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d’Altilia N, Mancini V, Falagario UG, Martino L, Di Nauta M, Calò B, Del Giudice F, Basran S, Chung BI, Porreca A, Bianchi L, Schiavina R, Brunocilla E, Busetto GM, Bettocchi C, Annese P, Cormio L, Carrieri G. A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques. Cancers (Basel) 2022; 14:cancers14184350. [PMID: 36139511 PMCID: PMC9496957 DOI: 10.3390/cancers14184350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Radical prostatectomy is considered the gold-standard treatment for patients with localized prostate cancer. The literature suggests there is no difference in oncological and functional outcomes between robotic-assisted radical prostatectomy (RARP) and open (RRP). (2) Methods: The aim of this study was to compare continence recovery rates after RARP and RRP measured with 24 h pad weights and the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF). After matching the population (1:1), 482 met the inclusion criteria, 241 patients per group. Continent patients with a 24 h pad test showing <20 g of urinary leakage were considered, despite severe incontinence, and categorized as having >200 g of urinary leakage. (3) Results: There was no difference between preoperative data. As for urinary continence (UC) and incontinence (UI) rates, RARP performed significantly better than RRP based on objective and subjective results at all evaluations. Univariable and multivariable Cox Regression Analysis pointed out that the only significant predictors of continence rates were the bilateral nerve sparing technique (1.25 (CI 1.02,1.54), p = 0.03) and the robotic surgical approach (1.42 (CI 1.18,1.69) p ≤ 0.001). (4) Conclusions: The literature reports different incidences of UC depending on assessment and definition of continence “without pads” or “social continence” based on number of used pads per day. In this, our first evaluation, the advantage of objective measurement through the weight of the 24 h and subjective measurement with the ICIQ-SF questionnaire best demonstrates the difference between the two surgical techniques by enhancing the use of robotic surgery over traditional surgery.
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Affiliation(s)
- Nicola d’Altilia
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Ugo Giovanni Falagario
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Leonardo Martino
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Michele Di Nauta
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Beppe Calò
- Department of Urology, Bonomo Teaching Hospital, 76123 Andria, Italy
| | | | - Satvir Basran
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Benjamin I. Chung
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 37138 Padua, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, 40126 Bologna, Italy
| | | | | | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
- Correspondence: ; Tel.: +39-0881-733856
| | - Carlo Bettocchi
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Pasquale Annese
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
- Department of Urology, Bonomo Teaching Hospital, 76123 Andria, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
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Pawlik MT, Prasser C, Zeman F, Harth M, Burger M, Denzinger S, Blecha S. Pronounced haemodynamic changes during and after robotic-assisted laparoscopic prostatectomy: a prospective observational study. BMJ Open 2020; 10:e038045. [PMID: 33020097 PMCID: PMC7537432 DOI: 10.1136/bmjopen-2020-038045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Robotic-assisted laparoscopic prostatectomy (RALP) is typically conducted in steep Trendelenburg position (STP). This study investigated the influence of permanent 45° STP and capnoperitoneum on haemodynamic parameters during and after RALP. DESIGN Prospective observational study. SETTING Haemodynamic changes were recorded with transpulmonary thermodilution and pulse contour analysis in men undergoing RALP under standardised anaesthesia. PARTICIPANTS Informed consent was obtained from 51 patients scheduled for elective RALP in a University Medical Centre in Germany. INTERVENTIONS Heart rate, mean arterial pressure, central venous pressure (CVP), Cardiac Index (CI), systemic vascular resistance (SVR), Global End-Diastolic Volume Index (GEDI), global ejection fraction (GEF), Cardiac Power Index (CPI) and stroke volume variation (SVV) were recorded at six time points: 20 min after induction of anaesthesia (T1), after insufflation of capnoperitoneum in supine position (T2), after 30 min in STP (T3), when controlling Santorini's plexus in STP (T4), before awakening in supine position (T5) and after 45 min in the recovery room (T6). Adverse cardiac events were registered intraoperatively and postoperatively. RESULTS All haemodynamic parameters were significantly changed by capnoperitoneum and STP during RALP and partly normalised at T6. CI, GEF and CPI were highest at T6 (CI: 3.9 vs 2.2 L/min/m²; GEF: 26 vs 22%; CPI: 0.80 vs 0.39 W/m²; p<0.001). CVP was highest at T4 (31 vs 7 mm Hg, p<0.001) and GEDI at T6 (819 vs 724 mL/m², p=0.005). Mean SVR initially increased (T2) but had decreased by 24% at T6 (p<0.001). SVV was highest at T5 (12 vs 9%, p<0.001). Two of the patients developed cardiac arrhythmia during RALP and one patient suffered postoperative cardiac ischaemia. CONCLUSIONS RALP led to pronounced perioperative haemodynamic changes. The combination of increased cardiac contractility and heart rate reflects a hyperdynamic situation during and after RALP. Anaesthesiologists should be aware of unnoticed pre-existing heart failure to worsen during STP in patients undergoing RALP.
