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Chatterjee S, Das S, Ganguly K, Mandal D. Advancements in robotic surgery: innovations, challenges and future prospects. J Robot Surg 2024; 18:28. [PMID: 38231455 DOI: 10.1007/s11701-023-01801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024]
Abstract
The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.
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Affiliation(s)
- Swastika Chatterjee
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | | | - Karabi Ganguly
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | - Dibyendu Mandal
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India.
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Civitella A, Prata F, Papalia R, Citriniti V, Tuzzolo P, Pascarella G, Forastiere EMA, Ragusa A, Tedesco F, Prata SM, Anceschi U, Simone G, Muto G, Scarpa RM, Cataldo R. Laparoscopic versus Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia Management after Radical Prostatectomy: Results from a Single Center Study. J Pers Med 2023; 13:1634. [PMID: 38138861 PMCID: PMC10744694 DOI: 10.3390/jpm13121634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Regional anesthesia, achieved through nerve blocks, has gained widespread acceptance as an effective pain management approach. This research aimed to evaluate the efficacy of laparoscopic (LAP) transversus abdominis plane (TAP) block in patients undergoing laparoscopic radical prostatectomy. (2) Methods: From January 2023 to July 2023, 60 consecutive patients undergoing minimally invasive radical prostatectomy were selected. Patients were split into two groups receiving ultrasound-guided (US) or laparoscopic-guided TAP block. The primary outcome was a pain score expressed by a 0-10 visual analog scale (VAS) during the first 72 h after surgery. (3) Results: Both LAP-TAP and US-TAP block groups were associated with lower pain scores postoperatively. No statistically significant differences were observed between the two groups in surgery time, blood loss, time to ambulation, length of stay, and pain after surgery (all p > 0.2). In the LAP-TAP block group, the overall operating room time was significantly shorter than in the US-TAP block group (140 vs. 152 min, p = 0.04). (4) Conclusions: The laparoscopic approach, compared to the US-TAP block, was equally safe and not inferior in reducing analgesic drug use postoperatively. Moreover, the intraoperative LAP-TAP block seems to be a time-sparing procedure that could be recommended when patient-controlled analgesia cannot be delivered.
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Affiliation(s)
- Angelo Civitella
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Vincenzo Citriniti
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (V.C.); (G.P.); (R.C.)
| | - Piergiorgio Tuzzolo
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Giuseppe Pascarella
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (V.C.); (G.P.); (R.C.)
| | | | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Salvatore Mario Prata
- Simple Operating Unit of Lower Urinary Tract Surgery, SS. Trinità Hospital, Sora, 03039 Frosinone, Italy;
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Giovanni Muto
- Department of Urology, GVM—Maria Pia Hospital, 10132 Turin, Italy;
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.C.); (R.P.); (P.T.); (A.R.); (F.T.); (R.M.S.)
| | - Rita Cataldo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (V.C.); (G.P.); (R.C.)
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Shugaba A, Subar DA, Slade K, Willett M, Abdel-Aty M, Campbell I, Heywood N, Vitone L, Sheikh A, Gill M, Zelhof B, Nuttall HE, Bampouras TM, Gaffney CJ. Surgical stress: the muscle and cognitive demands of robotic and laparoscopic surgery. ANNALS OF SURGERY OPEN 2023; 4:e284. [PMID: 37342254 PMCID: PMC7614670 DOI: 10.1097/as9.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Introduction Surgeons are among the most at-risk professionals for work-related musculoskeletal decline and experience high mental demands. This study examined the electromyographic (EMG) and electroencephalographic (EEG) activities of surgeons during surgery. Methods Surgeons who performed live laparoscopic (LS) and robotic (RS) surgeries underwent EMG and EEG measurements. Wireless EMG was used to measure muscle activation in four muscle groups bilaterally (biceps brachii, deltoid, upper trapezius, and latissimus dorsi), and an 8-channel wireless EEG device was used to measure cognitive demand. EMG and EEG recordings were completed simultaneously during (i) noncritical bowel dissection, (ii) critical vessel dissection, and (iii) dissection after vessel control. Robust ANOVA was used to compare the %MVCRMS and alpha power between LS and RS. Results Thirteen male surgeons performed 26 laparoscopic surgeries (LS) and 28 robotic surgeries (RS). Muscle activation was significantly higher in the right deltoid (p = 0.006), upper trapezius (left, p = 0.041; right, p = 0.032), and latissimus dorsi (left, p = 0.003; right, p = 0.014) muscles in the LS group. There was greater muscle activation in the right biceps than in the left biceps in both surgical modalities (both p = 0.0001). There was a significant effect of the time of surgery on the EEG activity (p <0.0001). A significantly greater cognitive demand was observed in the RS than in the LS with alpha, beta, theta, delta, and gamma (p = 0.002 - p <0.0001). Conclusion These data suggest greater muscle demands in laparoscopic surgery, but greater cognitive demands in robotic surgery.
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Affiliation(s)
- Abdul Shugaba
- Lancaster Medical School, Lancaster University, UK
- BRIDGES Research Group, Department of General Surgery, Royal Blackburn Teaching Hospitals NHS Trust
| | - Daren A. Subar
- East Lancashire NHS Hospitals Trust, UK
- BRIDGES Research Group, Department of General Surgery, Royal Blackburn Teaching Hospitals NHS Trust
| | - Kate Slade
- Department of Psychology, Lancaster University, UK
| | | | | | | | | | | | | | - Mike Gill
- East Lancashire NHS Hospitals Trust, UK
| | - Bachar Zelhof
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
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Rahimi AM, Hardon SF, Scholten SR, Bonjer HJ, Daams F. Objective measurement of retention of laparoscopic skills: a prospective cohort study. Int J Surg 2023; 109:723-728. [PMID: 37010141 PMCID: PMC10389389 DOI: 10.1097/js9.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/30/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION There has been an overall growth of 462% in laparoscopic procedures performed by surgical residents between 2000 and 2018. Therefore, training courses in laparoscopic surgery are advocated in many postgraduate programs. While the immediate effect is determined in some cases, the retention of acquired skills is rarely investigated. The objective of this study was to objectively measure the retention of laparoscopic technical skills to offer a more personalized training program. METHODS First year general surgery residents performed two fundamental laparoscopic skills tasks (Post and Sleeve and the ZigZag loop) on the Lapron box trainer. Assessment was performed before, directly after, and 4 months after completing the basic laparoscopy course. Force, motion, and time were the measured variables. RESULTS A total of 29 participants were included from 12 Dutch training hospitals and 174 trials were analyzed. The 4 months assessment of the Post and Sleeve showed a significant improvement in force ( P= 0.004), motion ( P ≤0.001), and time ( P ≤0.001) compared to the baseline assessment. The same was true for the ZigZag loop: force ( P ≤0.001), motion ( P= 0.005), and time ( P ≤0.001).Compared to the 4 months assessment, skill deterioration was present for the Post and Sleeve in the mean force ( P= 0.046), max impulse ( P= 0.12), and time ( P= 0.002). For the ZigZag loop, skill decay was observed for force ( P= 0.021), motion ( P= 0.015), and time ( P ≤0.001) parameters. CONCLUSION Acquired laparoscopic technical skills decreased 4 months after the basic laparoscopy course. Compared to baseline performance, participants showed significant improvement, however deterioration was observed compared to postcourse measurements. To preserve acquired laparoscopic skills, it is recommended to incorporate maintenance training, preferably with objective parameters, in training curricula.
