- and long-term outcomes were evaluated. This study enrolled 84 consecutive patients (47 in the robotic group and 37 in the laparoscopic group). The patient characteristics and operative data did not differ significantly between the groups except for the rate of conversion to open surgery (robot, 2.1 % vs laparoscopy, 16.2 %; p = 0.02). The postoperative outcomes also were similar in the two groups, but the hospital stay was shorter in the robotic group than in the laparoscopic group (robot, 9 days vs laparoscopy, 11 days; p = 0.011). No postoperative mortality occurred. The median follow-up period was 31.5 months. No difference was shown in local recurrence, 3-year overall survival, or disease-free survival between the two groups. Robotic uLAR and CAA with or without ISR is a safe and feasible surgical approach with a lower conversion rate, a shorter hospital stay, and similar oncologic outcomes compared with a laparoscopic approach. Further prospective and case-control cohort studies with longer follow-up periods are required.
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Affiliation(s)
- Se Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul, 120-527, South Korea
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10
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Robotic versus laparoscopic coloanal anastomosis with or without intersphincteric resection for rectal cancer. Surg Endosc 2013; 27:4157-63. [PMID: 23708725 DOI: 10.1007/s00464-013-3014-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 05/09/2013] [Indexed: 01/01/2023]
Abstract
Robotic surgery is increasingly used in the field of rectal cancer surgery. This study aimed to compare the short- and long-term outcomes between robotic and laparoscopic ultralow anterior resection (uLAR) and coloanal anastomosis (CAA). Between January 2007 and December 2010, a retrospective chart review was performed for all patients with low rectal cancer who underwent curative uLAR and CAA with or without intersphincteric resection using either a robotic or a laparoscopic approach. The study excluded patients with tumors invading the levator ani or external sphincter, patients with T4 cancers invading the prostate or vagina, and patients for whom an open approach was used. Patients' short- and long-term outcomes were evaluated. This study enrolled 84 consecutive patients (47 in the robotic group and 37 in the laparoscopic group). The patient characteristics and operative data did not differ significantly between the groups except for the rate of conversion to open surgery (robot, 2.1 % vs laparoscopy, 16.2 %; p = 0.02). The postoperative outcomes also were similar in the two groups, but the hospital stay was shorter in the robotic group than in the laparoscopic group (robot, 9 days vs laparoscopy, 11 days; p = 0.011). No postoperative mortality occurred. The median follow-up period was 31.5 months. No difference was shown in local recurrence, 3-year overall survival, or disease-free survival between the two groups. Robotic uLAR and CAA with or without ISR is a safe and feasible surgical approach with a lower conversion rate, a shorter hospital stay, and similar oncologic outcomes compared with a laparoscopic approach. Further prospective and case-control cohort studies with longer follow-up periods are required.
