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Banerjee I, Banerjee I, Banerjee S. Is Robotics the real game changer for Urological cancer care during COVID-19 crisis? Nepal J Epidemiol 2021; 11:988-993. [PMID: 34290889 PMCID: PMC8266403 DOI: 10.3126/nje.v11i2.38133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Indraneel Banerjee
- Consultant Uro oncologist and Robotic Surgeon, Apollo multi speciality Hospitals, Kolkata, West Bengal, India
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Bansal D, Chaturvedi S, Maheshwari R, Kumar A. Role of laparoscopy in the era of robotic surgery in urology in developing countries. Indian J Urol 2021; 37:32-41. [PMID: 33850353 PMCID: PMC8033240 DOI: 10.4103/iju.iju_252_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/04/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023] Open
Abstract
With the rapid expansion of robotic platforms in urology, there is an urgent and unmet need to review its cost and benefits in comparison to the traditional laparoscopy, especially in reference to a developing country. A nonsystematic review of the literature was conducted to compare the outcomes of pure laparoscopic and robot-assisted urologic procedures. Available literature over the past 30 years was reviewed. Robot-assisted surgery and laparoscopy were found to have similar outcomes in the areas of radical prostatectomy, partial and radical nephrectomy, radical cystectomy, retroperitoneal lymph node (LN) dissection, inguinal LN dissection, donor nephrectomy, and kidney transplantation. Robot-assisted surgery was found to be significantly costlier than pure laparoscopy. In the absence of a clear advantage of robot-assisted surgery over pure laparoscopy, lack of widespread availability and the currently prohibitive cost of robotic technology, laparoscopic urological surgery has a definite role in the developing world.
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Affiliation(s)
- Devanshu Bansal
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Samit Chaturvedi
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Ruchir Maheshwari
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
| | - Anant Kumar
- Department of Urology, Renal Transplantation, Robotics and Uro-Oncology, Max Hospital, New Delhi, India
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AI applications in robotics, diagnostic image analysis and precision medicine: Current limitations, future trends, guidelines on CAD systems for medicine. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100596] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Bora GS, Narain TA, Sharma AP, Mavuduru RS, Devana SK, Singh SK, Mandal AK. Robot-assisted surgery in India: A SWOT analysis. Indian J Urol 2020; 36:1-3. [PMID: 31983817 PMCID: PMC6961426 DOI: 10.4103/iju.iju_220_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
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Su CS, Shen CH, Chang KH, Lai CH, Liu TJ, Chen KJ, Lin TH, Chen YW, Lee WL. Clinical outcomes of patients with multivessel coronary artery disease treated with robot-assisted coronary artery bypass graft surgery versus one-stage percutaneous coronary intervention using drug-eluting stents. Medicine (Baltimore) 2019; 98:e17202. [PMID: 31567970 PMCID: PMC6756629 DOI: 10.1097/md.0000000000017202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A number of studies have reported on treatment outcomes of coronary stenting (PCI) for multivessel coronary artery diseases (MVD), and compared them with the conventional coronary artery bypass grafting (CABG). However, the clinical outcomes of robot-assisted CABG (R-CABG) in comparison with PCI in MVD patients have not been investigated.We recruited retrospectively MVD patients receiving R-CABG and PCI with drug-eluting stents for all vessels in one stage between January 2005 and December 2013 at our institution with at least 3 years of outcomes were retrospectively recruited and analyzed.A total of 638 MVD patients were studied. Among them, 281 received R-CABG, and 357 received PCI. Similar complete revascularizations were achieved in both groups (R-CABG: 40.2%, PCI: 41.5%, P = .751). The residual stenosis was 4.1 ± 4.4 in the R-CABG group, and comparably 3.5 ± 3.7 in the PCI group (P = .077). Patients in the R-CABG group were younger, with more severe coronary artery disease (CAD) and had more background risk factors. The in-hospital and long-term mortalities as well as the incidence of TLR, myocardial infarction (MI), stroke were all similar between groups. But the incidence of TVR and any revascularization were lower in the R-CABG group. The long-term mortality was predicted by age, left ventricular ejection fraction, and chronic kidney disease, but not by the revascularization modality, completeness of revascularization, nor residual SYNTAX scores. The last 3 factors were not predictors of long-term TLR, TVR, MI, and stroke.The in-hospital and long-term survival rates of MVD were similar for both the R-CABG and PCI groups. But the R-CABG group had rates of TVR and any revascularization lower than PCI. Revascularization modality, completeness of revascularization, and residual SYNTAX scores were not predictors of in-hospital and long-term mortalities, MI, and stroke in real-world practice. R-CABG was associated with lower rates of TLR and TVR, and is likely a safe and effective treatment and an alternative choice of PCI for MVD patients who have low surgical risks.