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Affiliation(s)
- A. Masie Rahimi
- Department of Surgery, Amsterdam UMC – VU University Medical Center
- Amsterdam Skills Centre for Health Sciences
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Sem F. Hardon
- Department of Surgery, Amsterdam UMC – VU University Medical Center
| | | | - H. Jaap Bonjer
- Department of Surgery, Amsterdam UMC – VU University Medical Center
- Amsterdam Skills Centre for Health Sciences
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC – VU University Medical Center
- Cancer Center Amsterdam, Amsterdam, The Netherlands
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Pauchard F, Ventimiglia E, Corrales M, Traxer O. A Practical Guide for Intra-Renal Temperature and Pressure Management during Rirs: What Is the Evidence Telling Us. J Clin Med 2022; 11:jcm11123429. [PMID: 35743499 PMCID: PMC9224584 DOI: 10.3390/jcm11123429] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION One of the main limitations of Ho:YAG lithotripsy is represented by its advancement speed. The need for faster lithotripsy has led to the introduction of high-power laser equipment. This general trend in increasing Ho:YAG lithotripsy power has certain points that deserve to be considered and analyzed. The objective is to carry out a narrative review on intrarenal temperature and pressure during ureteroscopy. METHODS A literature search using PUBMED database from inception to December 2021 was performed. The analysis involved a narrative synthesis. RESULTS Using more power in the laser correlates with an increase in temperature that can be harmful to the kidney. This potential risk can be overcome by increasing either the irrigation inflow or outflow. Increasing irrigant flow can lead to high intrarenal temperature (IRP). The factors that allow the reduction of intrarenal pressure are a low irrigation flow, the use of a ureteral access sheath of adequate diameter according to the equipment used, and the occupation of the working channel by the laser or basket. CONCLUSION To maintain a safe temperature profile, it has been proposed to use chilled irrigation fluid, intermittent laser activation or to increase irrigation flow. This last recommendation can lead to increased IRP, which can be overcome by using a UAS. Another option is to use low power laser configurations in order to avoid temperature increases and not require high irrigation flows.
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Affiliation(s)
- Felipe Pauchard
- Urology Department, Hospital Naval Almirante Nef, Viña del Mar 2520000, Chile;
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Mariela Corrales
- Groupe de Recherche Cliniques sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France;
| | - Olivier Traxer
- Groupe de Recherche Cliniques sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France;
- Service d’Urologie, Assitance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France
- Correspondence: ; Tel.: +33-1-56-01-61-53; Fax: +33-1-56-01-63-77
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García-Perdomo HA, Caparrós MJR, Asensio AA, Cabo AV. Effect of positive surgical margins in patients who undergo a partial nephrectomy regarding recurrence, overall survival, recurrence/progression-free survival, and metastasis-free survival. A systematic review and meta-analysis. Clin Genitourin Cancer 2022; 20:459-472. [DOI: 10.1016/j.clgc.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/29/2022] [Indexed: 11/03/2022]
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Halib N, Pavan N, Trombetta C, Dapas B, Farra R, Scaggiante B, Grassi M, Grassi G. An Overview of siRNA Delivery Strategies for Urological Cancers. Pharmaceutics 2022; 14:pharmaceutics14040718. [PMID: 35456552 PMCID: PMC9030829 DOI: 10.3390/pharmaceutics14040718] [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: 02/03/2022] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 02/05/2023] Open
Abstract
The treatment of urological cancers has been significantly improved in recent years. However, for the advanced stages of these cancers and/or for those developing resistance, novel therapeutic options need to be developed. Among the innovative strategies, the use of small interfering RNA (siRNA) seems to be of great therapeutic interest. siRNAs are double-stranded RNA molecules which can specifically target virtually any mRNA of pathological genes. For this reason, siRNAs have a great therapeutic potential for human diseases including urological cancers. However, the fragile nature of siRNAs in the biological environment imposes the development of appropriate delivery systems to protect them. Thus, ensuring siRNA reaches its deep tissue target while maintaining structural and functional integrity represents one of the major challenges. To reach this goal, siRNA-based therapies require the development of fine, tailor-made delivery systems. Polymeric nanoparticles, lipid nanoparticles, nanobubbles and magnetic nanoparticles are among nano-delivery systems studied recently to meet this demand. In this review, after an introduction about the main features of urological tumors, we describe siRNA characteristics together with representative delivery systems developed for urology applications; the examples reported are subdivided on the basis of the different delivery materials and on the different urological cancers.
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Affiliation(s)
- Nadia Halib
- Department of Basic Sciences & Oral Biology, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur 55100, Malaysia;
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, I-34149 Trieste, Italy; (N.P.); (C.T.)
| | - Carlo Trombetta
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, I-34149 Trieste, Italy; (N.P.); (C.T.)
| | - Barbara Dapas
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy; (B.D.); (R.F.); (B.S.)
| | - Rossella Farra
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy; (B.D.); (R.F.); (B.S.)
| | - Bruna Scaggiante
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy; (B.D.); (R.F.); (B.S.)
| | - Mario Grassi
- Department of Engineering and Architecture, Trieste University, Via Valerio 6, I-34127 Trieste, Italy;
| | - Gabriele Grassi
- Department of Life Sciences, Cattinara University Hospital, Trieste University, Strada di Fiume 447, I-34149 Trieste, Italy; (B.D.); (R.F.); (B.S.)
- Correspondence: ; Tel.: +39-040-399-3227
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Idelson C, Uecker J, Garcia JA, Kohli S, Handing G, Sriramprasad V, Yong K, Rylander C. Design and Performance Testing of a Novel In Vivo Laparoscope Lens Cleaning Device. J Med Device 2021. [DOI: 10.1115/1.4050955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
A common tool for diagnosis and treatment of gastrointestinal, gynecologic, and other anatomical pathologies is a form of minimally invasive surgery known as laparoscopy. Roughly 4 × 106 laparoscopic surgeries are performed in the U.S. every year, with an estimated 15 × 106 globally. During surgeries, lens clarity often becomes impaired via (1) condensation or (2) smearing of bodily fluids and tissues. The current gold standard solution requires scope removal from the body for cleaning, offering opportunity for decreased surgical safety and efficiency, while simultaneously generating mounting frustration for the operating room team. A novel lens cleaning device was designed and developed to clean a laparoscope lens in vivo during surgery. Benchtop experiments in a warm body simulated environment allowed quantification of lens cleaning efficacy for several lens contaminants. Image analysis techniques detected the differences between original (clean), postdebris, and postcleaning images. Mechanical testing was also executed to determine safety levels regarding potential misuse scenarios. Compared to gold standard device technologies, the novel lens cleaning device prototype showed strong performance and ability to clear a laparoscope lens of debris while mitigating the need for scope removal from the simulated surgical cavity. Mechanical testing results also suggest the design also holds inherently strong safety performance. Both objective metrics and subjective observation suggests the novel design holds promise to improve safety and efficiency during laparoscopic surgery.
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Affiliation(s)
- Christopher Idelson
- ClearCam Inc., Austin, TX 78744; Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - John Uecker
- ClearCam Inc., Austin, TX 78744; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX 78712
| | - James A. Garcia
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Sunjna Kohli
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Greta Handing
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Vishrudh Sriramprasad
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Kirstie Yong
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Christopher Rylander
- ClearCam Inc., Austin, TX 78744; Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712; Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712
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Cui X, He YB, Huang WH, Chen L, Chen JC, Zhou CM. Mini-laparoscopic pyeloplasty to treat UPJO in infants. MINIM INVASIV THER 2020; 31:473-478. [PMID: 33016819 DOI: 10.1080/13645706.2020.1826973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Xu Cui
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Yuan-Bin He
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Wen-Hua Huang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Liu Chen
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jian-Cai Chen
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Chao-Ming Zhou
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
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Manno S, Dell'Atti L, Cicione A, Spasari A. Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery. Urologia 2020; 88:14-20. [PMID: 32484072 DOI: 10.1177/0391560320921728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. PATIENTS AND METHODS We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. RESULTS Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications (p = 0.121). However, operative time (p = 0.003) and length of stay (p < 0.001) were greater in patients with versus those without previous open cholecystectomy. CONCLUSION Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.