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Koç G, Tazeh NN, Joudi FN, Winfield HN, Tracy CR, Brown JA. Lower Extremity Neuropathies After Robot-Assisted Laparoscopic Prostatectomy on a Split-Leg Table. J Endourol 2012; 26:1026-9. [DOI: 10.1089/end.2011.0653] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gökhan Koç
- Department of Urology, University of Iowa, Iowa City, Iowa
| | - Ngii N. Tazeh
- Department of Urology, University of Iowa, Iowa City, Iowa
| | - Fadi N. Joudi
- Department of Urology, University of Iowa, Iowa City, Iowa
| | | | - Chad R. Tracy
- Department of Urology, University of Iowa, Iowa City, Iowa
| | - James A. Brown
- Department of Urology, University of Iowa, Iowa City, Iowa
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Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, Ma Y. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol 2012; 19:3727-36. [PMID: 22752371 DOI: 10.1245/s10434-012-2429-9] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Robotic colorectal surgery may solve some of the problems inherent to conventional laparoscopic surgery (CLS). We sought to evaluate the advantages of robot-assisted laparoscopic surgery (RALS) using the da Vinci Surgical System over CLS in patients with benign and malignant colorectal diseases. METHODS PubMed and Embase databases were searched for relevant studies published before July 2011. Studies clearly documenting a comparison of RALS with CLS for benign and malignant colorectal diseases were selected. Operative and postoperative measures, resection margins, complications, and related outcomes were evaluated. Weighted mean differences, relative risks, and hazard ratios were calculated using a random-effects model. RESULTS The meta-analysis included 16 studies comparing RALS and CLS in patients with colorectal diseases and 7 studies in rectal cancer. RALS was associated with lower estimated blood loss in colorectal diseases (P = 0.04) and rectal cancer (P < 0.001) and lower rates of intraoperative conversion in colorectal diseases (P = 0.03) and rectal cancer (P < 0.001) than CLS. In patients with colorectal diseases, however, operating time (P < 0.001) and total hospitalization cost (P = 0.06) were higher for RALS than for CLS. CONCLUSIONS RALS was associated with reduced estimated blood loss and a lower intraoperative conversion rate than CLS, with no differences in complication rates and surrogate markers of successful surgery. Robotic colorectal surgery is a promising tool, especially for patients with rectal cancer.
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Affiliation(s)
- Yongzhi Yang
- Department of Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, People's Republic of China
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Abstract
PURPOSE OF REVIEW Advancements in the robotic surgical technology have revolutionized the standard of care for many surgical procedures. The purpose of this review is to evaluate the important considerations in developing a new robotics program at a given healthcare institution. RECENT FINDINGS Patients' interest in robotic-assisted surgery has and continues to grow because of improved outcomes and decreased periods of hospitalization. Resulting market forces have created a solid foundation for the implementation of robotic surgery into surgical practice. Given proper surgeon experience and an efficient system, robotic-assisted procedures have been cost comparable to open surgical alternatives. Surgeon training and experience is closely linked to the efficiency of a new robotics program. Formally trained robotic surgeons have better patient outcomes and shorter operative times. Training in robotics has shown no negative impact on patient outcomes or mentor learning curves. SUMMARY Individual economic factors of local healthcare settings must be evaluated when planning for a new robotics program. The high cost of the robotic surgical platform is best offset with a large surgical volume. A mature, experienced surgeon is integral to the success of a new robotics program.
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Baek SJ, Lee DW, Park SS, Kim SH. Current status of robot-assisted gastric surgery. World J Gastrointest Oncol 2011; 3:137-43. [PMID: 22046490 PMCID: PMC3205112 DOI: 10.4251/wjgo.v3.i10.137] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 10/04/2011] [Accepted: 10/10/2011] [Indexed: 02/05/2023] Open
Abstract
In an effort to minimize the limitations of laparoscopy, a robotic surgery system was introduced, but its role for gastric cancer is still unclear. The objective of this article is to assess the current status of robotic surgery for gastric cancer and to predict future prospects. Although the current study was limited by its small number of patients and retrospective nature, robot-assisted gastrectomy with lymphadenectomy for the treatment of gastric cancer is a feasible and safe procedure for experienced laparoscopic surgeons. Most studies have reported satisfactory results for postoperative short-term coutcomes, such as: postoperative oral feeding, gas out, hospital stay and complications, compared with laparoscopic surgery; the difference is a longer operation time. However, robotic surgery showed a shallow learning curve compared with the familarity of conventional open surgery; after the accumulation of several cases, robotic surgery could be expected to result in a similar operation time. Robotic-assisted gastrectomy can expand the indications of minimally invasive surgery to include advanced gastric cancer by improving the ability to perform lymphadenectomy. Moreover, ”total” robotic gastrectomy can be facilitated using a robot-sewing technique and gastric submucosal tumors near the gastroesophageal junction or pylorus can be resected safely by this novel technique. In conclusion, robot-assisted gastrectomy may offer a good alternative to conventional open or laparoscopic surgery for gastric cancer, provided that long-term oncologic outcomes can be confirmed.