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Affiliation(s)
- Michael T Pawlik
- Department of Anaesthesiology, Caritas-Krankenhaus Sankt Josef Regensburg, Regensburg, Bayern, Germany
| | - Christopher Prasser
- Department of Anaesthesiology, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Florian Zeman
- Centre for Clinical Studies, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Marion Harth
- Department of Anaesthesiology, Caritas-Krankenhaus Sankt Josef Regensburg, Regensburg, Bayern, Germany
| | - Maximilian Burger
- Department of Urology, Caritas-Krankenhaus Sankt Josef Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas-Krankenhaus Sankt Josef Regensburg, Regensburg, Germany
| | - Sebastian Blecha
- Department of Anaesthesiology, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
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Huben NB, Hussein AA, May PR, Whittum M, Krasowski C, Ahmed YE, Jing Z, Khan H, Kim HL, Schwaab T, Underwood W, Kauffman EC, Mohler JL, Guru KA. Development of a Patient-Based Model for Estimating Operative Times for Robot-Assisted Radical Prostatectomy. J Endourol 2019; 32:730-736. [PMID: 29631438 DOI: 10.1089/end.2018.0249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To develop a methodology for predicting operative times for robot-assisted radical prostatectomy (RARP) using preoperative patient, disease, procedural, and surgeon variables to facilitate operating room (OR) scheduling. METHODS The model included preoperative metrics: body mass index (BMI), American Society of Anesthesiologists score, clinical stage, National Comprehensive Cancer Network risk, prostate weight, nerve-sparing status, extent and laterality of lymph node dissection, and operating surgeon (six surgeons were included in the study). A binary decision tree was fit using a conditional inference tree method to predict operative times. The variables most associated with operative time were determined using permutation tests. Data were split at the value of the variable that results in the largest difference in mean for surgical time across the split. This process was repeated recursively on the resultant data. RESULTS A total of 1709 RARPs were included. The variable most strongly associated with operative time was the surgeon (surgeons 2 and 4-102 minutes shorter than surgeons 1, 3, 5, and 6, p < 0.001). Among surgeons 2 and 4, BMI had the strongest association with surgical time (p < 0.001). Among patients operated by surgeons 1, 3, 5, and 6, RARP time was again most strongly associated with the surgeon performing RARP. Surgeons 1, 3, and 6 were on average 76 minutes faster than surgeon 5 (p < 0.001). The regression tree output in the form of box plots showed operative time median and ranges according to patient, disease, procedural, and surgeon metrics. CONCLUSION We developed a methodology that can predict operative times for RARP based on patient, disease and surgeon variables. This methodology can be utilized for quality control, facilitate OR scheduling, and maximize OR efficiency.
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Affiliation(s)
- Neil B Huben
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.,2 Alabama College of Osteopathic Medicine , Dothan, Alabama
| | - Ahmed A Hussein
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.,3 Department of Urology, Cairo University , Cairo, Egypt
| | - Paul R May
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Michelle Whittum
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Collin Krasowski
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Youssef E Ahmed
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Zhe Jing
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Hijab Khan
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Hyung L Kim
- 4 Department of Urology, Cedar Sinai Medical Center , Los Angeles, California
| | - Thomas Schwaab
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Willie Underwood
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Eric C Kauffman
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - James L Mohler
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Khurshid A Guru
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
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van Poppel H, Everaerts W, Tosco L, Joniau S. Open and robotic radical prostatectomy. Asian J Urol 2018; 6:125-128. [PMID: 31061797 PMCID: PMC6488736 DOI: 10.1016/j.ajur.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022] Open
Abstract
Open retropubic radical prostatectomy has been the "gold standard" treatment for locally confined prostate cancer (PCa) but in recent years minimal invasive techniques as laparoscopy and robot-assisted prostatectomy have become widely available. The trifecta of the surgical treatment of PCa is cancer control, the preservation of continence, and erectile potency. Over the years the complication rates of radical prostatectomy have become very limited with improved cancer control and better functional results. We review the indications and the surgical technique of radical prostatectomy, be it open or laparoscopic, eventually robot-assisted as well as the pre- and postoperative measures and the surgery-related consequences.