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Affiliation(s)
- Stefano Manno
- Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy
| | - Lucio Dell'Atti
- Institute of Urology, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy
| | - Antonio Cicione
- Institute of Urology, University Hospital "S. Andrea," Roma, Italy
| | - Angelo Spasari
- Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy
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Systematic assessment of information about surgical urinary stone treatment on YouTube. World J Urol 2020; 39:935-942. [PMID: 32468108 DOI: 10.1007/s00345-020-03236-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To systematically assess the quality of videos on the surgical treatment of urinary stones available on YouTube using validated instruments. METHODS A systematic search for videos on YouTube addressing treatment options of urinary stones was performed in October 2019. Assessed parameters included basic data (e.g. number of views), the grade of misinformation reporting of conflicts of interest. Quality of content was analyzed using the validated DISCERN questionnaire. Data were analyzed using descriptive statistics. RESULTS A total of 100 videos with a median of 26,234 views (1020-1,720,521) were included in the analysis. Of these, only 26 videos were rated to contain no misinformation and only nine disclosed potential conflicts of interest. Overall, the median quality of the videos was low (2 out of 5 points for DISCERN question 16). Videos uploaded by healthcare professionals and medical societies/organizations offered significantly higher levels of quality. In particular, the videos provided by the EAU achieved the highest rating with a median score of 3.0. CONCLUSIONS The majority of videos concerning the surgical treatment of urinary stones have a low quality of content, are potentially subject to commercial bias and do not report on conflicts of interest. Videos provided by medical societies, such as the EAU, provide a higher level of quality. This highlights the importance of active recommendation of evidence-based patient education materials.
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Yu L, Yu X, Zhang Y. Microinstrument contact force sensing based on cable tension using BLSTM–MLP network. INTEL SERV ROBOT 2019. [DOI: 10.1007/s11370-019-00306-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kronenberg P, Traxer O. The laser of the future: reality and expectations about the new thulium fiber laser-a systematic review. Transl Androl Urol 2019; 8:S398-S417. [PMID: 31656746 PMCID: PMC6790412 DOI: 10.21037/tau.2019.08.01] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 01/08/2023] Open
Abstract
The Holmium:yttrium-aluminum-garnet (Ho:YAG) laser has been the gold-standard for laser lithotripsy over the last 20 years. However, recent reports about a new prototype thulium fiber laser (TFL) lithotripter have revealed impressive levels of performance. We therefore decided to systematically review the reality and expectations for this new TFL technology. This review was registered in the PROSPERO registry (CRD42019128695). A PubMed search was performed for papers including specific terms relevant to this systematic review published between the years 2015 and 2019, including already accepted but not yet published papers. Additionally, the medical sections of ScienceDirect, Wiley, SpringerLink, Mary Ann Liebert publishers, and Google Scholar were also searched for peer-reviewed abstract presentations. All relevant studies and data identified in the bibliographic search were selected, categorized, and summarized. The authors adhered to PRISMA guidelines for this review. The TFL emits laser radiation at a wavelength of 1,940 nm, and has an optical penetration depth in water about four-times shorter than the Ho:YAG laser. This results in four-times lower stone ablation thresholds, as well as lower tissue ablation thresholds. As the TFL uses electronically-modulated laser diodes, it offers the most comprehensive and flexible range of laser parameters among laser lithotripters, with pulse frequencies up to 2,200 Hz, very low to very high pulse energies (0.005-6 J), short to very long-pulse durations (200 µs up to 12 ms), and a total power level up to 55 W. The stone ablation efficiency is up to four-times that of the Ho:YAG laser for similar laser parameters, with associated implications for speed and operating time. When using dusting settings, the TFL outperforms the Ho:YAG laser in dust quantity and quality, producing much finer particles. Retropulsion is also significantly reduced and sometimes even absent with the TFL. The TFL can use small laser fibers (as small as 50 µm core), with resulting advantages in irrigation, scope deflection, retropulsion reduction, and (in)direct effects on accessibility, visibility, efficiency, and surgical time, as well as offering future miniaturization possibilities. Similar to the Ho:YAG laser, the TFL can also be used for soft tissue applications such as prostate enucleation (ThuFLEP). The TFL machine itself is seven times smaller and eight times lighter than a high-power Ho:YAG laser system, and consumes nine times less energy. Maintenance is expected to be very low due to the durability of its components. The safety profile is also better in many aspects, i.e., for patients, instruments, and surgeons. The advantages of the TFL over the Ho:YAG laser are simply too extensive to be ignored. The TFL appears to be a real alternative to the Ho:YAG laser and become a true game-changer in laser lithotripsy. Due to its novelty, further studies are needed to broaden our understanding of the TFL, and comprehend the full implications and benefits of this new technology, as well its limitations.
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Affiliation(s)
| | - Olivier Traxer
- Hôpital Tenon, Université Pierre et Marie Curie, Paris VI, Paris, France
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Li Q, Gao L, Li J, Zhang Y, Jiang Q. Total tubeless versus standard percutaneous nephrolithotomy: a meta-analysis. MINIM INVASIV THER 2019; 29:61-69. [PMID: 30849258 DOI: 10.1080/13645706.2019.1581224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Qiubo Li
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang Gao
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Li
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanfeng Zhang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zhou Y, Yang K. Prevention of arthrofibrosis during knee repair by extracorporeal shock wave therapy: Preliminary study in rabbits. Injury 2019; 50:633-638. [PMID: 30739764 DOI: 10.1016/j.injury.2019.01.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/31/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgery or trauma may induce extensive arthrofibrosis around joints and tendon for the restrictive range of motion. Although some approaches were proposed, this problem is not solved satisfactorily. Extracorporeal shock wave therapy (ESWT) has been used for orthopedic, musculoskeletal, and fibrotic disorders. Whether it could prevent the formation of arthrofibrosis during the joint repair is unknown. METHODS Intra-articular adhesions were created in the right knee of the rabbit by cortical bone shaving and subsequent cast immobilization. Arthrofibrosis in the control and ESWT group was evaluated and compared at week 4. RESULTS Macroscopic score of arthrofibrosis and contracture angle of the control group are significantly higher. Histologically, the apparent gap between patella and tibia, loose connective tissue, and much less density of the blood vessel are found in the ESWT group. CONCLUSIONS ESWT could noninvasively, effectively, and safely prevent the formation of arthrofibrosis during the knee repair.
