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Chen G, O’Malley AJ. Bayesian Hierarchical Network Autocorrelation Models for Estimating Direct and Indirect Effects of Peer Hospitals on Outcomes of Hospitalized Patients. RESEARCH SQUARE 2024:rs.3.rs-4014583. [PMID: 38496605 PMCID: PMC10942573 DOI: 10.21203/rs.3.rs-4014583/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
When an hypothesized peer effect (also termed social influence or contagion) is believed to act between units (e.g., hospitals) above the level at which data is observed (e.g., patients), a network autocorrelation model may be embedded within a hierarchical data structure thereby formulating the peer effect as a dependency between latent variables. In such a situation, a patient's own hospital can be thought of as a mediator between the effects of peer hospitals and their outcome. However, as in mediation analyses, there may be interest in allowing the effects of peer units to directly impact patients of other units. To accommodate these possibilities, we develop two hierarchical network autocorrelation models that allow for direct and indirect peer effect pathways between hospitals when modeling individual outcomes of the patients cared for at the hospitals. A Bayesian approach is used for model estimation while a simulation study is used to assess the performance of the models and sensitivity of results to different prior distributions. We construct a United States New England region patient-sharing hospital network and apply our Bayesian hierarchical models to study the diffusion of robotic surgery and hospital peer effects in patient outcomes using a cohort of United States Medicare beneficiaries in 2016 and 2017. The comparative fit of models to the data is assessed using Deviance information criteria tailored to hierarchical models that include peer effects as latent variables.
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Affiliation(s)
- Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, US
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, US
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, 03756, NH, US
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Kim G, Lee J, Delgado R, Oh SR, Ihn YS. Pose Tracking of Supermicrosurgical Robot Towards Multi-User Teleoperation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082941 DOI: 10.1109/embc40787.2023.10339969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This paper presents pose tracking experiments using a supermicrosurgical robot designed to consider teleoperation with multiple surgeons. Currently, existing supermicrosurgical robots assist only the primary surgeon. However, both primary and assistant surgeons need a high-precision motion for critical tasks that can easily damage microtissue. To assist multiple surgeons in supermicrosurgery with a surgical robot, dynamic collision avoidance becomes a critical issue due to the operation in a narrow surgical site. As a milestone to overcome this issue, we first developed a pose tracking algorithm by analyzing the inverse kinematics based on null-space control and a weighting matrix. Moreover, we also developed a control framework based on fully open-source software to run the pose tracking algorithm. Finally, we validated the proposed pose tracking algorithm by performing line tracing and rubber ring transferring experiments.
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Abstract
In this paper, we focus on providing a narrative review of healthcare services in which artificial intelligence (AI) based services are used as part of the operations and analyze key elements to create successful AI-based services for healthcare. The benefits of AI in healthcare are measured by how AI is improving the healthcare outcomes, help caregivers in work, and reducing healthcare costs. AI market in healthcare sector have also a high market potential with 28% global compound annual growth rate. This paper will collect outcomes from multiple perspectives of healthcare sector including financial, health improvement, and care outcome as well as provide proposals and key factors for successful implementation of AI methods in healthcare. It is shown in this paper that AI implementation in healthcare can provide cost reduction and same time provide better health outcome for all.