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Affiliation(s)
- Hendrik van Poppel
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Lorenzo Tosco
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
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Preoperative Brimonidine Tartrate 0.2% Does not Prevent an Intraocular Pressure Rise During Prostatectomy in Steep Trendelenburg Position. J Glaucoma 2018; 27:965-970. [PMID: 30095608 DOI: 10.1097/ijg.0000000000001047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated the effect of preoperative brimonidine tartrate 0.2% on intraocular pressure (IOP) during robotic-assisted laparoscopic radical prostatectomy in steep Trendelenburg position (sTBURG). MATERIALS AND METHODS In this prospective randomized controlled masked interventional trial, eligible patients scheduled for robotic-assisted laparoscopic radical prostatectomy in sTBURG at the Toronto General Hospital had one eye randomized to placebo (artificial tears) or drug (brimonidine tartrate 0.2%) preoperatively. Visual acuity (VA), tonometry, disc photography, visual field (VF), and retinal nerve fiber layer (RNFL) assessments were performed preoperatively and postoperatively. A standardized anesthetic protocol was followed intraoperatively. IOP was measured using Tono-Pen AVIA (Reichert Inc., New York, NY) as follows: preanesthesia supine, anesthetized supine, hourly in sTBURG and awake supine. The primary outcome was IOP in sTBURG in the drug group compared with the placebo group. Secondary outcomes were changes in VA, VF, RNFL thickness, mean arterial pressure, and ocular perfusion pressure. This study was approved by University Health Network Research Ethics Board. RESULTS In total, 26 eligible patients, mean age 61.9±5.1 years, were randomized to brimonidine (11 patients) and placebo (15 patients). Baseline IOP was not significantly different between the drug and placebo groups (P=0.42). Significant and sustained IOP elevation of >1.5X baseline in the sTBURG was noted in both groups. The mean IOP 1 hour after sTBURG was 29.4±6.9 and 27.2±3.4 mm Hg in the drug and placebo groups, respectively (P=0.35). No significant changes were noted in VA, VF, or RNFL. CONCLUSIONS Significant and sustained IOP increases occur during sTBURG. Preoperative brimonidine does not prevent IOP spikes in sTBURG.
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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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Bang SL, Png KS, Yeow YY, Tan GYM, Chong YL. Developing technical expertise in robot-assisted laparoscopic prostatectomy in a moderate-volume center through a proctor-based team approach. J Robot Surg 2014; 8:245-50. [PMID: 27637685 DOI: 10.1007/s11701-014-0460-5] [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: 08/20/2013] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
Abstract
Our aim is to report our preliminary experience of a proctor-based team approach in robot-assisted laparoscopic prostatectomy (RALP) for the treatment of localized prostate cancer. Data was collected between December 2008 and February 2012. RALP was performed on 100 consecutive patients with prostate cancer by a team of five urologists proctored by two fellowship-trained surgeons from a single hospital. Clinical and pathological data of these patients were reviewed. The mean age of the patients was 66 years (range 48-76). Clinical stages were 82 % cT1c, 3 % cT1b, 13 % cT2a and 2 % cT3a disease. Preoperative mean prostate-specific antigen level was 11.33 ng/ml (SD 10.47). Mean operative time was 342 min and mean blood loss was 717 ml (SD 988). Mean hospital stay and duration of the indwelling catheter were 3.2 days (SD 1.8) and 12.6 days (SD 8.5), respectively. Pathological staging showed 65 patients with pT2a (65 %) disease and 33 patients with pT3a (33 %) disease. Thirty-five patients (35 %) had positive surgical margins. Eighteen patients underwent adjuvant radiotherapy. Overall postoperative complication rate was 14 %. There were six Clavien grade 1 complications, seven Clavien grade 2 complications and one Clavien grade 3 complication. At mean follow-up of 36 months, 100 % of patients remained free of biochemical recurrence with continence at 70 %. Our proctor-based team approach will continue to improve each surgeon's technical competency. He or she will continue to improve and gradually move on to achieving his or her outcomes learning curve.