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Affiliation(s)
- Yufeng Zhou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
| | - Kai Yang
- SG Med International Pte Ltd, Singapore
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Wang N, Zhang D, Zhang YT, Xu W, Wang YS, Zhong PP, Jia TZ, Xiu YF. Endothelium corneum gigeriae galli extract inhibits calcium oxalate formation and exerts anti-urolithic effects. JOURNAL OF ETHNOPHARMACOLOGY 2019; 231:80-89. [PMID: 30194056 DOI: 10.1016/j.jep.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/13/2018] [Accepted: 09/02/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional Chinese Medicine is preferred because of its safety and minimal/reduced side effects. Endothelium Corneum Gigeriae Galli (ECGG) extract, a traditional Chinese drug consisting of the dried gizzard membrane of Gallus gallus domesticus Brisson, was assessed for its effects and mechanism on urolithiasis. AIMS OF STUDY To evaluate the effects of ECGG extract on calcium oxalate (CaOx) crystal formation in vitro, and assess the anti-urolithic effects of ECGG extract in vivo and explore the underlying mechanism. MATERIALS AND METHODS In vitro, CaOx crystals were treated with ECGG extract (0.05, 0.2, and 0.8 g/mL), and assessed by scanning electron microscopy, Fourier-transform infrared spectroscopy, X-ray powder diffraction and electrical conductivity. Then, a rat model of renal calculi was established by ethylene glycol and ammonium chloride treatment, and ECGG extract (5.0, 10.0 and 20.0 g/kg) was administered orally. After treatment, urine, serum and kidney bioindicators were analyzed, as well as kidney's pathological features. RESULTS In the presence of ECGG extract, calcium oxalate dihydrate (COD) crystals with typical tetragonal bipyramidal morphology were obtained; meanwhile, the formation of calcium oxalate monohydrate (COM), a major urinary stone component, was inhibited; in addition, the equilibration time of the chemical reaction of Ca2+ and C2O42- ions was delayed in a concentration dependent manner. ECGG extract actually showed anti-urolithic effects; the incidence rates of crystal formation in the kidney in the model, low, middle and high dose groups were 100%, 90%, 70% and 60%, respectively, with a dose-dependent alleviation of kidney stone amounts and kidney damage. Treatment with middle and high ECGG extract doses significantly decreased urine uric acid and oxalic acid amounts, serum creatinine, urea nitrogen and uric acid contents, and kidney tissue oxalic acid and calcium levels, while increasing kidney and urinary magnesium and superoxide dismutase levels (P < 0.05). CONCLUSION ECGG extract has outstanding anti-urolithic effects, potentially with included bioorganic molecules inducing COD crystal nucleation and growth. Therefore, ECGG extract is a promising drug for preventing and treating urolithiasis.
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Affiliation(s)
- Nan Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Dan Zhang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Department of Pharmacy, Shanxi Provincial People's Hospital, Xian 710068, China
| | - Yong-Tai Zhang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Wen Xu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Ying-Shu Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Ping-Ping Zhong
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Tian-Zhu Jia
- School of Pharmacy, Liaoning University of Traditional Chinese Medicine, Dalian 116600, China
| | - Yan-Feng Xiu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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Racial and Ethnic Trends in Prostate Cancer Incidence and Mortality in Philadelphia, PA: an Observational Study. J Racial Ethn Health Disparities 2018; 6:371-379. [PMID: 30520002 DOI: 10.1007/s40615-018-00534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND To learn more about local prostate cancer (PCa) disparities, we conducted descriptive analyses of the role of race and age in PCa using the Pennsylvania Cancer Registry data for Philadelphia (2005-2014). METHODS We focused on the most prevalent race/ethnic groups: white (33%), black (44%), and Hispanic (9%). Outcomes included PCa rates, tumor stage, and tumor grade. Percent change was used to describe changes in age-adjusted incidence and mortality rates. Frequency tables and logistic regression models were used to describe trends in proportions of advanced PCa by race and time. Race-by-time interaction terms were retained in the models if statistically significant. RESULTS PCa incidence was highest for black men over time. Incidence rates declined over time for all race groups (- 28% for white men to - 38% for Hispanic men). PCa mortality rates declined in a less universal manner (- 5% for blacks to - 32% for whites). Each year, odds increased across all race groups for advanced tumor stage (4% each year among white and Hispanic men and 9% each year among black men) and for advanced tumor grade (4% each year among white and black men and 23% each year among Hispanic men). Among younger men, black men experienced significantly increased odds of advanced tumor stage each year (8%) and Hispanics experienced significantly increased odds of advanced tumor grade each year (30%). CONCLUSIONS Black men remain at highest PCa risk relative to other racial/ethnic groups in Philadelphia. Younger black and Hispanic men are at particular risk for advanced PCa at diagnosis.
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Yildirim K, Olcucu MT, Colak ME. Trends in the treatment of urinary stone disease in Turkey. PeerJ 2018; 6:e5390. [PMID: 30083475 PMCID: PMC6074772 DOI: 10.7717/peerj.5390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/17/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction In this study, a survey was prepared for urologists that asked about their primary choice of treatment for urolithiasis in daily practice and their answers were evaluated. Methods The survey was prepared on the Google Docs website and it was sent to 1,016 urologists via email with 752 confirmed deliveries. In addition to the demographic questions about each participant's age, gender, and institution, the survey presented case scenarios focusing on their preferred treatment modalities for distal ureteric, proximal ureteric, and renal calculi. The participating urologists were divided into two groups according to the frequency that they treat urolithiasis patients. Results Of the 752 surveys delivered, 211 urologists (28.05%) responded and 204 answered all questions. According to the results, there were no significant differences between the treatment approaches and the other localizations, but there was a statistically significant difference for treatment approaches to lower pole stones between two groups. In response to the question of which stone treatment method was used less frequently, 124 (60.7%) participants answered that they used shock wave lithotripsy less in the last 10 years. Conclusion The present study has shown that while the management of renal and ureteric calculi by Turkish urologists is highly varied, the overall treatment patterns are in accordance with the European Association of Urology guidelines. However, similar to the global trend extracorporeal shock wave lithotripsy is less preferred by Turkish urologists.
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He MH, Chen L, Zheng T, Tu Y, He Q, Fu HL, Lin JC, Zhang W, Shu G, He L, Yuan ZX. Potential Applications of Nanotechnology in Urological Cancer. Front Pharmacol 2018; 9:745. [PMID: 30038573 PMCID: PMC6046453 DOI: 10.3389/fphar.2018.00745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 06/19/2018] [Indexed: 01/16/2023] Open
Abstract
Nowadays, the potential scope of nanotechnology in uro-oncology (cancers of the prostate, bladder, and kidney) is broad, ranging from drug delivery, prevention, and diagnosis to treatment. Novel drug delivery methods using magnetic nanoparticles, gold nanoparticles, and polymeric nanoparticles have been investigated in prostate cancer. Additionally, renal cancer treatment may be profoundly influenced by applications of nanotechnology principles. Various nanoparticle-based strategies for kidney cancer therapy have been proposed. Partly due to the dilution of drug concentrations by urine production, causing inadequate drug delivery to tumor cells in the treatment of bladder cancer, various multifunctional bladder-targeted nanoparticles have been developed to enhance therapeutic efficiency. In each of these cancer research fields, nanotechnology has shown several advantages over widely used traditional methods. Different types of nanoparticles improve the solubility of poorly soluble drugs, and multifunctional nanoparticles have good specificity toward prostate, renal, and bladder cancer. Moreover, nanotechnology can also combine with other novel technologies to further enhance effectivity. As our understanding of nanotechnologies grows, additional opportunities to improve the diagnosis and treatment of urological cancer are excepted to arise. In this review, we focus on nanotechnologies with potential applications in urological cancer therapy and highlight clinical areas that would benefit from nanoparticle therapy.