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Affiliation(s)
- Se-Jin Baek
- Se-Jin Baek, Dong-Woo Lee, Department of Surgery, Korea University College of Medicine, MIS and Robotic Surgery Center, Korea University Medical Center, Korea University Anam Hospital, Seoul 136-705, South Korea
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Panaro F, Piardi T, Cag M, Cinqualbre J, Wolf P, Audet M. Robotic liver resection as a bridge to liver transplantation. JSLS 2011; 15:86-9. [PMID: 21902950 PMCID: PMC3134704 DOI: 10.4293/108680811x13022985131417] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentation. Robotic surgery for hepatic resection has not yet been extensively reported. The aim of this article is to report the first known case of liver resection with the use of a robot in France. METHODS A 61-year-old male with hepatitis C liver cirrhosis and hepatocellular carcinoma was referred for surgical treatment. Preoperative clinical evaluation and laboratory data disclosed a Child-Pugh class A5 patient. Magnetic resonance imaging showed a 3.4-cm tumor in segment III. Liver size was normal, and there were not signs of portal hypertension. Five trocars were used. RESULTS Liver transection was achieved with Harmonic scalpel and bipolar forceps without pedicle clamping. Hemostasis of raw surface areas was accomplished with interrupted stitches. Operative time was 180 minutes. Blood loss was minimal, and the patient did not receive transfusion. The recovery was uneventful, and the patient was discharged on the fifth postoperative day without ascites formation. CONCLUSION The robotic approach may enable liver resection in patients with cirrhosis. The da Vinci robotic system allowed for technical refinements of laparoscopic liver resection due to 3-dimensional visualization of the operative field and instruments with wrist-type end-effectors.
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Affiliation(s)
- Fabrizio Panaro
- Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hopitaux Universitaires de Strasbourg, Strasbourg, France.
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Robot-assisted laparoscopic radical prostatectomy: initial experience with first 112 cases. J Robot Surg 2011; 6:283-8. [PMID: 27628466 DOI: 10.1007/s11701-011-0307-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
Abstract
In this study we report our initial robot-assisted laparoscopic radical prostatectomy (RALRP) experience for organ-confined prostate cancer with the first 112 cases between August 2009 and January 2011. The mean age was 61 (46-76) years. Gleason scores ranged between 4 and 9, and the mean prostate volume was 38.7 (15-115) ml. The mean follow-up time was 8.1 (1-18) months. The mean operative time was 174.7 (75-360) min, and the mean estimated blood loss was 141 (60-800) ml. A nerve-sparing procedure was performed bilaterally in 79 cases and unilaterally in 15 cases. All the complications seen (8 out of 112 patients, 7.1%) were grade 1 and 2 according to the Clavien classsification system. Postoperatively, five (4.4%) patients needed transfusion. Mean drain extraction time was 3.2 (2-15) days and mean hospital stay was 4 (2-18) days. The catheter was removed on postoperative day 8.5 (6-20). Surgical margin was positive in 13 (11.6%) patients. Forty-nine patients have 6 months and 30 patients have 12 months follow-up. The continence rate were 29.4, 64.2, 84.2, 91.1 and 96.6% immediately after catheter removal and at 1, 3, 6 and 12 months, respectively. No anastomotic stricture or urinary retention was seen in the follow-up period. RALRP is a safe and feasible technique in the treatment of localized prostate cancer. Our initial experience with this procedure shows promising short-term outcomes.
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Fu Q, Moul JW, Sun L. Contemporary radical prostatectomy. Prostate Cancer 2011; 2011:645030. [PMID: 22110994 PMCID: PMC3200259 DOI: 10.1155/2011/645030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 02/17/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP) has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.