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Affiliation(s)
| | | | - Yu Yi Yeow
- Tan Tock Seng Hospital, Singapore, Singapore
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Singh I, Garg G. Re: formalin disinfection of biopsy needle minimizes the risk of sepsis following prostate biopsy: M. M. Issa, U. A. Al-Qassab, J. Hall, C. W. M. Ritenour, J. A. Petros and J. W. Sullivan J Urol 2013;190:1769-1775. J Urol 2014; 191:1473-4. [PMID: 24513145 DOI: 10.1016/j.juro.2013.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Iqbal Singh
- Department of Surgery, Division of Urology, University College of Medical Sciences, University of Delhi, New Delhi, Delhi, India.
| | - Gaurav Garg
- Department of Surgery, Division of Urology, University College of Medical Sciences, University of Delhi, New Delhi, Delhi, India
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Muramaki M, Miyake H, Behnsawy HM, Furukawa J, Harada KI, Fujisawa M. Assessment of postoperative quality of life: comparative study between laparoscopic and minimum incision endoscopic radical prostatectomies. Int J Clin Oncol 2013; 19:1092-7. [PMID: 24370729 DOI: 10.1007/s10147-013-0659-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/12/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND To investigate the changes in postoperative quality of life (QOL) in patients with prostate cancer who underwent laparoscopic radical prostatectomy (LRP) or minimum incision endoscopic radical prostatectomy (MIE-RP). METHODS This study included a total of 115 Japanese patients with clinically localized prostate cancer who underwent either LRP or MIE-RP and were subsequently followed for more than 12 months. Before and 12 months after surgery, health-related QOL and disease-specific QOL were assessed using the Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) and the Expanded Prostate Index Composite (EPIC), respectively. RESULTS LRP and MIE-RP were performed in 57 and 58 patients, respectively, and there were no significant differences in major clinicopathological parameters between these two groups. There were no significant differences in perioperative outcomes between the two groups except for the estimated blood loss, which was lower in the LRP group. There were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the SF-8 survey. Of the fourteen scores evaluated by the EPIC survey, postoperative scores for urinary summary, sexual summary, urinary function, urinary incontinence and sexual function were significantly worse than these preoperative scores in both LRP and MIE-RP groups, while there were no significant differences between the two groups in the preoperative and postoperative all-scale scores of the EPIC survey. CONCLUSIONS The postoperative QOL status in patients undergoing MIE-RP appeared to be equivalent to that in those undergoing LRP.
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Affiliation(s)
- Mototsugu Muramaki
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Oncological outcomes of robotic-assisted radical prostatectomy after more than 5 years. World J Urol 2013; 32:413-8. [DOI: 10.1007/s00345-013-1120-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/19/2013] [Indexed: 11/26/2022] Open
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Singh I, Patel BN, Thohan V, Hemal AK. Robot-assisted laparoscopic radical prostatectomy after heart transplantation. Urol Ann 2013; 5:56-8. [PMID: 23662015 PMCID: PMC3643328 DOI: 10.4103/0974-7796.106972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/18/2011] [Indexed: 11/13/2022] Open
Abstract
Prostate cancer (CaP) is the leading visceral malignancy in males. Patients who undergo cardiac transplantation are immune compromised, thus presenting a therapeutic challenge. Immunosuppresion could accelerate tumor growth, while medical intervention may be associated with increased treatment mortality or morbidity. Due to paucity of such cases, there are no randomized trials that address the treatment algorithm for cardiac transplant patients with CaP, with only a few scattered reports in the literature. Treatment options range from hormonal manipulation to radiation therapy to radical prostatectomy. To our knowledge, we report the first successful robot-assisted laparoscopic radical prostatectomy in a heart transplant patient with CaP.