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Affiliation(s)
- Ming-Hui He
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Li Chen
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Ting Zheng
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Yu Tu
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Qian He
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Hua-Lin Fu
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Ju-Chun Lin
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Wei Zhang
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Gang Shu
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Lili He
- College of Pharmacy, Southwest Minzu University, Chengdu, China
| | - Zhi-Xiang Yuan
- Department of Pharmacy, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
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Müller PF, Schlager D, Hein S, Bach C, Miernik A, Schoeb DS. Robotic stone surgery - Current state and future prospects: A systematic review. Arab J Urol 2017; 16:357-364. [PMID: 30140470 PMCID: PMC6104666 DOI: 10.1016/j.aju.2017.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/19/2017] [Accepted: 09/27/2017] [Indexed: 12/23/2022] Open
Abstract
Objective To provide a comprehensive review of robot-assisted surgery in urolithiasis and to consider the future prospects of robotic approaches in stone surgery. Materials and methods We performed a systematic PubMed© literature search using predefined Medical Subject Headings search terms to identify PubMed-listed clinical research studies on robotic stone surgery. All authors screened the results for eligibility and two independent reviewers performed the data extraction. Results The most common approach in robotic stone surgery is a robot-assisted pyelolithotomy using the da Vinci™ system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Several studies show this technique to be comparable to classic laparoscopic and open surgical interventions. One study that focused on ureteric stones showed a similar result. In recent years, promising data on robotic intrarenal surgery have been reported (Roboflex Avicenna™; Elmed Medical Systems, Ankara, Turkey). Initial studies have shown its feasibility and high stone-free rates and prove that this novel endoscopic approach is safe for the patient and comfortable for the surgeon. Conclusions The benefits of robotic devices in stone surgery in existing endourological, laparoscopic, and open treatment strategies still need elucidation. Although recent data are promising, more prospective randomised controlled studies are necessary to clarify the impact of this technique on patient safety and stone-free rates.
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Affiliation(s)
- Philippe F Müller
- Department of Urology, Faculty of Medicine, University of Freiburg, Medical Centre, Freiburg, Germany
| | - Daniel Schlager
- Department of Urology, Faculty of Medicine, University of Freiburg, Medical Centre, Freiburg, Germany
| | - Simon Hein
- Department of Urology, Faculty of Medicine, University of Freiburg, Medical Centre, Freiburg, Germany
| | - Christian Bach
- Department of Urology, University Hospital Aachen, Aachen, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg, Medical Centre, Freiburg, Germany
| | - Dominik S Schoeb
- Department of Urology, Faculty of Medicine, University of Freiburg, Medical Centre, Freiburg, Germany
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Borofsky S, George AK, Gaur S, Bernardo M, Greer MD, Mertan FV, Taffel M, Moreno V, Merino MJ, Wood BJ, Pinto PA, Choyke PL, Turkbey B. What Are We Missing? False-Negative Cancers at Multiparametric MR Imaging of the Prostate. Radiology 2017; 286:186-195. [PMID: 29053402 DOI: 10.1148/radiol.2017152877] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To characterize clinically important prostate cancers missed at multiparametric (MP) magnetic resonance (MR) imaging. Materials and Methods The local institutional review board approved this HIPAA-compliant retrospective single-center study, which included 100 consecutive patients who had undergone MP MR imaging and subsequent radical prostatectomy. A genitourinary pathologist blinded to MP MR findings outlined prostate cancers on whole-mount pathology slices. Two readers correlated mapped lesions with reports of prospectively read MP MR images. Readers were blinded to histopathology results during prospective reading. At histopathologic examination, 80 clinically unimportant lesions (<5 mm; Gleason score, 3+3) were excluded. The same two readers, who were not blinded to histopathologic findings, retrospectively reviewed cancers missed at MP MR imaging and assigned a Prostate Imaging Reporting and Data System (PI-RADS) version 2 score to better understand false-negative lesion characteristics. Descriptive statistics were used to define patient characteristics, including age, prostate-specific antigen (PSA) level, PSA density, race, digital rectal examination results, and biopsy results before MR imaging. Student t test was used to determine any demographic differences between patients with false-negative MP MR imaging findings and those with correct prospective identification of all lesions. Results Of the 162 lesions, 136 (84%) were correctly identified with MP MR imaging. Size of eight lesions was underestimated. Among the 26 (16%) lesions missed at MP MR imaging, Gleason score was 3+4 in 17 (65%), 4+3 in one (4%), 4+4 in seven (27%), and 4+5 in one (4%). Retrospective PI-RADS version 2 scores were assigned (PI-RADS 1, n = 8; PI-RADS 2, n = 7; PI-RADS 3, n = 6; and PI-RADS 4, n = 5). On a per-patient basis, MP MR imaging depicted clinically important prostate cancer in 99 of 100 patients. At least one clinically important tumor was missed in 26 (26%) patients, and lesion size was underestimated in eight (8%). Conclusion Clinically important lesions can be missed or their size can be underestimated at MP MR imaging. Of missed lesions, 58% were not seen or were characterized as benign findings at second-look analysis. Recognition of the limitations of MP MR imaging is important, and new approaches to reduce this false-negative rate are needed. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Samuel Borofsky
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Arvin K George
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Sonia Gaur
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Marcelino Bernardo
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Matthew D Greer
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Francesca V Mertan
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Myles Taffel
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Vanesa Moreno
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Maria J Merino
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Bradford J Wood
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Peter A Pinto
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Peter L Choyke
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
| | - Baris Turkbey
- From the Molecular Imaging Program (S.B., S.G., M.B., M.D.G., F.V.M., P.L.C., B.T.), Urologic Oncology Branch (A.K.G.), and Laboratory of Pathology (V.M., M.J.M.), National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B85, Bethesda, MD 20892; Department of Radiology, George Washington University Hospital, Washington, DC (S.B., M.T., P.A.P.); and Center for Interventional Oncology, National Cancer Institute, and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (B.J.W.)
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Ceylan Y, Ucer O, Bozkurt O, Gunlusoy B, Mertoglu O, Zumrutbas AE, Yildiz G, Irer B, Muezzinoglu T, Demir O. The effect of SWL and URS on health-related quality of life in proximal ureteral stones. MINIM INVASIV THER 2017; 27:148-152. [DOI: 10.1080/13645706.2017.1350719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yasin Ceylan
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Oktay Ucer
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Ozan Bozkurt
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Oguz Mertoglu
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Ersin Zumrutbas
- Department of Urology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Guner Yildiz
- Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training, Research Hospital, İzmir, Turkey
| | - Bora Irer
- Department of Urology, Esrefpaşa Hospital, Izmir, Turkey
| | - Talha Muezzinoglu
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Omer Demir
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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23
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Aghamir SMK, Salavati A. Endovisually guided zero radiation ureteral access sheath placement during ureterorenoscopy. MINIM INVASIV THER 2017; 27:143-147. [DOI: 10.1080/13645706.2017.1335644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Seyed Mohammad Kazem Aghamir
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Urology, Yas Hosp, Tehran University of Medical Sciences, Tehran, Iran
| | - Alborz Salavati
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Urology, Yas Hosp, Tehran University of Medical Sciences, Tehran, Iran
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Ouellet S, Sabbagh R, Jeldres C. Transperitoneal laparoscopic nephrectomy: Assessing complication risk in cases of previous abdominal surgery. Can Urol Assoc J 2017; 11:131-135. [PMID: 28515813 DOI: 10.5489/cuaj.4107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We aimed to assess the effect of previous abdominal surgery on perioperative outcomes in patients undergoing transperitoneal laparoscopic partial (LPN) or radical (LRN) nephrectomy for renal masses. METHODS We retrospectively reviewed all cases of LPN and LRN for renal masses at our institution between 2008 and 2014. Patients were divided in two groups, those with and without prior abdominal surgery. Four perioperative outcomes were compared, namely, operative time (OT), estimated blood loss (EBL), length of stay (LOS), and 30-days complications rate. A subanalysis was performed to address the impact of previous open cholecystectomy on right LPN or LRN. RESULTS Of 293 patients identified, 146 (49.8%) had previous abdominal surgery. In univariate analysis, no differences in operative time (136 vs. 144 minutes; p=0.154), EBL (88 vs. 100 mL; p=0.211), or 30-day complication rate (24 vs. 14%; p=0.069) were recorded between the groups. Only LOS favoured patients without previous abdominal surgery (3 vs. 4 days; p=0.001). In multivariate analysis, prior abdominal surgery was not associated with an increased OT, EBL, LOS, or complication rate. The analysis of right nephrectomies showed increased OT (148 vs. 128 minutes; p=0.049) and complication rate (42 vs. 16%; p=0.004) for patients with past open cholecystectomy compared to those without. Multivariate analysis revealed that prior open cholecystectomy was associated with a longer LOS (ORmedian=2.7 [1.2-8.0]) and an increased risk of complications (ORmedian=4.5 [1.6-10.5]). CONCLUSIONS In this cohort, previous abdominal surgery was not associated with worse perioperative outcomes after transperitoneal LPN and LRN for renal masses. However, previous open cholecystectomy resulted in a higher risk of complication and a longer LOS in patients undergoing right laparoscopic nephrectomy.