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Melling N, Scognamiglio P, Teller S, Izbicki JR, Dreimann M, Perez D. First in Literature Intraneuronal Sacral Nerve Stimulation for Fecal Incontinence After Robotic-Assisted En-Bloc Sacrectomy with Transection of Nerve Roots. World Neurosurg 2020; 136:208-212. [DOI: 10.1016/j.wneu.2019.12.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 12/25/2022]
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Qi F, Wang S, Xu H, Gao Y, Cheng G, Hua L. A comparison of perioperative outcome between robot-assisted and laparoscopic radical prostatectomy: experience of a single institution. Int Braz J Urol 2019; 45:695-702. [PMID: 30901171 PMCID: PMC6837604 DOI: 10.1590/s1677-5538.ibju.2018.0367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/25/2018] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To compare perioperative and pathological results in different approaches of robotic or laparoscopic radical prostatectomy. MATERIALS AND METHODS We retrospectively reviewed 206 patients diagnosed with pros¬tate cancer (PC) from June 2016 to October 2017 in the First Affiliated Hospital of Nan¬jing Medical University. A total of 132 cases underwent robot-assisted laparoscopic radical prostatectomy (RLRP) including 54 patients on transperitoneal robot-assisted laparoscopic radical prostatectomy (Tp-RLRP) and 78 on extraperitoneal robot-assisted laparoscopic radical prostatectomy (Ep-RLRP). Meanwhile, 74 patients performed with extraperitoneal laparoscopic radical prostatectomy (Ep-LPR) were also included. Peri¬operative and pathological data were compared among these groups. RESULTS All operations were completed without conversion. There was no signifi¬cant difference in basic and pathological characteristics of patients between each two groups. In Tp-RLRP vs. Ep-RLRP: Significant differences were found in the comparison in to¬tal operation time [235.98 ± 59.16 vs. 180.45 ± 50.27 min, P = 0.00], estimated blood loss (EBL) [399.07 ± 519.57 vs. 254.49 ± 308.05 mL, P = 0.0473], postoperative pelvic drainage time [5.37 ± 2.33 vs. 4.24 ± 3.08 d, P = 0.0237] and postoperative length of stay [8.15 ± 3.30 vs. 6.49 ± 3.49 d, P = 0.0068] while no significant differences were detected in other variables. In Ep-RLRP vs. Ep-LPR: Longer total operation time was observed in Ep-RLRP when compared to Ep-LPR [180.45 ± 50.27 vs. 143.80 ± 33.13 min, P = 0.000]. No significant differences were observed in other variables. CONCLUSION In RLRP, Ep-RLRP was proved a safe and effective approach based on the perioperative results compared to Tp-RLRP. Ep-RLRP and Ep-LPR provides equivalent perioperative and pathological outcomes.
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Affiliation(s)
- Feng Qi
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shangqian Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haoxiang Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yiren Gao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gong Cheng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lixin Hua
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Blackwell RH, Kothari AN, Shah A, Gange W, Quek ML, Luchette FA, Flanigan RC, Kuo PC, Gupta GN. Adhesive Bowel Obstruction Following Urologic Surgery: Improved Outcomes with Early Intervention. Curr Urol 2018; 11:175-181. [PMID: 29997459 DOI: 10.1159/000447215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/25/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To describe the long-term incidence of adhesive bowel obstruction following major urologic surgery, and the effect of early surgery on perioperative outcomes. Methods The Healthcare Cost and Utilization Project State Inpatient Databases for California and Florida (2006-2011) were used to identify major urologic oncologic surgery patients. Subsequent adhesive bowel obstruction admissions were identified and Kaplan-Meier time-to-event analysis was performed. Early surgery for bowel obstruction was defined as occurring on-or-before hospital-day four. The effects of early surgery on postoperative minor/moderate complications (wound infection, urinary tract infection, deep vein thrombosis, and pneumonia), major complications (myocardial infarction, pulmonary embolism, and sepsis), death, and postoperative length-of-stay were assessed. Results Major urologic surgery was performed on 104,400 patients, with subsequent 5-year cumulative incidence of adhesive bowel obstruction admission of 12.4% following radical cystectomy, 3.3% following kidney surgery, and 0.9% following prostatectomy. During adhesive bowel obstruction admission, 71.6% of patients were managed conservatively and 28.4% surgically. Early surgery was performed in 65.4%, with decreased rates of minor/moderate complications (18 vs. 30%, p = 0.001), major complications (10 vs. 19%, p = 0.002), and median postoperative length of stay (8 vs. 11 days, p < 0.001) compared with delayed surgery. On multivariate analysis early surgery decreased the odds of minor/ moderate complications by 43% (p = 0.01), major complications by 45% (p = 0.03), and postoperative length of stay by 3.1 days (p = 0.01). Conclusion Adhesive bowel obstruction is a significant long-term sequela of urologic surgery, for which early surgical management may be associated with improved perioperative outcomes.