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Affiliation(s)
- Qiang Fu
- Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, P.O. Box 3707, Durham, NC 27710, USA
| | - Judd W. Moul
- Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, P.O. Box 3707, Durham, NC 27710, USA
| | - Leon Sun
- Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, P.O. Box 3707, Durham, NC 27710, USA
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Ou YC, Yang CR, Wang J, Cheng CL, Patel VR. Learning Curve of Robotic-assisted Radical Prostatectomy With 60 Initial Cases by a Single Surgeon. Asian J Surg 2011; 34:74-80. [DOI: 10.1016/s1015-9584(11)60023-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 04/27/2010] [Accepted: 05/12/2010] [Indexed: 11/28/2022] Open
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Singh I, Hemal AK. Robotic-assisted radical prostatectomy in 2010. Expert Rev Anticancer Ther 2011; 10:671-82. [PMID: 20470000 DOI: 10.1586/era.10.35] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article reviews the current status of robotic-assisted radical prostatectomy (RARP) with outcome analysis. The published English literature (PubMed) database was searched extensively for major publications and large series on RARP. The search was carried out over the preceding 3-year period. Selected series were then reviewed, summarized and analyzed for their salient features. A literature search yielded 19 major publications on RARP in the preceding 2 years. A review of the current RARP literature (2006-2009) of multi-institutional cases of RARP demonstrated a mean operating room time, blood loss, hospital stay, positive surgical margin rate and perioperative-complication rate of approximately 194 min, 196 ml, 1.43 days, 25.7% and 5.83 %, respectively (based on the analysis of data using central tendency measures [mean]). The overall potency and continence rates were 73.6 and 87.1%, respectively (based on analysis of the published and reported data). All RARP cases were performed with the use of da Vinci robotic system (Intuitive Surgical, CA, USA). It is expected that in 2010 close to 70% of radical prostatectomies in the USA will be performed with robotic assistance. The patient and surgeon appeal for RARP continues to expand exponentially. It seems pertinent to conclude that increasing experience with RARP may reduce the incidence of positive surgical margins and will improve the functional outcome, which is the challenge at this point in time. Although the early cancer control and intermediate follow-up on functional outcome with RARP appears to be convincing and favorable, the long-term ( approximately 10 years) data are still awaited.
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Affiliation(s)
- Iqbal Singh
- Department of Urology & Institute of Regenerative Medicine, Director, Robotics & Minimally Invasive Surgery, Wake Forest University Medical Sciences & Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC-27157, USA
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Ou YC, Yang CR, Wang J, Cheng CL, Patel VR. Robotic-assisted laparoscopic radical prostatectomy: Learning curve of first 100 cases. Int J Urol 2010; 17:635-40. [DOI: 10.1111/j.1442-2042.2010.02546.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Coronato EE, Harmon JD, Ginsberg PC, Harkaway RC, Singh K, Braitman L, Sloane BB, Jaffe JS. A multi-institutional comparison of radical retropubic prostatectomy, radical perineal prostatectomy, and robot-assisted laparoscopic prostatectomy for treatment of localized prostate cancer. J Robot Surg 2009; 3:175. [DOI: 10.1007/s11701-009-0158-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 09/09/2009] [Indexed: 11/27/2022]
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Chen DYT, Uzzo RG. Optimal management of localized renal cell carcinoma: surgery, ablation, or active surveillance. J Natl Compr Canc Netw 2009; 7:635-42; quiz 643. [PMID: 19555585 DOI: 10.6004/jnccn.2009.0044] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 04/16/2009] [Indexed: 01/31/2023]
Abstract
Radical nephrectomy is historically accepted as standard treatment for localized renal cell carcinoma (RCC). However, the presentation of RCC has changed dramatically over the past 3 decades. Newer alternative interventions aim to reduce the negative impact of open radical nephrectomy, with the natural history of RCC now better understood. This article discusses current surgical and management options for localized kidney cancer.
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Affiliation(s)
- David Y T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19111, USA.