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Affiliation(s)
- Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- School of Medicine, National Yang-Ming University, Taipei
| | - Keng-Hao Chang
- Department of Internal Medicine, Cheng Ching Hospital, Taichung
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Kuan-Ju Chen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzu-Hsiang Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei
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Neville CW. Telehealth: A Balanced Look at Incorporating This Technology Into Practice. SAGE Open Nurs 2018; 4:2377960818786504. [PMID: 33415198 PMCID: PMC7774340 DOI: 10.1177/2377960818786504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/30/2018] [Accepted: 06/10/2018] [Indexed: 11/16/2022] Open
Abstract
This article explores the use of telehealth and the ability to provide health care to patients through interactive technology and telecommunication tools. The use of telehealth continues to grow, reaching multiple medical specialties and providing care to a greater population of patients. The purpose of this article is to increase the knowledge of telehealth, identify positive outcomes associated with telehealth as well as potential barriers, and evaluate the benefits against the downfalls to determine whether the positive outcomes outweigh the barriers.
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Su CS, Chen YW, Shen CH, Liu TJ, Chang Y, Lee WL. Clinical outcomes of left main coronary artery disease patients undergoing three different revascularization approaches. Medicine (Baltimore) 2018; 97:e9778. [PMID: 29443740 PMCID: PMC5839844 DOI: 10.1097/md.0000000000009778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Significant unprotected left main (LM) coronary artery disease is frequently associated with severe multivessel disease and increased mortality and morbidity compared with non-LM coronary artery disease. This study compared the clinical outcomes of patients with LM disease who received percutaneous coronary intervention (PCI) with stenting, conventional coronary-artery bypass grafting (C-CABG), and robot-assisted CABG (R-CABG).This retrospective study analyzed 472 consecutive LM disease patients who underwent three different revascularization approaches at a tertiary medical center between January 2005 and November 2013.Of the 472 LM disease patients, 139 received R-CABG, 147 received C-CABG, and 186 received PCI. The need for target vessel revascularization (TVR) was highest in the PCI group. The R-CABG group had significantly lower rates of in-hospital and follow-up all-cause deaths compared with the other 2 groups (1.4% vs. 3.4% and 9.7%, P = .0058; 13.7% vs. 29.3% and 29.6%, P = .0023, respectively). Patients in the R-CABG group had significantly lower rates of intra-aortic balloon pump assistance, and shorter duration of ICU and total hospital stay compared to patients in the C-CABG group. However, revascularization modality, SYNTAX scores, and residual SYNTAX scores were not independent predictors of in-hospital or long-term mortality.In this cohort of LM disease patients treated at a tertiary medical center, PCI is a reasonable choice in patients with less lesion complexity but who are older and have comorbidities. R-CABG is feasible in stable LM disease patients with high SYNTAX scores, and is an effective alternative to C-CABG in LM disease patients with few risk factors. However, revascularization modality per se was not a determinant for long-term mortality in our real-world practice.