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Affiliation(s)
- Robert H Blackwell
- Department of Urology, Loyola University Medical Center, Maywood, IL.,the One: MAP Division of Clinical Analytics, Loyola University Medical Center, Maywood, IL, USA
| | - Anai N Kothari
- Department of Surgery, Loyola University Medical Center, Maywood, IL.,the One: MAP Division of Clinical Analytics, Loyola University Medical Center, Maywood, IL, USA
| | - Arpeet Shah
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - William Gange
- the One: MAP Division of Clinical Analytics, Loyola University Medical Center, Maywood, IL, USA
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Fred A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL.,Department of Surgical Services, Edward Hines Jr Veterans Administration Medical Center, Hines
| | - Robert C Flanigan
- Department of Urology, Loyola University Medical Center, Maywood, IL.,the One: MAP Division of Clinical Analytics, Loyola University Medical Center, Maywood, IL, USA
| | - Paul C Kuo
- Department of Surgery, Loyola University Medical Center, Maywood, IL.,the One: MAP Division of Clinical Analytics, Loyola University Medical Center, Maywood, IL, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL.,Department of Surgery, Loyola University Medical Center, Maywood, IL.,the One: MAP Division of Clinical Analytics, Loyola University Medical Center, Maywood, IL, USA
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Russell JO, Noureldine SI, Al Khadem MG, Tufano RP. Minimally invasive and remote-access thyroid surgery in the era of the 2015 American Thyroid Association guidelines. Laryngoscope Investig Otolaryngol 2016; 1:175-179. [PMID: 28894814 PMCID: PMC5510273 DOI: 10.1002/lio2.36] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 12/11/2022] Open
Abstract
Thyroid surgery has evolved throughout the years from being one of the most dangerous surgeries to becoming one of the safest surgical procedures performed today. Recent technologic innovations have allowed surgeons to remove the thyroid gland from a remote site while avoiding visible neck scars. There are many endoscopic approaches for thyroidectomy. The most common cervical approach is the minimally invasive video‐assisted technique developed by Miccoli et al. The robotic transaxillary and axillary breast approaches avoid a neck scar and have been demonstrated to be safe and effective in international populations. Novel approaches under investigation include face‐lift robotic thyroidectomy and the transoral approach. This article aims to provide the reader with an overview of the current minimally invasive and alternate‐site approaches used and their capability to assist the surgeons in accomplishing remote‐access thyroid surgery under the scope of the 2015 American Thyroid Association Guidelines.
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Affiliation(s)
- Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Salem I Noureldine
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Mai G Al Khadem
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland U.S.A
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Patel R, Modi PK, Elsamra SE, Kim IY. Long-Term Outcomes of Using Hyaluronic Acid-Carboxymethylcellulose Adhesion Barrier Film on the Neurovascular Bundle. J Endourol 2016; 30:709-13. [PMID: 27072291 DOI: 10.1089/end.2016.0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION/OBJECTIVE We hypothesize that the use of hyaluronic acid-carboxymethylcellulose (HACM) adhesion barrier at the neurovascular bundle may hasten the return of erectile function after robot-assisted laparoscopic prostatectomy. MATERIALS AND METHODS A retrospective review identified 462 consecutive patients who underwent a nerve-sparing prostatectomy between 2009 and 2012. The first 246 patients were administered the barrier film, while the next 216 patients, the control group, did not receive HACM. Postoperative erectile function and oncologic outcomes were compared. Independent t-test and Kaplan-Meier analysis were conducted, p < 0.05 was considered significant. RESULTS The two groups were well matched, without significant differences in age, weight, operative time, prostate size, preoperative prostate-specific antigen, sexual health inventory for men (SHIM), or AUA symptom scores. The mean SHIM was significantly higher for the experimental group at 6 months (6.39 vs 4.75, p = 0.008), 9 months (7.32 vs 5.44, p = 0.006), 1 year (8.52 vs 6.90, p = 0.049), and 18 months (10.01 vs 7.60, p = 0.018). This effect was not noted beyond 18 months. A subgroup analysis of patients with initial SHIM scores 22 or greater demonstrated a higher rate of return to the preoperative SHIM score for the barrier film group, 23% vs 12% (p = 0.046). There was no significant difference in biochemical recurrence between groups, with a median follow-up duration of 18 months. CONCLUSIONS HACM application at the neurovascular bundle during prostatectomy may decrease the time to return of erectile function, with improved SHIM at 6 to 18 months after surgery. This effect is more pronounced in patients with better baseline erectile function. There is no significant effect on biochemical recurrence.