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Mulhall JP. EDITORIAL: The Quest for the Truth in Medical Literature. J Sex Med 2009; 6:1495-1497. [DOI: 10.1111/j.1743-6109.2009.01311.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Direct Comparison of Surgical and Functional Outcomes of Robotic-Assisted Versus Pure Laparoscopic Radical Prostatectomy: Single-Surgeon Experience. Urology 2009; 73:119-23. [DOI: 10.1016/j.urology.2008.08.491] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 07/18/2008] [Accepted: 08/26/2008] [Indexed: 11/22/2022]
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Mandhani A, Dorsey, Jr. PJ, Ramanathan R, Salamanca JI, Rao S, Leung R, Berryhill Jr. R, Tewari AK. Real Time Monitoring of Temperature Changes in Neurovascular Bundles During Robotic Radical Prostatectomy: Thermal Map for Nerve-Sparing Radical Prostatectomy. J Endourol 2008; 22:2313-7. [DOI: 10.1089/end.2008.9712] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anil Mandhani
- New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021
| | - Philip J. Dorsey, Jr.
- New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021
| | - Rajan Ramanathan
- New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021
| | - Juan I. Salamanca
- New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021
| | - Sandhya Rao
- New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021
| | - Robert Leung
- New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021
| | - Roy Berryhill Jr.
- New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021
| | - Ashutosh K. Tewari
- New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021
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Patriti A, Ceccarelli G, Bellochi R, Bartoli A, Spaziani A, Di Zitti L, Casciola L. Robot-assisted laparoscopic total and partial gastric resection with D2 lymph node dissection for adenocarcinoma. Surg Endosc 2008; 22:2753-60. [PMID: 18813994 DOI: 10.1007/s00464-008-0129-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 07/09/2008] [Accepted: 07/31/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND Lymph node dissection and esophageal anastomosis, considered the more demanding steps of laparoscopic gastrectomy for gastric adenocarcinoma, can be performed with the use of a remote-controlled robot. METHODS Thirteen patients with a histologically proved gastric cancer (six stage I, six stage II, and one stage III) were enrolled in a prospective study to assess feasibility and safety of the Da Vinci surgical system in total and partial gastrectomy with extended lymph node dissection. Outcome measures were conversion rate, intra- and postoperative morbidity and mortality, operative time, blood loss, number of lymph nodes harvested, and macroscopic and microscopic evaluation of resection margins. RESULTS Eight distal, four total, and one proximal laparoscopic gastrectomies were completed without conversion. Extended lymph node dissection, and esophagojejunal and esophagogastric anastomoses were successfully carried out using the da Vinci System. Mean operative time was 286 +/- 32.6 min and blood loss was 103 +/- 87.5 ml. Mean number of nodes retrieved was 28.1 +/- 8.3 and all resection margins were negative. There was no mortality. Trocar bleeding requiring laparoscopy was the only major complication encountered. No recurrence occurred during a mean follow-up time of 12.2 +/- 4.5 months. CONCLUSIONS Robot-assisted laparoscopic lymph node dissection and esophageal anastomosis are feasible and safe. Longer follow-up time and randomized studies are needed to evaluate long-term outcome and clinical advantages of this new technology.
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Affiliation(s)
- Alberto Patriti
- Department of General, Vascular, Minimally Invasive and Robotic Surgery, San Matteo degli Infermi Hospital-Spoleto, Via Loreto, 3, 06049, Spoleto, Perugia, Italy.