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Affiliation(s)
- Chieh-Shou Su
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Institute of Clinical Medicine, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Division of Cardiology, Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi
| | - Ching-Hui Shen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Department of Surgery
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Yen Chang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- Department of Surgery
- Department of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
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Robot-assisted post-chemotherapy retroperitoneal lymph node dissection in germ cell tumor: is the single-docking with lateral approach relevant? World J Urol 2018; 36:655-661. [PMID: 29353314 DOI: 10.1007/s00345-018-2177-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Surgical treatment of post-chemotherapy residual mass of germ cell tumor (GCT) may be performed in various techniques. We assess the feasibility, safety, and efficacy of single-docking with lateral approach robot-assisted retroperitoneal lymph node dissection (R-RPLND) in residual mass of GCT in our center. MATERIALS AND METHODS A retrospective review of patients undergoing R-RPLND for residual mass of CGT was performed between January 2014 and April 2017. Patients with residual mass < 3 cm for seminoma or < 1 cm for non-seminoma were eligible. All surgeries were performed with single-docking RPNLD technique in lateral decubitus. We assessed preoperative characteristics (age, testicular pathology, template, chemotherapy regimen, lesion size, and clinical stage), peroperative (operative time, estimated blood loss, intraoperative complication, node count, pathology, and number of positive node), and postoperative outcomes (postoperative complications, hospital length of stay, recurrence-free survival at 2 year, and ejaculation dysfunction). RESULTS Eleven patients underwent R-RPLND with a median size of the residual mass of 20 mm. Median operative time was 153 min with 120 ml of estimated blood loss, without intraoperative complication. Median nodes count was 7 [1; 24]. Two patients had post-chemotherapy necrotic nodes and one no tumorous node. One patient had postoperative Clavien I complication (chyloperitoneum). We report 72.7% of antegrade ejaculation at 1 month from the surgery. Median clinical recurrence-free survival was 100% after 2 years from the surgery (n = 6). CONCLUSION Lateral approach with single-docking R-RPLND for residual mass of GCT is feasible and safe, with satisfying functional and oncologic outcomes.
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Dias BH, Ali MS, Dubey S, Krishnaswamy SA, Rao AR, Dubey D. Impact of learning curve on the perioperative outcomes following robot-assisted partial nephrectomy for renal tumors. Indian J Urol 2018; 34:62-67. [PMID: 29343915 PMCID: PMC5769252 DOI: 10.4103/iju.iju_169_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/17/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Robot-assisted partial nephrectomy (RAPN) is an established, minimally invasive technique to treat patients with renal masses. The aim of this study was to assess the learning curve (LC) of RAPN, evaluate its impact on perioperative outcomes following RAPN and to study the role of surgeon experience in achieving "trifecta" outcomes following RAPN. METHODS We prospectively analyzed the clinical and pathological outcomes of 108 consecutive patients who underwent RAPN for renal tumors from January 2012 to December 2016 by a laparoscopy trained surgeon with no prior robotic experience. We used warm ischemia time (WIT) <20 min, operative time <120 min, and blood loss <100 ml as endpoints for plotting the LCs. Trifecta was analyzed in relation to our LC. RESULTS Surgeon experience was found to correlate with WIT, operative time, and blood loss. Overall 18.5% of patients developed complications. Complication rate reduced with increasing surgeon experience. LC was 44 cases for WIT ≤20 min, 44 cases for operative time <120 min, and 54 cases for blood loss <100 ml. Trifecta outcome was achieved in 67.6% patients overall and was found to correlate with increasing surgeon experience. Improvement in trifecta outcomes continued to occur beyond the LC. CONCLUSIONS RAPN is a viable option for nephron-sparing surgery in patients with renal carcinoma. For a surgeon trained in laparoscopy, acceptable perioperative outcomes following RAPN can be achieved after an LC of about 44 cases. Increasing surgeon experience was associated with improved "trifecta" achievement following RAPN.
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Affiliation(s)
| | - Mohammed Shahid Ali
- Department of Urology and Renal Transplantation, Manipal Hospital, Bengaluru, Karnataka, India
| | - Shiv Dubey
- Department of Urology and Renal Transplantation, Manipal Hospital, Bengaluru, Karnataka, India
| | | | - Amrith Raj Rao
- Department of Urology and Renal Transplantation, Manipal Hospital, Bengaluru, Karnataka, India
| | - Deepak Dubey
- Department of Urology and Renal Transplantation, Manipal Hospital, Bengaluru, Karnataka, India
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Ram D, Rajappa SK, Rawal S, Singh A, Singh PB, Dewan AK. Is robot-assisted radical cystectomy superior to standard open radical cystectomy? An Indian perspective. J Minim Access Surg 2018; 14:298-303. [PMID: 29483372 PMCID: PMC6130186 DOI: 10.4103/jmas.jmas_150_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Open radical cystectomy (ORC) has been the standard treatment for muscle-invasive bladder cancer, but this is associated with significant morbidity and mortality. Robot-assisted radical cystectomy (RARC) has been proposed as minimally invasive alternative with improved morbidity and acceptable oncological outcomes, but a large series featuring RARC and their comparison with ORC is still lacking in India despite more than a decade of its inception. We have conducted this study with an objective to see the feasibility of RARC in the Indian context and compare it with contemporary standard. Methods: This is a prospective cohort study conducted at two tertiary cancer institutes. We have evaluated the patients pertaining to operative and early post-operative factors from January 2014 to December 2015. Necessary statistical tests applied to see comparability of the arms and their outcomes. Results: A total of 170 patients underwent surgery for carcinoma bladder (45 ORC while 125 RARC). Intraoperative blood loss (RARC and ORC: 228 and 529 ml) and average transfusion rate were lower with RARC. A trend towards benefit was noted in favour of robotic arm in terms of mean complication rate (RARC and ORC: 54 and 39%). Conclusions: The present study has shown comparable surgical and early post-operative outcomes with clear advantage of robotic approach in terms of intraoperative blood transfusion and lymph node yield. Although the study was non-randomised in nature, it should provide substantial evidence on safety and feasibility of RARC in the Indian context and a reference point of evidence to look ahead.