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Affiliation(s)
- Rutveej Patel
- Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, Rutgers Cancer Institute of New Jersey , Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Parth K Modi
- Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, Rutgers Cancer Institute of New Jersey , Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Sammy E Elsamra
- Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, Rutgers Cancer Institute of New Jersey , Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Isaac Yi Kim
- Section of Urologic Oncology and Dean and Betty Gallo Prostate Cancer Center, Rutgers Cancer Institute of New Jersey , Rutgers, The State University of New Jersey, New Brunswick, New Jersey
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Udwadia TE. Robotic surgery is ready for prime time in India: Against the motion. J Minim Access Surg 2015; 11:5-9. [PMID: 25598592 PMCID: PMC4290119 DOI: 10.4103/0972-9941.147655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 09/26/2014] [Indexed: 11/15/2022] Open
Abstract
The use of Robotic Surgery as a purported adjunct and aid to Minimal Access Surgery (MAS) is growing in several areas. The acknowledged advantages as also the obvious and hidden disadvantages of Robotic Surgery are highlighted. Survey of literature shows that while Robotic Surgery is “feasible” and the results are “comparable” there is no convincing evidence that it is any better than MAS or even open surgery in most areas. To move “Robotic Surgery is ready for prime time in India” with no less than two dozen robots, many sub-optimally utilized for a population of 1.2 billion seems untenable.
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Affiliation(s)
- Tehemton E Udwadia
- Department of Minimal Access Surgery, Hinduja Hospital, Veer Savarkar Road, Mumbai, Maharashtra, India
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Whelan P, Ekbal S, Nehra A. Erectile dysfunction in robotic radical prostatectomy: Outcomes and management. Indian J Urol 2014; 30:434-42. [PMID: 25378827 PMCID: PMC4220385 DOI: 10.4103/0970-1591.142078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Robot-assisted laparoscopic prostatectomy (RALP) has emerged as the most common treatment for localized prostate cancer. With improved surgical precision, RALP has produced hope of improved potency rates, especially with the advent of nerve-sparing and other modified techniques. However, erectile dysfunction (ED) remains a significant problem for many men regardless of surgical technique. To identify the functional outcomes of robotic versus open and laparoscopic techniques, new robotic surgical techniques and current treatment options of ED following RALP. A Medline search was performed in March 2014 to identify studies comparing RALP with open retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy, modified RALP techniques and treatment options and management for ED following radical prostatectomy. RALP demonstrates adequate potency rates without compromising oncologic benefit, with observed benefit for potency rates compared with RRP. Additionally, specific surgical technical modifications appear to provide benefit over traditional RALP. Phosphodiesterase-5 inhibitors (PDE5I) demonstrate benefit for ED treatment compared with placebo. However, long-term benefit is often lost after use. Other therapies have been less extensively studied. Additionally, correct patient identification is important for greatest clinical benefit. RALP appears to provide beneficial potency rates compared with RRP; however, these effects are most pronounced at high-volume centers with experienced surgeons. No optimal rehabilitation program with PDE5Is has been identified based on current data. Additionally, vacuum erection devices, intracavernosal injections and other techniques have not been well validated for post RALP ED treatment.