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Choi SB, Park JS, Kim JK, Hyung WJ, Kim KS, Yoon DS, Lee WJ, Kim BR. Early experiences of robotic-assisted laparoscopic liver resection. Yonsei Med J 2008; 49:632-8. [PMID: 18729307 PMCID: PMC2615291 DOI: 10.3349/ymj.2008.49.4.632] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentations. Robotic surgery for hepatic resection has not yet been extensively reported. PATIENTS AND METHODS Between March and May 2007, we performed 3 robot-assisted left lateral sectionectomies of the liver. Case 1 had a hepatocellular carcinoma (HCC), case 2 had colon cancer with liver metastasis, and case 3 had intrahepatic duct stones. RESULTS All patients had successful operation and recovered without complications. Shorter length of hospital stays, earlier start of oral feeding and less amount of ascites were found. However, case 1 had recurrent HCC at 3 months after operation. CONCLUSION Robotic-assisted liver surgery is still a new field in its developing stage. In patients with small malignant tumors and benign liver diseases, robotic-assisted laparoscopic resection is feasible and safe. Through experience, the use of robotics is expected to increase in the treatment of benign diseases and malignant neoplasms. However, careful patient selection is important and long-term outcomes need to be evaluated.
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Affiliation(s)
- Sae Byeol Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seong Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Keun Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Sup Yoon
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jung Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byong Ro Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Robotic-assisted radical prostatectomy by a single surgeon in Taiwan: experience with the initial 30 cases. J Robot Surg 2008; 2:173-9. [DOI: 10.1007/s11701-008-0107-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 08/05/2008] [Indexed: 10/21/2022]
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Eggener SE, Guillonneau B. Laparoscopic radical prostatectomy: ten years later, time for evidence-based foundation. Eur Urol 2008; 54:4-7. [PMID: 18339477 DOI: 10.1016/j.eururo.2008.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 02/26/2008] [Indexed: 01/28/2023]
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MacKenzie R, Chapman S, Holding S, McGeechan K. 'A matter of faith, not science': analysis of media coverage of prostate cancer screening in Australian news media 2003-2006. J R Soc Med 2008. [PMID: 18048709 DOI: 10.1258/jrsm.100.11.513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Despite a near universal absence of evidence-based policies supporting population screening for prostate cancer, the prostate-specific antigen (PSA) test is aggressively promoted in the media as a life-saving form of screening. The objective of this study was to examine media coverage of prostate-cancer screening in Australia. DESIGN Frame analysis of all direct or attributed quotes about prostate cancer. SETTING Australian capital city newspapers (February 2003-December 2006) and Sydney television news (January 2003-December 2006). MAIN OUTCOME MEASURES Quotes regarding prostate cancer screening: n=436 in newspapers and television news. RESULTS Seven rhetorical frames were identified. 86% of all quotes framed prostate screening and its outcomes as desirable, associating PSA testing as being consonant with other early-detection cancer-control messages. Adverse surgical sequelae to screening were often minimized, scientific progress highlighted and gender equity appeals appropriated. Those questioning screening were vilified, with epidemiology being framed as an inferior form of knowledge than clinical experience. CONCLUSIONS Australian men are exposed to unbalanced and often non-evidence-based appeals to seek PSA testing. There is a disturbing lack of effort to redress this imbalance.
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Affiliation(s)
- Ross MacKenzie
- School of Public Health, University of Sydney 2006, Australia
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MacKenzie R, Chapman S, Holding S, McGeechan K. 'A matter of faith, not science': analysis of media coverage of prostate cancer screening in Australian news media 2003-2006. J R Soc Med 2008; 100:513-21. [PMID: 18048709 DOI: 10.1177/014107680710001114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Despite a near universal absence of evidence-based policies supporting population screening for prostate cancer, the prostate-specific antigen (PSA) test is aggressively promoted in the media as a life-saving form of screening. The objective of this study was to examine media coverage of prostate-cancer screening in Australia. DESIGN Frame analysis of all direct or attributed quotes about prostate cancer. SETTING Australian capital city newspapers (February 2003-December 2006) and Sydney television news (January 2003-December 2006). MAIN OUTCOME MEASURES Quotes regarding prostate cancer screening: n=436 in newspapers and television news. RESULTS Seven rhetorical frames were identified. 86% of all quotes framed prostate screening and its outcomes as desirable, associating PSA testing as being consonant with other early-detection cancer-control messages. Adverse surgical sequelae to screening were often minimized, scientific progress highlighted and gender equity appeals appropriated. Those questioning screening were vilified, with epidemiology being framed as an inferior form of knowledge than clinical experience. CONCLUSIONS Australian men are exposed to unbalanced and often non-evidence-based appeals to seek PSA testing. There is a disturbing lack of effort to redress this imbalance.
