Robot-Assisted Radical Prostatectomy by Lateral Approach: Technique, Reproducibility and Outcomes

BACKGROUND

Radical prostatectomy by lateral approach allows performing a prostatectomy through a buttonhole, with direct access to the seminal vesicle and fully sparing the anterior pubovesical complex. Our aim is to show the results of reproducing the technique of robotic radical prostatectomy by lateral approach, in terms of intraoperative, postoperative, oncological and functional parameters.

METHODS

We analyzed 513 patients submitted to robotic radical prostatectomy by lateral approach from January 2015 to March 2021, operated on by two surgeons in our institution. The oncological and functional results of both surgeons were compared.

RESULTS

When comparing both surgeons, the rate of positive surgical margins (PSM) was 32.87% and 37.9% and significant surgical margins (PSM > 2 mm) were 5.88% and 7.58% (p = 0.672) for surgeon 1 and surgeon 2, respectively. Immediate continence was 86% and 85% and sexual potency at one year 73% and 72%, with a similar rate of complications for surgeon 1 and 2.

CONCLUSIONS

Radical prostatectomy by the lateral approach technique with preservation of the anterior pubovesical complex is reproducible and offers good oncological and functional results.

The process of clinical trials: a model for successful clinical trial participation

PURPOSE/OBJECTIVES

To present barriers and strategies related to successful clinical trial participation and integrate them into a model for successful trial participation.

DATA SOURCES

The proposed model was developed based on a literature review related to clinical trial participation, review of empirical studies related to clinical trials, and experiences with subject participation.

DATA SYNTHESIS

Successful clinical trial participation depends on study design, participant factors, issues related to ethnic diversity, the informed consent process, and physician factors.

CONCLUSIONS

Clinical trial participation is critical for all disciplines. However, nurses either are researchers or co-investigators with physicians on clinical trials, and it is critical for them to understand specific barriers and success strategies for patient participation. Future studies need to be conducted related to participation in nursing clinical trial research. These study results will facilitate successful nursing clinical trials.

IMPLICATIONS FOR NURSING PRACTICE

This model can be used in implementation of clinical trials across disciplines prior to and during enrollment of patients into studies.

Improved surgical technique for carotid endarterectomy

Despite improved results following carotid endarterectomy, a small but significant incidence of neurological deficit may follow the operation. Emphasis has deviated from the importance of the technical details of the operative procedure to consideration of the role of physiological factors (e.g., shunt, stump pressure, EEG vigilance, type of anesthesia). The surgical principles outlined in this report were used in a consecutive series of 214 patients undergoing carotid endarterectomy. A neurological deficit was noted in two patients (0.9%) in whom thrombosis of the repair site was proven.

Noninvasive carotid artery evaluation following endarterectomy

There has been recent interest in carotid restenosis following endarterectomy. To evaluate the significance of this complication, 2549 consecutive patients who were evaluated for suspected carotid artery occlusive disease by carotid phonoangiography, ocular plethysmography, and B-mode scanning techniques over a 21-month period were reviewed. Within this group a total of 155 patients had previously undergone a carotid endarterectomy. Of these, only four patients manifested clinically significant restenosis. In the majority of patients the carotid bifurcation was free of significant disease. The "carotid shelf" that represents the superior aspect of residual intimal plaque following endarterectomy could be clearly identified in the early postoperative period; however, it later blended to become less distinct. In a few instances, however, the amount of residual plaque at the lower extent of the endarterectomy was very prominent and remained so during follow-up studies, suggesting the possibility that this might represent a focus for future thrombosis. We conclude that noninvasive testing as used herein is an accurate method of assessing the carotid artery following endarterectomy. The accuracy of these techniques has been of such high degree that 16 carefully selected patients have subsequently undergone carotid endarterectomy without preoperative angiography.

Rounded atelectasis

A little-known form of collapse, rounded atelectasis, is occasionally seen on chest radiographs. Previous reports are mostly in the German and French literature (Hanke collected more than 50 personal cases). Rounded atelectasis appears as a masslike lesion that often mimics a pulmonary neoplasm. Distinctive features that permit radiographic diagnosis include a rounded or oval shadow 2.5--5 cm in greatest diameter, pleural-based, usually lying along the posterior surface of a lower lobe. The blood vessels near the mass appear to be gathered together in a sheaf as they converge in a curved course toward the mass, much like the tail of a comet. The mass itself is always in contact with a chronically thickened pleura. Five cases of rounded atelectasis have been identified in recent years; three of these are reported here in some detail. Lack of familiarity with this clinically innocuous entity usually leads to a mistaken diagnosis of neoplasm and thoracotomy may be performed.