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Affiliation(s)
- Patrick Whelan
- Department of Urology, Rush University, Rush Medical College, Chicago, IL, USA
| | - Shahid Ekbal
- Department of Urology, Rush University, Rush Medical College, Chicago, IL, USA
| | - Ajay Nehra
- Department of Urology, Rush University, Rush Medical College, Chicago, IL, USA
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Young MT, Menon G, Feldmann TF, Mills S, Carmichael J, Stamos MJ, Pigazzi A. Laparoscopic versus Robotic-assisted Rectal Surgery: A Comparison of Postoperative Outcomes. Am Surg 2014. [DOI: 10.1177/000313481408001032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rectal surgery continues to be an area of advancement for minimally invasive techniques. However, there is controversy regarding whether a robotic approach imparts any advantages over established laparoscopic procedures. The aim of this study was to analyze and compare outcomes of laparoscopic and robotic rectal resection operations. A single-institution retrospective review was performed identifying 83 consecutive patients undergoing low rectal resection requiring proximal diversion between 2009 and 2013. The cohort was comprised of 38 laparoscopic and 45 robotic cases. Data were analyzed for postoperative outcomes as well as 30-day morbidity and mortality. Male gender frequency, body mass index, and American Society of Anesthesiologists class were higher in the robotic group (71%, 28.6 kg/m2, and 2.6, respectively) compared with the laparoscopic group (42%, 23.7 kg/m2, and 2.2, respectively; P < 0.01). Length of stay was significantly longer for patients undergoing laparoscopic (7.5 days) compared with robotic procedures (5.7 days, P < 0.01). This difference was even greater when comparing patients who underwent a hybrid laparoscopic-assisted open total mesorectal excision (TME) with robotic TME (8.2 vs 5.7 days, respectively, P < 0.01). Conversion rate was 7.9 per cent for the laparoscopic group and zero per cent for the robotic ( P = 0.09). There were no mortalities in either group. A pure laparoscopic or robotic rectal surgery may be associated with a shorter hospital stay compared with a laparoscopic-assisted approach.
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Affiliation(s)
- Monica T. Young
- Department of Surgery University of California Irvine School of Medicine, Orange, California
| | - Gopal Menon
- Department of Surgery University of California Irvine School of Medicine, Orange, California
| | - Timothy F. Feldmann
- Department of Surgery University of California Irvine School of Medicine, Orange, California
| | - Steven Mills
- Department of Surgery University of California Irvine School of Medicine, Orange, California
| | - Joseph Carmichael
- Department of Surgery University of California Irvine School of Medicine, Orange, California
| | - Michael J. Stamos
- Department of Surgery University of California Irvine School of Medicine, Orange, California
| | - Alessio Pigazzi
- Department of Surgery University of California Irvine School of Medicine, Orange, California
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Onozawa M, Hinotsu S, Tsukamoto T, Oya M, Ogawa O, Kitamura T, Suzuki K, Naito S, Namiki M, Nishimura K, Hirao Y, Akaza H. Recent Trends in the Initial Therapy for Newly Diagnosed Prostate Cancer in Japan. Jpn J Clin Oncol 2014; 44:969-81. [DOI: 10.1093/jjco/hyu104] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Huri E. Novel anatomical identification of nerve-sparing radical prostatectomy: fascial-sparing radical prostatectomy. Prostate Int 2014; 2:1-7. [PMID: 24693527 PMCID: PMC3970983 DOI: 10.12954/pi.13038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/07/2014] [Indexed: 11/15/2022] Open
Abstract
Radical prostatectomy (RP) became a first choice of treatment for prostate cancer after the advance in nerve-sparing techniques. However, the difficult technical details still involved in nerve-sparing RP (nsRP) can invite unwanted complications. Therefore, learning to recognize key anatomical features of the prostate and its surrounding structures is crucial to further improve RP efficacy. Although the anatomical relation between the pelvic nerves and pelvic fascias is still under investigation, this paper characterizes the periprostatic fascias in order to define a novel fascial-sparing approach to RP (fsRP), which will help spare neurovascular bundles. In uroanatomic perspective, it can be stated that nsRP is a functional identification of the surgical technique while fsRP is an anatomic identification as well. The functional and oncological outcomes related to this novel fsRP are also reviewed.