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Affiliation(s)
- Iqbal Singh
- Department of Urology, Wake Forest University Medical Sciences and Baptist Medical Centre, Winston-Salem, NC, USA
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12
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Katz A, Ferrer M, Suárez JF. Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer. Radiat Oncol 2012; 7:194. [PMID: 23164305 PMCID: PMC3528663 DOI: 10.1186/1748-717x-7-194] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument. Methods Patients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients) or SBRT (n = 216 American patients). QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24, and 36 months. Differences in patient characteristics between the two groups were assessed using Chi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE) models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL. Results The largest differences in QOL occurred in the first 1–6 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients. Conclusions Overall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment, especially in evaluating the value of non-invasive treatments, such as SBRT.
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Affiliation(s)
- Alan Katz
- Flushing Radiation Oncology, Flushing, NY 11354, USA.
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Valero R, Schatloff O, Chauhan S, HwiiKo Y, Sivaraman A, Coelho R, Palmer K, Davila H, Patel V. Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot-assisted radical prostatectomy. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.acuroe.2012.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Valero R, Schatloff O, Chauhan S, HwiiKo Y, Sivaraman A, Coelho R, Palmer K, Davila H, Patel V. [Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy]. Actas Urol Esp 2012; 36:69-74. [PMID: 21889821 DOI: 10.1016/j.acuro.2011.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/15/2011] [Indexed: 10/26/2022]
Abstract
BACKGROUND The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. OBJECTIVE To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. MATERIAL AND METHODS The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture RESULTS All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. CONCLUSION The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leakage rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament.
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Zilinberg K, Roosen A, Belka C, Ganswindt U, Stief CG. [Management of prostate cancer]. MMW Fortschr Med 2012; 154:47-50. [PMID: 22642004 DOI: 10.1007/s15006-012-0036-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Katja Zilinberg
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Grosshadern.
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16
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Spana G, Rane A, Kaouk JH. Is robotics the future of laparoendoscopic single-site surgery (LESS)? BJU Int 2011; 108:1018-23. [DOI: 10.1111/j.1464-410x.2011.10513.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Koie T, Yamamoto H, Hatakeyama S, Kudoh S, Yoneyama T, Hashimoto Y, Kamimura N, Ohyama C. Minimum incision endoscopic radical prostatectomy: clinical and oncological outcomes at a single institute. Eur J Surg Oncol 2011; 37:805-10. [PMID: 21782374 DOI: 10.1016/j.ejso.2011.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 05/12/2011] [Accepted: 06/14/2011] [Indexed: 11/27/2022] Open
Abstract
AIMS The objective of this study was to investigate the clinical and oncological outcomes of prostatectomy patients undergoing minimum incision endoscopic radical prostatectomy (MIE-RP). METHODS Between September 2005 and May 2010, 541 patients underwent MIE-RP with bilateral lymphadenectomy for clinically localized prostate cancer at Hirosaki University Hospital. The present retrospective study enrolled 375 patients who had not received neoadjuvant or adjuvant therapy. MIE-RP was performed through a 6-cm suprapubic midline incision. A 30° laparoscope was conveniently positioned on the head side of the patient for precise observation and monitoring. RESULTS The median operating time was 119 min, and the estimated blood loss was 900 ml. The most frequent perioperative complication was leakage from the vesicourethral anastomosis (6.7%), and rectal injury occurred in 1.0%. Overall, 31.2% of the patients had a positive surgical margin, including 11.1% with pT2, 52.9% with pT3 and 100% with pT4 diseases. The post-operative median follow-up period was 40.5 months (range, 2-56.5 months). The 5-year PSA-free survival rate was 71.6%. In multivariate analysis, high-risk patients (according to the D'Amico risk criteria), pathological T stage and positive surgical margins were identified as independent predictors of PSA-free survival. The limitations of this study included a retrospective study, relatively short follow-up period and single-institution nature of the study. CONCLUSIONS MIE-RP is a safe and minimally invasive procedure that may represent a reliable alternative to laparoscopic and robotic-assisted RP.