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Affiliation(s)
- Simon Ouellet
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Robert Sabbagh
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Claudio Jeldres
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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Tuğcu V, Şener NC, Şahin S, Yavuzsan AH, Akbay FG, Apaydın S. Robotic kidney transplantation: The Bakırköy experience. Turk J Urol 2016; 42:295-298. [PMID: 27909625 DOI: 10.5152/tud.2016.12369] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Robotic kidney transplantation, first described by Hoznek and colleagues, and has been improved by investigators like Oberholzer and Menon. We realized the first robotic kidney transplant (RKT) in our clinic in December 2015. In this study, we aimed to present the first 15 cases we performed within 3 months. MATERİAL AND METHODS Starting from January 2016, we performed 15 RKTs in our hospital. Before surgery, the whole robotic procedure was thoroughly explained to the patients and their informed consents were taken. RESULTS We performed RKT in 7 male and 8 female patients. Mean patient age was 37.4±10.8 years. Mean body mass index of the patients was 22.6±3.35 kg/m2. Mean preoperative creatinine and hemoglobin levels were 6.14±2.12 mg/dL and 10.04±1.64 g/dL, respectively. Mean operative time was 300.3±104.2 minutes. Mean warm ischemia and re-warming times were 1.9±0.54 minutes and 73.3±30.7 minutes, respectively. We did not need any necessity to switch to open surgery, and any intraoperative complication did not develop in any patient. Lymphocele which is one of the most frequently encountered complications was not observed in our series. CONCLUSION We think that using a minimally invasive approach greater number of patients will be able to benefit from this treatment modality, and this important health issue may decrease significantly.
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Affiliation(s)
- Volkan Tuğcu
- Clinic of Urology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Nevzat Can Şener
- Clinic of Urology, Numune Teaching and Research Hospital, Adana, Turkey
| | - Selçuk Şahin
- Clinic of Urology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | | | - Fatih Gökhan Akbay
- Clinic of Nephrology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Süheyla Apaydın
- Clinic of Nephrology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Wang X, Hu M, Zhao Z, Li C, Zhao G, Xu Y, Xu D, Liu R. An Improved Surgical Technique for Pure Laparoscopic Left Hemihepatectomy: Ten Years Experience in a Tertiary Center. J Laparoendosc Adv Surg Tech A 2016; 26:862-869. [PMID: 27513376 PMCID: PMC5107719 DOI: 10.1089/lap.2016.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: This study details our experience with an improved surgical technique involving the hepatic pedicle during laparoscopic left hemihepatectomy (LLH). Methods: We describe an improved laparoscopic technique to extraparenchymally divide the left hepatic pedicle. A retrospective analysis of all of the patients who underwent laparoscopic liver procedures between 2002 and 2012 was conducted. The patients were divided into two groups, an early LLH group (ELLH group) and a recent LLH group (RLLH group), based on the surgical approach used for the left hepatic pedicle. Results: A total of 72 cases of LLH (26 ELLH and 46 RLLH) were identified. The RLLH group exhibited a shorter median operative time, median length of hospital stay, and lower median blood loss compared to the ELLH group (182, 162.5–223.7 versus 232.5, 200–357.5 minutes, P < .01; 5, 4.2–7 versus 7, 6–8.7 days, P < .05; 150, 100–257.5 versus 300, 200–337.5 mL, P < .05, respectively). No perioperative mortality was observed. Conclusions: This study confirms that our improved surgical technique for LLH is practical, safe, and effective. The main advantage of this method compared to other techniques is the possibility of attaining rapid and precise control of vascular inflow, thus facilitating LLH.
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Affiliation(s)
- Xuefei Wang
- 1 Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital , Beijing, China .,2 Emergency Department, Chinese PLA Navy General Hospital , Beijing, China
| | - Minggen Hu
- 1 Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital , Beijing, China
| | - Zhiming Zhao
- 1 Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital , Beijing, China
| | - Chenggang Li
- 1 Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital , Beijing, China
| | - Guodong Zhao
- 1 Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital , Beijing, China
| | - Yong Xu
- 1 Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital , Beijing, China
| | - Dabin Xu
- 1 Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital , Beijing, China
| | - Rong Liu
- 1 Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital , Beijing, China
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Roberts G, Opondo D, Nott L, Razvi H, de la Rosette J, Beiko D. Do urologists follow the golden rule? A global urolithiasis management study by the Clinical Research Office of the Endourological Society. Can Urol Assoc J 2016; 10:50-4. [PMID: 26977207 DOI: 10.5489/cuaj.3282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The primary objective of this study was to compare surgical management options for various urolithiasis scenarios that urologists would choose for themselves vs. the options they would recommend for their patients. The secondary objective was to identify the common recommended treatments for upper urinary tract stones of various sizes and locations. METHODS Two surveys were sent by the Clinical Research Office of the Endourological Society (CROES) to members of the Endourological Society. Standard demographic information was collected. The first survey asked the urologists to recommend treatment for urolithiasis in 10 different scenarios assuming that they were the patient with stone disease. The second survey, sent eight months later, asked urologists to recommend treatment for the same 10 scenarios for a theoretical patient. Only urologists who responded to the first and the second survey were included. Recommended treatment options were compared between the surveys. Agreement between the two scenarios was measured with Cohen's kappa. Surveys were conducted on the Internet using SurveyMonkey™. All statistical analyses were performed using R statistical program version 2.12.2. RESULTS The two surveys had response rates of 78% (160/205) and 84% (172/205), respectively with urologists from 38 countries. Median experience of respondents was seven years (range: 2-30). The majority of respondents, 117 (75%), were affiliated with academic hospitals. Recommended treatments for stone disease in different scenarios were not entirely consistent when the urologists considered themselves as the patients compared to the choice they might recommend for their patients. Cohen's kappa ranged from 0.292-0.534 for the different scenarios. Overall, shock wave lithotripsy (SWL) and ureteroscopy (URS) were the most commonly chosen treatment options, with medical expulsive therapy (MET) and laparoscopy being the least recommended by urologists for themselves, as well as for their patients. CONCLUSIONS Although urologists were not entirely consistent in their recommendations for stone treatment, they generally followed the "golden rule" and treated their patients as they would want to be treated. The most commonly recommended treatments for upper urinary tract stones were SWL and URS.
