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Abou Chedid W, Carbin DD, Innes M, Casson H, Broe M, Hossain M, Frajkoulis G, Whiting D, Adamou C, Kusuma M, Moschonas D, Hicks J, Patil K, Eden C, Perry MJA. Self-removal of catheter after robot-assisted radical prostatectomy: a feasibility study. J Robot Surg 2023; 17:2697-2701. [PMID: 37548820 DOI: 10.1007/s11701-023-01690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
Self-removal of urinary catheter as an option after robot-assisted radical prostatectomy (RARP) has never been explored in literature. We report the feasibility and outcome of the first study of this novel concept in our hospital. We conducted a prospective audit of self-TWOC (trial without catheter) in men who underwent consecutive RARP in our centre between April 2022 and September 2022. Men who had self-TWOC filled a questionnaire about the outcomes of self-TWOC. Carbon footprint and carbon offset for each hospital TWOC avoided were calculated. Of the 129 who underwent self-TWOC, 112 filled the questionnaire and were hence included in the final analysis. Self-TWOC was successful in all the 112 (100%) men in the study. 99.1% of men were satisfied with self-TWOC at home. We managed to avoid 79.6 ± 36.72 km of travel and 77 min of travel time for every self-TWOC. This also saved 85£/patient on clinic expenses and fuel cost savings of 9.87-15.99£ per patient depending on car engine size/type. The carbon footprint calculated was 20 kg CO2 assuming average engine sized diesel/petrol cars and 10 kg CO2 for an average UK petrol hybrid car. The calculated carbon offset per patient for diesel/petrol cars: 0.32£, petrol hybrid: 0.16£. Self-TWOC for 80-160 patients will save the carbon emissions equivalent to that of a passenger on a London-New York Trans-Atlantic flight. Self-TWOC is safe, affordable and is sustainable to the environment. Widespread acceptance of this practice change will be a small, but steady step towards greener health systems across the world.
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Affiliation(s)
- Wissam Abou Chedid
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | | | - Maria Innes
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Helen Casson
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Mark Broe
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Mohammad Hossain
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Gerasimos Frajkoulis
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Danielle Whiting
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Constantinos Adamou
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Murthy Kusuma
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Dimitrios Moschonas
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - James Hicks
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Krishna Patil
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Egerton Road, Guildford, UK
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Carbin Joseph DD, Dranova S, Harrison H, Papanikolou D, Uribe S, Broe M, Adamou C, Whiting D, Frajkoulis G, Moschonas D, Patil K, Kusuma VRM, Hicks J, Abou Chedid W, Perry MJA. Functional and oncological outcomes of robot-assisted radical prostatectomy in obese men: a matched-pair analysis. J Robot Surg 2023; 17:2027-2033. [PMID: 37131055 DOI: 10.1007/s11701-023-01607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
Robot-assisted radical prostatectomy (RARP) in men with body mass index (BMI) ≥ 35 kg/m2 is considered technically challenging. We conducted a retrospective matched-pair analysis to compare the oncological and functional outcomes of RARP in men with BMI ≥ 35 kg/m2. We interrogated our prospectively maintained RARP database and identified 1273 men who underwent RARP from January 2018 till June 2021. Among them, 43 had BMI ≥ 35 kg/m2, and 1230 had BMI < 35 kg/m2. A 1:1 genetic matching was performed between these two groups for PSA, Gleason grades, clinical stage, D'Amico risk stratification, and nerve-spare extent. Continence rates and biochemical rates on 1-year follow-up were analysed. We performed statistical analysis using SPSS, and Paired tests were done using Wilcoxon sign rank-sum test. p < 0.05 was considered statistically significant. The two groups were comparable in almost all parameters except for age. Console time (p = 0.20) and estimated blood loss (p > 0.90) were not significantly different. There was no blood transfusion, open conversion or (Clavien-Dindo grade ≥ 3) intra/postoperative complication in either of the two groups. The two groups did not have any difference in biochemical recurrence rates (BCR) on 1-year follow-up (p > 0.90). Men with BMI ≥ 35 achieved continence rates equivalent to men with BMI < 35 within 1 year. On logistic regression analysis, age (p < 0.001) and extent of nerve sparing (p = 0.026) emerged as significant factors influencing continence recovery. RARP is safe in men with BMI ≥ 35 kg/m2. The 1-year continence and oncological outcomes are similar to matched men with BMI < 35 kg/m2 undergoing RARP.
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Affiliation(s)
| | - Sabina Dranova
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Holly Harrison
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Santiago Uribe
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Mark Broe
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Danielle Whiting
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | | | - Krishna Patil
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - James Hicks
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
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