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Affiliation(s)
- Ross MacKenzie
- School of Public Health, University of Sydney 2006, Australia
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Gomella LG, Valicenti RK. Concluding Remarks. Prostate Cancer 2008. [DOI: 10.1007/978-1-60327-079-3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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MacKenzie R, Chapman S, Barratt A, Holding S. "The news is [not] all good": misrepresentations and inaccuracies in Australian news media reports on prostate cancer screening. Med J Aust 2007; 187:507-10. [PMID: 17979615 DOI: 10.5694/j.1326-5377.2007.tb01391.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 06/19/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To list and critically review recent inaccurate statements made by advocates of prostate cancer screening in Australian news media. DESIGN Accuracy audit of all news on prostate cancer broadcast on Sydney footprint free-to-air television stations between 2 May 2005 and 18 December 2006 (42 items), and published in print media from 6 February 2003 to 31 December 2006 in Australian capital cities (388 items). These contained 436 direct or attributed statements. RESULTS Of the 436 statements analysed, 44 (10%) were factually inaccurate or made claims not supported by the scientific literature or most cancer control agencies. Misleading statements about prostate screening and its sequelae were found in five categories: mortality from prostate cancer; expert agency support for screening; the efficacy of screening in preventing death from prostate cancer and the importance of early detection; the accuracy of the prostate-specific antigen test; and prevalence and severity of adverse effects from treatment. CONCLUSIONS Despite near universal lack of support for prostate cancer screening of asymptomatic men by leading international and Australian cancer control agencies, Australians are exposed to an unbalanced stream of encouragement to seek testing. This coverage includes inaccurate information which ignores scientific evidence and the general lack of expert agency support.
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Affiliation(s)
- Ross MacKenzie
- School of Public Health, University of Sydney, Sydney, NSW, Australia.
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Pierini P, Baldassarre E, Lillaz B. Robotic prostatectomy: an opportunity. Int J Clin Pract 2007; 61:2133-4; author reply 2134. [PMID: 17997814 DOI: 10.1111/j.1742-1241.2007.01533.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hellan M, Anderson C, Ellenhorn JDI, Paz B, Pigazzi A. Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 2007; 14:3168-73. [PMID: 17763911 DOI: 10.1245/s10434-007-9544-z] [Citation(s) in RCA: 192] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 06/30/2007] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic total mesorectal excision for rectal cancer remains a difficult procedure with high conversion rates. We have sought to improve on some of the pitfalls of laparoscopy by using the DaVinci robotic system. Here we report our two-year experience with robotic-assisted laparoscopic surgery for primary rectal cancer. METHODS A prospectively maintained database of all rectal cancer cases starting in November 2004 was created. A series of 39 consecutive unselected patients with primary rectal cancer was analyzed. Clinical and pathologic outcomes were reviewed retrospectively. RESULTS 22 patients had low anterior, 11 intersphincteric and six abdominoperineal resections. Postoperative mortality and morbidity were % and 12.8%, respectively. The median operative time was 285 minutes (range 180-540 mins). The conversion rate was 2.6%. A total mesorectal excision with negative circumferential and distal margins was accomplished in all patients, and a median of 13 (range 7-28) lymph nodes was removed. The anastomotic leak rate was 12.1%. The median hospital stay was 4 days. There have been no local recurrences at a median follow-up of 13 months. CONCLUSIONS Robotic-assisted surgery for rectal cancer can be carried out safely and according to oncological principles. This approach shows promising short-term outcomes and may facilitate the adoption of minimally invasive rectal surgery.
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Affiliation(s)
- Minia Hellan
- Department of General and Oncologic Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
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