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Affiliation(s)
- Gregory Roberts
- Department of Urology, Queen's University Kingston, ON, Canada
| | - Dedan Opondo
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - Linda Nott
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Jean de la Rosette
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - Darren Beiko
- Department of Urology, Queen's University Kingston, ON, Canada
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A new forecasting kinematic algorithm of automatic navigation for a laparoscopic minimally invasive surgical robotic system. ROBOTICA 2016. [DOI: 10.1017/s0263574715001137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
SUMMARYThis paper presents a novel forecasting kinematic algorithm for autonomously navigating the 3D visual window of laparoscopic minimally invasive surgical robotic system (LMISRS). By the application of the proposed technique, a constant distribution area ratio of the micro devices can be guaranteed in the visual window; real-time concurrency motion of the visual window of the laparoscope and the mark points of the instruments is realized, i.e. the visual window can keep tracking the movement of the marks automatically, so that the user does not have to switch between the master-slave controlling targets. The implementation of the new technique is summarized as follows: the robotic kinematics and space analytic geometry are thoroughly analyzed and modeled, and a “following kinematic algorithm” is proposed for the visual window of the laparoscope, which tracks the mark points of the instrument arms; a “forecasting kinematic algorithm” is established by using a combination of the “following kinematic algorithm”, the basic visual parameters of 3D visual field, the Verhulst Grey Model and the filtered amendment method. The proposed technique is verified by a series of simulations by using two groups of marks' motion trails with different sampling times, indicating that the technique is accurate, feasible and robust.
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Tinay I, Gelpi-Hammerschmidt F, Leow JJ, Allard CB, Rodriguez D, Wang Y, Chung BI, Chang SL. Trends in utilisation, perioperative outcomes, and costs of nephroureterectomies in the management of upper tract urothelial carcinoma: a 10-year population-based analysis. BJU Int 2015; 117:954-60. [DOI: 10.1111/bju.13375] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ilker Tinay
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Marmara University School of Medicine; Istanbul Turkey
| | - Francisco Gelpi-Hammerschmidt
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Massachusetts General Hospital; Boston MA USA
| | - Jeffrey J. Leow
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Tan Tock Seng Hospital; Singapore
| | - Christopher B. Allard
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Massachusetts General Hospital; Boston MA USA
| | - Dayron Rodriguez
- Department of Urology; Massachusetts General Hospital; Boston MA USA
| | - Ye Wang
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Benjamin I. Chung
- Department of Urology; Stanford University Medical Center; Stanford CA USA
| | - Steven L. Chang
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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Gu X, Araki M, Wong C. Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP). MINIM INVASIV THER 2015; 24:364-71. [DOI: 10.3109/13645706.2015.1027711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sanchís-Bonet A, Arribas-Gómez I, Sánchez-Rodríguez C, Sánchez-Chapado M. Evolution of the patient characteristics of candidates for radical prostatectomy and the results obtained with the technique. Actas Urol Esp 2015; 39:78-84. [PMID: 24909335 DOI: 10.1016/j.acuro.2014.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the oncological profile and risk of biochemical recurrence of patients with prostate cancer who underwent radical prostatectomy based on the time period in which the patients were operated. To evaluate the differences in prostate-specific antigen (PSA) at diagnosis of patients with or without biochemical recurrence based on these time periods. MATERIAL AND METHODS Observation carried forward study of a cohort of 972 radical prostatectomies performed during 3 time periods (1994-2000, 2001-2006, 2007-2011). The importance of PSA at diagnosis on the time periods and on biochemical recurrence was assessed using a generalized linear model. The independent predictive behavior of biochemical recurrence was analyzed using Cox regression. RESULTS The median follow-up was 38 (16-76) months. PSA levels at diagnosis were higher in the period 1994-2000 (12.97ng/mL, P<.001). Seventy-two percent of the patients from the period 2007-2011 were diagnosed as clinical stage T1c (P<.001), compared with 55% from the period 1994-2000. The percentage of extracapsular extension in the specimen decreased from 27% to 18% from the period 1994-2000 to the period 2007-2011 (p<.001). The percentage of patients with biochemical recurrence went from 38% to 14% from the first to the third period (P>.001). The difference between PSA levels at diagnosis for the patients with or without biochemical recurrence was independent of the period (P=.84). The period during which surgery was performed was not an independent predictive factor for biochemical recurrence (P=.09). CONCLUSIONS Patients from the 2007-2011 period had less extracapsular disease in the radical prostatectomy. The period was not an independent predictive factor for biochemical recurrence.
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Affiliation(s)
- A Sanchís-Bonet
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - I Arribas-Gómez
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Fundación para la Investigación Biomédica del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - C Sánchez-Rodríguez
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M Sánchez-Chapado
- Servicio de Urología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Sugihara T, Yasunaga H, Yu C, Horiguchi H, Nishimatsu H, Fushimi K, Kattan MW, Homma Y. Perioperative Outcome Comparisons Between Open and Laparoscopic Nephroureterectomy Among a Population-Based Cohort from 2010 to 2012. J Endourol 2014; 29:770-6. [PMID: 25423298 DOI: 10.1089/end.2014.0428] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To compare the perioperative outcomes and costs between open and laparoscopic nephroureterectomy for malignant diseases on a contemporary population-based level. PATIENTS AND METHODS Based on the Japanese Diagnosis Procedure Combination database for 2010 to 2012, we compared six end points of in-hospital mortality, intraoperative and postoperative complications, transfusion, anesthesia time, postoperative length of stay, and costs between open and laparoscopic nephroureterectomy under one-to-one matching based on the propensity scores. Multivariate analyses included sex, age, Charlson comorbidity index, body mass index, oncologic stage, hospital volume, and hospital academic status. Missing values were filled in by five-copy multiple imputations. RESULTS Among 3595 open and 3349 laparoscopic nephroureterectomies, an average of 2902 matched pairs were generated by the imputation and matching process. The outcomes showing significantly favorable association with the laparoscopic approach over the open approach were in-hospital mortality (0.3% vs 0.7%; odds ratio [OR], 0.41 [95% confidence interval, CI, 0.17 to 0.99]), postoperative complications (9.4% vs 12.6%; OR, 0.73 [0.58 to 0.91]), transfusion (12.9% vs 20.6%; OR, 0.54 [0.46 to 0.64]), postoperative length of stay (median, 11 vs 12 days; Beta, -0.041 [-0.059 to -0.023]), and costs without the operating room (median, $6607 vs $7077; Beta, -0.030 [-0.048 to -0.013]), while significantly longer anesthesia time (median, 278 vs 245 min; Beta, 0.057 [0.041 to 0.074]) and higher total costs (median, $15691 vs $12846; Beta, 0.078 [0.068 to 0.088]) for laparoscopic than for open nephroureterectomies were noted. There was no difference in intraoperative complications (P=0.774). CONCLUSION Several favorable perioperative outcomes including low mortality were observed in laparoscopic nephroureterectomy compared with open nephroureterectomy.