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Affiliation(s)
- Emre Huri
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
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Gilbert H, Hendrick R, Remirez A, Webster R. A robot for transnasal surgery featuring needle-sized tentacle-like arms. Expert Rev Med Devices 2013; 11:5-7. [PMID: 24308740 DOI: 10.1586/17434440.2013.854702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper discusses a new class of robots known as concentric tube robots and their application to transnasal skull base surgery. The endonasal approach has clear benefits for patients, but the surgery presents challenges that strongly motivate the use of robotic tools. In this paper, the concentric tube robot concept is described, and preliminary experimental results for transnasal skull base surgery are reviewed. Just as the da Vinci robot has revolutionized many laparoscopic surgeries, we expect concentric tube robots will enable the advancement of skull base surgery and the development of other minimally invasive procedures that require access through constrained paths.
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Affiliation(s)
- Hunter Gilbert
- Vanderbilt University - Mechanical Engineering, 2301 Vanderbilt Place PMB 351592, Nashville, TN 37235, USA
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Liu JJ, Maxwell BG, Panousis P, Chung BI. Perioperative Outcomes for Laparoscopic and Robotic Compared With Open Prostatectomy Using the National Surgical Quality Improvement Program (NSQIP) Database. Urology 2013; 82:579-83. [DOI: 10.1016/j.urology.2013.03.080] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/20/2013] [Accepted: 03/12/2013] [Indexed: 12/21/2022]
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Robotic Surgery in Otolaryngology: Endocrine. CURRENT OTORHINOLARYNGOLOGY REPORTS 2013. [DOI: 10.1007/s40136-013-0024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schroeck FR, Kaufman SR, Jacobs BL, Skolarus TA, Miller DC, Weizer AZ, Montgomery JS, Wei JT, Shahinian VB, Hollenbeck BK. Technology diffusion and diagnostic testing for prostate cancer. J Urol 2013; 190:1715-20. [PMID: 23669564 DOI: 10.1016/j.juro.2013.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE While the dissemination of robotic prostatectomy and intensity modulated radiotherapy may fuel the increased use of prostatectomy and radiotherapy, these new technologies may also have spillover effects related to diagnostic testing for prostate cancer. Therefore, we examined the association of regional technology penetration with the receipt of prostate specific antigen testing and prostate biopsy. MATERIALS AND METHODS In this retrospective cohort study we included 117,857 men 66 years old or older from the 5% sample of Medicare beneficiaries living in Surveillance, Epidemiology and End Results (SEER) areas from 2003 to 2007. Regional technology penetration was measured as the number of providers performing robotic prostatectomy or intensity modulated radiotherapy per population in a health care market, ie hospital referral region. We assessed the association of technology penetration with the prostate specific antigen testing rate and prostate biopsy using generalized estimating equations. RESULTS High technology penetration was associated with an increased rate of prostate specific antigen testing (442 vs 425/1,000 person-years, p<0.01) and a similar rate of prostate biopsy (10.1 vs 9.9/1,000 person-years, p=0.69). The impact of technology penetration on prostate specific antigen testing and prostate biopsy was much less than the effect of age, race and comorbidity, eg the prostate specific antigen testing rate per 1,000 person-years was 485 vs 373 for men with only 1 vs 3+ comorbid conditions (p<0.01). CONCLUSIONS Increased technology penetration is associated with a slightly higher rate of prostate specific antigen testing and no change in the prostate biopsy rate. Collectively, our findings temper concerns that adopting new technology accelerates diagnostic testing for prostate cancer.