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Affiliation(s)
- T Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036 8562, Japan
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18
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Heldt JP, Jellison FC, Yuen WD, Tenggardjaja CF, Lui PD, Ruckle HC, Barker GR, Baldwin DD. Patients with End-Stage Renal Disease Are Candidates for Robot-Assisted Laparoscopic Radical Prostatectomy. J Endourol 2011; 25:1175-80. [DOI: 10.1089/end.2010.0680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jonathan P. Heldt
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Forrest C. Jellison
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Walter D. Yuen
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | | | - Paul D. Lui
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Herbert C. Ruckle
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - Gary R. Barker
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
| | - D. Duane Baldwin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California
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Hemal AK, Agarwal MM, Babbar P. Impact of newer unidirectional and bidirectional barbed suture on vesicourethral anastomosis during robot-assisted radical prostatectomy and its comparison with polyglecaprone-25 suture: an initial experience. Int Urol Nephrol 2011; 44:125-32. [PMID: 21523325 DOI: 10.1007/s11255-011-9967-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 04/06/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate impact of unidirectional barbed suture on vesicourethral anastomosis (VUA) during robot-assisted radical prostatectomy (RARP) and its comparison with Polyglecaprone-25 suture. PATIENTS AND METHODS The study was initiated as pilot study; the participants were grouped into three based on the suture material used for VUA, i.e., monofilament Polyglecaprone-25 (group 1), unidirectional barbed Glycolic acid-trimethylene carbonate (group 2), and bidirectional barbed Polyglycolic acid-polycaprolactone (group 3), respectively. Group 1 was included retrospectively and the latter two prospectively. All cases were operated upon by the same surgeon, proficient in RARP. Patient-demographics, intraoperative and peri-operative data were collected. Our technique of mucosa-to-mucosa VUA is carried out in a choreographed manner using unibarbed suture. RESULTS Fifty-five patients were included; 25 each in group 1 and 2. The group 3 was prematurely closed after 5 cases due to perceived inappropriateness of needle characteristics of the suture material. Therefore, the statistical analysis was performed between group 1 and 2 only. Preoperative characteristics including age, PSA, clinical stage, and biopsy grade were similar between the groups. The anastomosis time was significantly less in group 2 (8.4 ± 1.7 min vs. 14.3 ± 4.8 min; P = 0.0001; t test). Postoperative hospital stay was less in group 2 (2.7 ± 1.1 days vs. 1.9 ± 0.8 days; P = 0.023; Mann-Whitney U). None of the patient had presented with urinary leaks, urinary retention, or anastomotic strictures at follow-up of 6 months. CONCLUSION VUA with unidirectional barbed suture is safe and takes less time compared to monofilament suture as repeated cinching; help of assistance and knot tying are not required by virtue of its self-retaining characteristics.
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Affiliation(s)
- Ashok K Hemal
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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20
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Current world literature. Curr Opin Urol 2011; 21:257-64. [PMID: 21455039 DOI: 10.1097/mou.0b013e3283462c0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Descazeaud A, Roupret M, Piéchaud T, Rischmann P. [How to improve the surgery of prostate cancer?]. Prog Urol 2011; 21 Suppl 1:S7-11. [PMID: 21211729 DOI: 10.1016/s1166-7087(11)70002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This work summarizes the highlights of the satellite symposium of the seventh edition of the European Robotic Urology Symposium. Treatment options of T3 prostate cancer were discussed, including the results of the Tap 032 study. In this phase III study, 264 patients with locally advanced prostate cancer were randomized to be treated by leuproreline 11,25 mg for 3 years alone or radiotherapy plus leuproreline 11,25 mg for 3 years. The median of disease free survival (Phoenix definition : PSA nadir + 2 ng/ml) was significantly longer in the group of patients treated with the combined treatment (6,96 years vs 3,46 years, p = 0,0005). No statistical difference was observed in specific survival (93,2% vs 86,1%, p = 0,11). In the second part of the satellite symposium, perioperative, oncological, and functional outcomes of laparoscopic robotic-assisted radical prostatectomy were presented, as well as today and future developments of robotic surgery.
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Singh I. Robotics in urological surgery: Review of current status and maneuverability, and comparison of robot-assisted and traditional laparoscopy. ACTA ACUST UNITED AC 2011; 16:38-45. [DOI: 10.3109/10929088.2010.541620] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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