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Affiliation(s)
- Toru Sugihara
- 1 Department of Quantitative Health Sciences, Cleveland Clinic Foundation , Cleveland, Ohio.,2 Department of Urology, The University of Tokyo , Tokyo, Japan
| | - Hideo Yasunaga
- 3 Department of Health Economics and Epidemiology Research, The University of Tokyo , Tokyo, Japan
| | - Changhong Yu
- 1 Department of Quantitative Health Sciences, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Hiromasa Horiguchi
- 4 Department of Clinical Data Management and Research, Clinical Research Center , National Hospital Organization Headquarters, Tokyo, Japan
| | | | - Kiyohide Fushimi
- 5 Department of Health Care Informatics, Tokyo Medical and Dental University , Tokyo, Japan
| | - Michael W Kattan
- 1 Department of Quantitative Health Sciences, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Yukio Homma
- 2 Department of Urology, The University of Tokyo , Tokyo, Japan
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Wang H, Zhang J, Zhang N, Li D, Zou H, Zhou Y, Liang S, Mao J, Li J. Bronchoscopic intervention as a main treatment for tracheobronchial adenoid cystic carcinoma. MINIM INVASIV THER 2014; 24:167-74. [DOI: 10.3109/13645706.2014.977298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis. J Shoulder Elbow Surg 2014; 23:1843-1851. [PMID: 25441567 DOI: 10.1016/j.jse.2014.08.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/28/2014] [Accepted: 08/13/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of adhesive capsulitis is a dilemma for orthopaedic rehabilitation specialists. In this study, we assessed whether extracorporeal shockwave therapy (ESWT) improves the functional outcome of primary shoulder adhesive capsulitis. METHODS In this prospective, randomized, controlled, single-blind clinical trial, we enrolled 40 patients with primary adhesive capsulitis to assess whether ESWT can improve the functional outcome of primary adhesive capsulitis better than oral steroid therapy. Patients were allocated to the oral steroid group or ESWT group with randomization. Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Oxford Shoulder Score. RESULTS Both groups showed significant improvement in the Oxford Shoulder Score evaluation throughout the study period. In the ESWT group, the total CSS and range of motion (ROM) parameter of the CSS in the ESWT group showed significant improvement from the fourth week that was better than that in the steroid group; the activities–of–daily living (ADL) parameter of the CSS achieved significance and was better than that in the steroid group at the sixth week. For the steroid group, pain was significantly reduced from baseline to the fourth week of the study; ADL and ROM improved at the fourth to 12th week. For the ESWT group, ADL and ROM improvements were significant from baseline to the sixth week. CONCLUSION Our results showed that ESWT can be an alternative treatment, at least in the short-term, for primary adhesive capsulitis of the shoulder. In addition, all of the side effects of ESWT were transient and tolerable.
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Gözen AS, Tokas T, Akin Y, Klein J, Rassweiler J. Impact of barbed suture in controlling the dorsal vein complex during laparoscopic radical prostatectomy. MINIM INVASIV THER 2014; 24:108-13. [PMID: 25347038 DOI: 10.3109/13645706.2014.960940] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare applications of unidirectional knotless barbed suture and traditional two single polyglactin sutures for dorsal vein complex (DVC) control during laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS This was a non-randomized, prospective matched-pair pilot study. Thirty-one LRP cases with barbed suture (V-Loc®) were match-paired with 31 LRP cases in which traditional two single polyglactin stitches according to patient's prostate volume and body mass index (BMI) were used. Time needed for DVC ligation, DVC control and operation time were recorded. Peri- and postoperative parameters were noted. Statistical analyses were performed. RESULTS Mean age was 65.4±6.3 years. Mean follow-up was 20.2±3.3 months. Mean BMI and prostate volume were similar in both groups. Mean preoperative clinical stage, Gleason score, and PSA were comparable between both groups. Mean DVC ligature time and mean DVC controlling time in group 1 were statistically shorter than in group 2 (p=0.04, p<0.001). Continence rates were significantly higher in group 1 than in group 2 in early follow-up (p=0.005).
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn , Germany
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Zdichavsky M, Schmidt A, Luithle T, Manncke S, Fuchs J. Three-dimensional laparoscopy and thoracoscopy in children and adults: A prospective clinical trial. MINIM INVASIV THER 2014; 24:154-60. [DOI: 10.3109/13645706.2014.968171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Collins JW, Hosseini A, Sooriakumaran P, Nyberg T, Sanchez-Salas R, Adding C, Schumacher MC, Wiklund NP. Tips and Tricks for Intracorporeal Robot-Assisted Urinary Diversion. Curr Urol Rep 2014; 15:457. [DOI: 10.1007/s11934-014-0457-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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38
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Mo CQ, Yu Z, Tan WL, Mao XP, Chen X, Liu JC, Qiu SP. Comparison between laparoscopic partial nephrectomy and laparoscopic ablation therapy: a meta-analysis. MINIM INVASIV THER 2014; 23:317-25. [PMID: 25180534 DOI: 10.3109/13645706.2014.925930] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To conduct a meta-analysis of the literature evaluating comparisons on the peri-operative and oncological outcomes between laparoscopic partial nephrectomy (LPN) and laparoscopic ablation therapy (LAT) in the treatment of small renal masses (SRMs). MATERIAL AND METHODS MEDLINE, EMBASE, Google Scholar, Cochrane Library, and CNKI were searched for clinical trials comparing LPN with LAT. Data of peri-operative and follow-up outcomes were extracted and compared. Publication bias was identified and sensitivity analysis was also performed. RESULTS Data from 11 studies including 928 patients (525 patients in the LPN group and 403 in the LAT group) were collected. Baseline characteristics were compared and differences were found in age, preoperative renal function and proportion of solitary kidney (p < 0.05 respectively). For peri-operative outcomes, the LPN group had greater estimated blood loss, longer operative duration and length of hospital stay, and more peri-operative complications (p < 0.05, respectively). The LAT group had a significantly higher local recurrence (p < 0.05). There was no significant difference in postoperative change of renal function (p = 0.21). CONCLUSION In comparison with LPN, LAT provides better peri-operative outcomes, but a higher local recurrence rate. LAT does not seem to provide an obvious advantage in protecting renal function. Further clinical trials with randomized design and long-term follow-up are needed.
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Affiliation(s)
- Cheng-Qiang Mo
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
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Pastuszak AW. Reply. Urology 2014; 84:456. [DOI: 10.1016/j.urology.2014.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Jay Shah
- College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912
| | - Arpita Vyas
- Assistant Professor, Department of Pediatrics, Adjunct Professor, Institute of International Health, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912
| | - Dinesh Vyas
- Assistant Professor, Department of Surgery, Advanced Robotic and GI Surgeon, Adjunct Professor, Institute of International Health, Director, MS Surgery Clerkship, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912,
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Kramer MW, Abdelkawi IF, Wolters M, Bach T, Gross AJ, Nagele U, Conort P, Merseburger AS, Kuczyk MA, Herrmann TRW. Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer. MINIM INVASIV THER 2014; 23:206-13. [DOI: 10.3109/13645706.2014.880065] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rassweiler J, Rassweiler MC, Frede T, Alken P. Extracorporeal shock wave lithotripsy: An opinion on its future. Indian J Urol 2014; 30:73-9. [PMID: 24497687 PMCID: PMC3897058 DOI: 10.4103/0970-1591.124211] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The development of miniaturized nephroscopes which allow one-stage stone clearance with minimal morbidity has brought the role of shock wave lithotripsy (SWL) in stone management into question. Design innovations in SWL machines over the last decade have attempted to address this problem. We reviewed the recent literature on SWL using a MEDLINE/PUBMED research. For commenting on the future of SWL, we took the subjective opinion of two senior urologists, one mid-level expert, and an upcoming junior fellow. There have been a number of recent changes in lithotripter design and techniques. This includes the use of multiple focus machines and improved coupling designs. Additional changes involve better localization real-time monitoring. The main goal of stone treatment today seems to be to get rid of the stone in one session rather than being treated multiple times non-invasively. Stone treatment in the future will be individualized by genetic screening of stone formers, using improved SWL devices for small stones only. However, there is still no consensus about the design of the ideal lithotripter. Innovative concepts such as emergency SWL for ureteric stones may be implemented in clinical routine.
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Affiliation(s)
| | | | - Thomas Frede
- Department of Urology, Helios Kliniken Müllheim, Germany
| | - Peter Alken
- Department of Urology, Medical School of Mannheim, University of Heidelberg, Germany
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Yu H, Jiang J, Xie L, Liu L, Shi Y, Cai P. Design and static calibration of a six-dimensional force/torque sensor for minimally invasive surgery. MINIM INVASIV THER 2013; 23:136-43. [DOI: 10.3109/13645706.2013.873469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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