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Affiliation(s)
- Florian R Schroeck
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan
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Tan N, Margolis DJA, McClure TD, Thomas A, Finley DS, Reiter RE, Huang J, Raman SS. Radical prostatectomy: value of prostate MRI in surgical planning. ACTA ACUST UNITED AC 2013; 37:664-74. [PMID: 21993567 DOI: 10.1007/s00261-011-9805-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The introduction of serum prostate-specific antigen to the prostate cancer screening algorithm has led to an increase in prostate cancer diagnosis as well as a migration toward lower-stage cancer at the time of diagnosis. This stage migration has coincided with changes in treatment options; these include active surveillance, new therapies, and advances in surgical techniques. Use of robot-assisted radical prostatectomy (RARP) as a surgical technique has seen a significant increase over the past several years: the number of patients undergoing RARP has risen from 1% to 40% of all prostatectomies from 2001-2006 to as many as 80% in 2010. The robotic interface provides a 3D magnified view of the surgical field, intuitive instrument manipulation, motion scaling, tremor filtration, and excellent dexterity and range of motion. However, in some cases, the lack of tactile (haptic) feedback may limit the surgeon's decision making ability in assessing malignant involvement of the neurovascular bundles. Pre-operative planning relies on nomograms based on limited clinical and prostate biopsy information. The surgical decision to spare or resect the neurovascular bundles is based on clinical information which is not spatially or anatomically based. Advances in magnetic resonance imaging (MRI) may provide spatially localized information to fill this void and aid surgical planning, particularly for robotic surgeons. In this review, we discuss the potential role of pre-operative MRI in surgical planning for radical prostatectomy.
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Affiliation(s)
- Nelly Tan
- Department of Radiology, University of California, Los Angeles, 90095, USA.
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Lim SK, Kim KH, Shin TY, Rha KH. Current status of robot-assisted laparoscopic radical prostatectomy: How does it compare with other surgical approaches? Int J Urol 2012; 20:271-84. [DOI: 10.1111/j.1442-2042.2012.03193.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Sey Kiat Lim
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; South Korea
| | - Kwang Hyun Kim
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; South Korea
| | - Tae-Young Shin
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; South Korea
| | - Koon Ho Rha
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul; South Korea
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Anesthetic considerations for robotic prostatectomy: a review of the literature. J Clin Anesth 2012; 24:494-504. [DOI: 10.1016/j.jclinane.2012.03.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 03/20/2012] [Accepted: 03/30/2012] [Indexed: 12/22/2022]
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Simorov A, Otte RS, Kopietz CM, Oleynikov D. Review of surgical robotics user interface: what is the best way to control robotic surgery? Surg Endosc 2012; 26:2117-25. [PMID: 22350236 DOI: 10.1007/s00464-012-2182-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 01/11/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND As surgical robots begin to occupy a larger place in operating rooms around the world, continued innovation is necessary to improve our outcomes. METHODS A comprehensive review of current surgical robotic user interfaces was performed to describe the modern surgical platforms, identify the benefits, and address the issues of feedback and limitations of visualization. RESULTS Most robots currently used in surgery employ a master/slave relationship, with the surgeon seated at a work-console, manipulating the master system and visualizing the operation on a video screen. Although enormous strides have been made to advance current technology to the point of clinical use, limitations still exist. A lack of haptic feedback to the surgeon and the inability of the surgeon to be stationed at the operating table are the most notable examples. The future of robotic surgery sees a marked increase in the visualization technologies used in the operating room, as well as in the robots' abilities to convey haptic feedback to the surgeon. This will allow unparalleled sensation for the surgeon and almost eliminate inadvertent tissue contact and injury. CONCLUSIONS A novel design for a user interface will allow the surgeon to have access to the patient bedside, remaining sterile throughout the procedure, employ a head-mounted three-dimensional visualization system, and allow the most intuitive master manipulation of the slave robot to date.
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Affiliation(s)
- Anton Simorov
- University of Nebraska Medical Center, Center for Advanced Surgical Technology, 985126 Nebraska Medical Center, Omaha, NE 68198-5126, USA
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Finkelstein J, Eckersberger E, Sadri H, Taneja SS, Lepor H, Djavan B. Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience. Rev Urol 2011. [PMID: 20428292 DOI: 10.3909/riu0470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Open radical prostatectomy (ORP) is the reference standard for the surgical management of localized prostate cancer. With wider availability of minimally invasive radical prostatectomy techniques, there is a debate regarding the standard treatment of the management of localized prostate cancer. Therefore, we reviewed the current status of laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALRP) as compared with ORP. Because no prospective, randomized trials comparing the different techniques have been performed, outcomes must be assessed from published series by centers that focus on ORP, LRP, and RALRP. Aside from reducing the amount of blood loss, current data suggest that the most significant outcomes (cure, continence, and potency) are no better with LRP or RALRP than with conventional ORP. Therefore, in experienced hands, ORP remains the gold standard procedure. However, there is a trend toward consistently better outcomes following RALRP in comparison with LRP. In the end, individual patient outcomes can be maximized by choosing the best modality based on the patient's comorbid medical conditions, cancer characteristics, and surgeon experience. Future studies are needed to further investigate long-term cancer control as well as functional outcomes for RALRP series.
