Does 3-Dimensional (3-D) visualization improve the quality of assistance during robotic radical prostatectomy?

Objective: 3-Dimensional (3-D) visualization by the surgeon is considered to be one of the major advantages of robotic prostatectomy. We undertook this study to see if passing on this technology to the surgical assistants would improve the efficiency of their assistance.

Materials And Methods: The study was conducted in consecutive patients undergoing robotic radical prostatectomy by the same team, in one month at our center.

Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes.

Objective: To study the feasibility of avoiding a urethral catheter after robotic radical prostatectomy by using suprapubic diversion with a urethral splint, as urethral catheterization is often a source of major discomfort and pain to the patient, and can cause more concern to the patient than the procedure; we present the outcomes of a pilot study.

Patients And Methods: This pilot study involved 30 patients; in group 1 (the study group of 10 patients) we used a custom-made suprapubic catheter which provided a small anastomotic splint, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. Group 2 was a control group of 20 patients who had standard urethral catheterization with an 18 F Silastic Foley catheter.

Second Prize: Pelvic neuroanatomy and innovative approaches to minimize nerve damage and maximize cancer control in patients undergoing robot-assisted radical prostatectomy.

Robot-assisted radical prostatectomy is an option for surgical management of clinically localized prostate cancer. There have been theoretical concerns, however, regarding lack of anatomic data with specific relevance to robot-assisted prostatectomy, use of thermal or electrical energy during nerve sparing, and lack of tactile feedback. To address these concerns, we have revisited anatomic foundations and have incorporated a few modifications and strategies in the technique of robot-assisted prostatectomy to maximize cancer control, preserve neurovascular tissue, and emulate time-tested steps of anatomic radical prostatectomy.

Robotic prostatectomy: a review of outcomes compared with laparoscopic and open approaches.

Prostate cancer affects the lives of millions of Americans each year. Since the advent of prostate-specific antigen testing, many cancers are found in initial stages and have the potential for curative resection; however, choosing which type of surgery to undergo can be a difficult task. This article reviews the outcomes of robotic prostatectomy in comparison with laparoscopic or open procedures.

Surgical technique to overcome anatomical shortcoming: balancing post-prostatectomy continence outcomes of urethral sphincter lengths on preoperative magnetic resonance imaging.

Purpose: Shorter urethral sphincter length on preoperative endorectal magnetic resonance imaging has been associated with an increased risk of postoperative urinary incontinence as well as longer time to achieve continence. We determined that our techniques of anatomical reconstruction for restoring the continence mechanism could markedly improve continence outcomes, especially in patients with a shorter urethral sphincter.

Materials And Methods: Our cohort consisted of 274 patients who underwent robotic radical prostatectomy, as performed by a single surgeon, and for whom preoperative magnetic resonance imaging and postoperative evaluations were available.

Total reconstruction of the vesico-urethral junction.

Objective: We describe a novel technique of total vesico-urethral reconstruction, which combines the tactics of previous surgeons, and compare the outcome of our innovative changes for return to early continence with prostatectomies with no or partial reconstruction of the vesico-urethral junction.

Patients And Methods: Between 1 January 2005 and 5 June 2007 a cohort of 700 patients undergoing robotic radical prostatectomy were prospectively evaluated. Patients in 2005 (214) served as a control group, they received no additional methods to provide support to the vesico-urethral junction; a standard anastomosis was made.

Cancer control and the preservation of neurovascular tissue: how to meet competing goals during robotic radical prostatectomy.

Objective: To present early functional and oncological data for the athermal trizonal nerve-sparing technique of robotic radical prostatectomy (RP), that addresses the concerns about deviations from the principles of open RP and revisits the anatomical foundations of this surgery from the robotic perspective.

Patients And Methods: The study involved close collaboration between the Cornell Institute of Robotic Surgery in New York, USA, and the Institute of Urology at the University of Innsbruck in Austria. The cadaveric studies and standardization of the athermal technique were conducted at Innsbruck, and the technique was used in 215 patients in New York.

Nerve advancement with end-to-end reconstruction after partial neurovascular bundle resection:a feasibility study.

Background And Purpose: It is clear that some patients with prostate cancer require a total or partial neurovascular bundle (NVB) resection for oncologic safety to be guaranteed. Nerve grafting is an alternative for these patients to maintain erectile function; however, we report on a feasible option where the NVB is released, and both terminal nerve fibers are approximated; this is the "nerve advancement technique (NAT)."