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Affiliation(s)
- Dharma Ram
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Suhas K Rajappa
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Sudhir Rawal
- Department of Uro-oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Amitabh Singh
- Department of Uro-oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Prem B Singh
- Department of Urological Services, Max Superspeciality Hospital, New Delhi, India
| | - Ajay K Dewan
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
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Muthigi A, Sidana A, George AK, Kongnyuy M, Maruf M, Valayil S, Wood BJ, Pinto PA. Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance-targeted biopsy. Urol Oncol 2016; 35:32.e1-32.e7. [PMID: 27743850 DOI: 10.1016/j.urolonc.2016.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/04/2016] [Accepted: 08/19/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVE Multiparametric magnetic resonance imaging (MRI) and magnetic resonance (MR) -targeted biopsy have a growing role in the screening and evaluation of prostate cancer. We aim to evaluate the current knowledge, attitude, and practice patterns of urologists regarding this new technique. METHODS An anonymous online questionnaire was designed to collect information on urologists' beliefs and use of prostate multiparametric MRI and MR-targeted biopsy. The survey was sent to members of the Society of Urologic Oncology, the Endourological Society, and European Association of Urology. Multivariate logistic regression analysis was performed to determine predictors for use of prostate MRI and MR-targeted biopsy. RESULTS A total of 302 responses were received (Endourological Society: 175, European Association of Urology: 23, and Society of Urologic Oncology: 104). Most respondents (83.6%) believe MR-targeted biopsy to be moderately to extremely beneficial in the evaluation of prostate cancer. Overall, 85.7% of responders use prostate MRI in their practice, and 63.0% use MR-targeted biopsy. The 2 most common settings for use of MR-targeted biopsy include patients with history of prior negative biopsy result (96.3%) and monitoring patients on active surveillance (72.5%). In those who do not use MR-targeted biopsy, the principal reasons were lack of necessary infrastructure (64.1%) and prohibitive costs (48.1%). On multivariate logistic regression analysis, practice in an academic setting (1.86 [1.02-3.40], P = 0.043) and performing greater than 25 radical prostatectomies per year (2.32 [1.18-4.56], P = 0.015) remained independent predictors for using MR-targeted biopsy. CONCLUSIONS Most respondents of our survey look favorably on use of prostate MRI and MR-targeted biopsy in clinical practice. Over time, reduction in fixed costs and easier access to equipment may lead to further dissemination of this novel and potentially transformative technology.
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Affiliation(s)
- Akhil Muthigi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Arvin K George
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Michael Kongnyuy
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Subin Valayil
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Post chemotherapy retroperitoneal lymph node dissection in germ cell tumor: robotic way. J Robot Surg 2016; 11:279-285. [PMID: 27503429 DOI: 10.1007/s11701-016-0631-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/23/2016] [Indexed: 10/21/2022]
Abstract
Post chemotherapy residual masses are considered extremely challenging to remove even by the most experienced laparoscopic surgeons. Robotic technology has added a new dimension to the management of such cases and has lessened the fear and discomfort associated with such challenging surgery but is still evolving. We present our experience of management of post chemotherapy residual mass with robotic assistance along with tips and tricks required to perform such procedure.
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