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Affiliation(s)
- Julia Finkelstein
- Department of Urology, New York University School of Medicine New York, NY
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Singh I, Hemal AK. Robotic-assisted radical prostatectomy in 2010. Expert Rev Anticancer Ther 2011; 10:671-82. [PMID: 20470000 DOI: 10.1586/era.10.35] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article reviews the current status of robotic-assisted radical prostatectomy (RARP) with outcome analysis. The published English literature (PubMed) database was searched extensively for major publications and large series on RARP. The search was carried out over the preceding 3-year period. Selected series were then reviewed, summarized and analyzed for their salient features. A literature search yielded 19 major publications on RARP in the preceding 2 years. A review of the current RARP literature (2006-2009) of multi-institutional cases of RARP demonstrated a mean operating room time, blood loss, hospital stay, positive surgical margin rate and perioperative-complication rate of approximately 194 min, 196 ml, 1.43 days, 25.7% and 5.83 %, respectively (based on the analysis of data using central tendency measures [mean]). The overall potency and continence rates were 73.6 and 87.1%, respectively (based on analysis of the published and reported data). All RARP cases were performed with the use of da Vinci robotic system (Intuitive Surgical, CA, USA). It is expected that in 2010 close to 70% of radical prostatectomies in the USA will be performed with robotic assistance. The patient and surgeon appeal for RARP continues to expand exponentially. It seems pertinent to conclude that increasing experience with RARP may reduce the incidence of positive surgical margins and will improve the functional outcome, which is the challenge at this point in time. Although the early cancer control and intermediate follow-up on functional outcome with RARP appears to be convincing and favorable, the long-term ( approximately 10 years) data are still awaited.
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Affiliation(s)
- Iqbal Singh
- Department of Urology & Institute of Regenerative Medicine, Director, Robotics & Minimally Invasive Surgery, Wake Forest University Medical Sciences & Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC-27157, USA
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Chauhan S, Coelho RF, Rocco B, Palmer KJ, Orvieto MA, Patel VR. Techniques of nerve-sparing and potency outcomes following robot-assisted laparoscopic prostatectomy. Int Braz J Urol 2010; 36:259-72. [DOI: 10.1590/s1677-55382010000300002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2010] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Rafael F. Coelho
- University of Central Florida School of Medicine, USA; University of Sao Paulo, Brazil; European Institute of Oncology, Italy
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Abstract
PURPOSE OF REVIEW To review the recent urologic literature with a focus on refinements of surgical technique in robot-assisted laparoscopic prostatectomy (RALP) and to discuss the impact of these developments on the 'trifecta' of prostate cancer management: oncologic, continence, and potency outcomes. RECENT FINDINGS Refinements in the surgical technique during the established steps of radical prostatectomy have led to improved functional outcomes following RALP. Early continence rates have increased, and potency, with evolving respect for the neurovascular bundle and neural anatomy, has further promise. 'Long-term' outcomes demonstrate favorable results in continence and potency. Oncologic outcomes, specifically low positive margin rates, have been maintained and even improved in many series during the evolution of this widely accepted procedure. SUMMARY RALP has continued to rapidly disseminate through the urologic community, but the ultimate impact remains under scrutiny. The procedure has seen birth from open and laparoscopic prostatectomy, and its success has been measured against contemporary open prostatectomy series during its infancy. Short and long-term oncologic outcomes must be followed carefully. The assessment of functional outcomes of continence and potency requires honest and, as best possible, objective analysis. Prospective, randomized clinical trials with long-term follow-up utilizing validated instruments are necessary to evaluate RALP and all associated technical modifications.
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