Patients And Methods: Since 2005, a total of 215 men aged 48 to 70 years (mean 59 years) with a Sexual Health Inventory for Men (SHIM) score of 22 have undergone robotic radical prostatectomy for cancer.

Predictive correlation between the International Index of Erectile Function (IIEF) and Sexual Health Inventory for Men (SHIM): implications for calculating a derived SHIM for clinical use.

Introduction: Validated questionnaires are used to assess postoperative continence, sexual function, and other quality-of-life issues after radical prostatectomy. The International Index of Erectile Function (IIEF) is one such well-tested inventory that is routinely used. However, some centers use the Sexual Health Inventory for Men (SHIM) or the IIEF-6 to record erectile function, and comparison between the three can be difficult.

Future directions of robotic surgery: a case study of the Cornell athermal robotic technique of prostatectomy.

Robotic radical prostatectomy (RRP) has become an effective modality in the treatment of localized prostate cancer. We detail the experience at our institution and provide a perspective for future considerations of RRP with respect to improved preoperative imaging and surgical instrumentation.

Anatomic restoration technique of continence mechanism and preservation of puboprostatic collar: a novel modification to achieve early urinary continence in men undergoing robotic prostatectomy.

Objectives: The puboprostatic ligaments, puboperinealis muscle, and arcus tendineus are all recognized as important for continence in men and women. This complex of ligaments, muscles, and tendineus aponeurosis acts in unison to provide continence and can be disrupted during robotic prostatectomy. We propose that preservation of the puboprostatic collar during robotic surgery will help to restore early continence in men undergoing robotic prostatectomy.

Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy--a propensity scoring approach.

Purpose: We performed a retrospective cohort study using propensity score analysis to calculate long-term survival in patients with prostate cancer with Gleason score 8 or greater who were treated with conservative therapy, radiation therapy and radical prostatectomy.

Materials And Methods: Between January 1, 1980 and December 31, 1997, 3,159 patients in the Henry Ford Health System were diagnosed with clinically localized prostate cancer. Of these patients 453 had a Gleason score of 8 or greater in the biopsy specimen and they were the cohort.

Bladder cancer incidence and risk factors in men with prostate cancer: results from Cancer of the Prostate Strategic Urologic Research Endeavor.

Purpose: We evaluated a large disease registry to determine the incidence of bladder cancer in patients with prostate cancer and investigate whether the type of treatment for prostate cancer increased the risk of bladder cancer.

Materials And Methods: We analyzed the CaPSURE disease registry for men diagnosed with prostate cancer plus bladder cancer between 1989 and 2003. Demographics, comorbidities and prostate cancer treatment modalities were compared in patients with and without bladder cancer.

Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy).

Objectives: To report the long-term survival probability in more than 3000 men with localized prostate cancer treated either conservatively or by definitive treatment (radiotherapy or radical prostatectomy).

Methods: We studied 3159 men with biopsy-confirmed, clinically localized prostate cancer diagnosed from 1980 to 1997. We restricted our analysis to men 75 years of age or younger.

Pelvic autonomic nerve mapping around the prostate by intraoperative electrical stimulation with simultaneous measurement of intracavernous and intraurethral pressure.

Purpose: In previous studies we noted that the neurovascular bundle was not identical to the bundle of the cavernous nerve fibers. In this study we sought to prove these anatomical findings electrophysiologically and map the autonomic nerve fibers by intraoperative simultaneous measurement of intracavernous pressure and intraurethral pressure.

Materials And Methods: Between January 2004 and May 2005 electrical stimulation was performed in 27 open pelvic surgeries, including 26 radical retropubic prostatectomies and 1 radical cystectomy, using an original bipolar electrode before prostate removal.

Management of clinically localized prostate cancer: pathologic processing to robotic prostatectomy.

Prostate cancer management has undergone significant changes in recent years. The existing modalities are being refined, and a better understanding of pathologic parameters is helping in decision making. Newer sources of energy can be used to kill cancer cells, and modern robots are lending a helping hand in surgical removal of prostate cancer.

Anatomical foundations and surgical manoeuvres for precise identification of the prostatovesical junction during robotic radical prostatectomy.

Objective: To develop a technique to identify the bladder neck during robotic radical prostatectomy (RRP) using anatomical and patient studies, and to evaluate its efficacy during and after surgery.

Patients And Methods: The data for this study were from 10 fresh cadaveric dissections and 50 consecutive athermal RRPs performed at our institution. We used a technique we term 'the bimanual bladder neck pinch'.

Preservation of the puboprostatic collar and puboperineoplasty for early recovery of urinary continence after robotic prostatectomy: anatomic basis and preliminary outcomes.

Objectives: The aims of the present study are to prove the hypothesis that the preservation of the puboprostatic collar and puboperineoplasty contribute to the early recovery of urinary continence after robotic radical prostatectomy. We reconfirm the anatomy of the periurethral supporting tissue and show the preliminary result on the early continence of patients undergoing this modification.

Methods: Using 10, male, fresh cadavers, we traced the endopelvic fascia, the fascia of levator ani, puboprostatic ligaments, rhabdosphincter, and puboperinealis muscle to devise strategies in preserving this complex.

The proximal neurovascular plate and the tri-zonal neural architecture around the prostate gland: importance in the athermal robotic technique of nerve-sparing prostatectomy.

Objective: To review the neural architecture around the prostate gland, as it is relevant for nerve-sparing robotic prostatectomy, including in particular the anatomy of the proximal neurovascular tissue, the neurovascular bundle (NVB), and accessory neural pathways (ANPs).

Materials And Methods: The aims of this study were achieved in collaboration between the Cornell Institute of Robotic Surgery, New York, NY, USA and the Institute of Urology at the University of Innsbruck, Austria. The broad steps were: (i) anatomical studies of 10 fresh and two fixed male cadavers; and (ii) collection of videotape and still image data from 200 men undergoing radical prostatectomy by the athermal robotic technique at the Cornell Institute.

Identification of the retrotrigonal layer as a key anatomical landmark during robotically assisted radical prostatectomy.

Objective: To define the gross and microscopic anatomy, and the surgical significance, of the newly described retrotrigonal layer of the bladder neck, as an aid during robotic radical prostatectomy (RRP).

Materials And Methods: The data for this study were obtained from five fresh cadaveric dissections and 100 consecutive RRPs. Five male cadavers with no previous pelvic or urethral surgery were dissected to expose the posterior bladder neck and identify the retrotrigonal layer.

Athermal Robotic Technique of prostatectomy in patients with large prostate glands (>75 g): technique and initial results.

Objective: To report our experience with robotic radical prostatectomy (rRP) for prostate glands of >75 g, as this technique is developing rapidly.

Patients And Methods: Between January 2005 and November 2005, 30 men with prostates of >75 g had rRP. Their clinicopathological and operative data were reviewed.

Anatomy of autonomic nerve component in the male pelvis: the new concept from a perspective for robotic nerve sparing radical prostatectomy.

The DaVinci Robot (Intuitive Surgical, Sunnyvale California) with its magnified 3-D vision and multi-jointed wristed instruments enabled us to perform radical prostatectomy with consideration for the pelvic anatomy. In the present paper, we review the pelvic autonomic neuroanatomy with respect to robotic prostatectomy and demonstrate the procedures and critical points of nerve-sparing robotic radical prostatectomy based on novel anatomic concepts. Microscopic and macroscopic data were acquired from 30 fresh and 25 fixed male cadavers.

Robotic prostatectomy: a pooled analysis of published literature.

Objective: Robotic prostatectomy has been recently added to the treatment armamentarium of localized prostate cancer. We reviewed published data on this modality with critical appraisal of outcomes and complications.

Methods: A Medline search was performed that encompassed all published articles on robotic prostatectomy.

Comparison of two-dimensional and three-dimensional suturing: is there a difference in a robotic surgery setting?

Background And Purpose: Robotic surgery allows three-dimensional (3D) viewing of tissues. We compared two-dimensional (2D) and 3D suturing drills using the daVinci surgical system to determine if the latter is advantageous.

Materials And Methods: Twenty-eight anastomotic drills were completed by seven surgeons using the daVinci robot.

Factors contributing to the racial differences in prostate cancer mortality.

Objective: To analyse, in a retrospective cohort study, differences in rates of surgical treatment for prostate cancer between African-Americans and White Americans, and to evaluate the extent to which these differences are associated with disparities in survival rates between these groups.

Patients And Methods: Clinical, pathological, and demographic data from 4279 men diagnosed with clinically localized prostate cancer between 1980 and 1997 were used. The variables assessed included age, disease stage, tumour grade, comorbidities, treatment method, and socio-economic status (SES).