Advances in Robotic Vena Cava Tumor Thrombectomy: Intracaval Balloon Occlusion, Patch Grafting, and Vena Cavoscopy.

Unlabelled: Robotic level III inferior vena cava (IVC) tumor thrombectomy was described recently. We present ongoing robotic advances in this arena in a case series of six patients with Mayo level II-III thrombi who underwent robotic caval thrombectomy, radical nephrectomy, and retroperitoneal lymphadenectomy. In four patients, proximal intra- or retrohepatic IVC control was obtained solely with an intracaval Fogarty balloon catheter; in one patient, robot-guided flexible cystoscopy of the IVC lumen was performed to rule out any residual or secondary skip thrombi.

Determining the True Costs of Treating Small Renal Masses Using Time Driven, Activity Based Costing.

Introduction: We report the implementation of time driven, activity based costing for competing treatments of small renal masses at an academic referral center.

Methods: To use time driven, activity based costing we developed a process map outlining the steps to treat small renal masses. We then derived the costs of supplying every resource per unit time.

Utilizing time-driven activity-based costing to understand the short- and long-term costs of treating localized, low-risk prostate cancer.

Background: Given the costs of delivering care for men with prostate cancer remain poorly described, this article reports the results of time-driven activity-based costing (TDABC) for competing treatments of low-risk prostate cancer.

Methods: Process maps were developed for each phase of care from the initial urologic visit through 12 years of follow-up for robotic-assisted laparoscopic prostatectomy (RALP), cryotherapy, high-dose rate (HDR) and low-dose rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and active surveillance (AS). The last modality incorporated both traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy.

Outlining the limits of partial nephrectomy.

Amongst nephron-sparing modalities, partial nephrectomy (PN) is the standard of care in the treatment of renal cell carcinoma (RCC). Despite the increasing utilization of PN, particularly propagated by robot-assisted, minimally invasive approaches for small renal masses (SRMs), the limits of PN appear to be also evolving. In this review, we sought to address the tumour stage beyond which PN may be oncologically perilous.

Laparoscopic nephroureterectomy with a circumaortic left renal vein.

Renal vasculature anomalies can present technical challenges to laparoscopic urologic surgery. The use of preoperative imaging has made it possible to recognize and plan for such aberrant vascular anatomy. We describe a patient with a circumaortic left renal vein who underwent successful laparoscopic radical nephroureterectomy for the management of urothelial carcinoma of the renal pelvis.

Laparoscopic pelvic nephrectomy: essential preoperative and intraoperative considerations.

Pelvic kidneys are typically asymptomatic, but surgical intervention may be required in select cases. Laparoscopic pelvic nephrectomy is a feasible option. Given the highly variable vascular anatomy, careful surgical planning and meticulous technique are necessary.

Value of contrast-enhanced ultrasonography in prostate cancer.

Purpose Of Review: Traditional grayscale ultrasonography has poor discrimination between benign and malignant areas within the prostate. Current biopsy techniques commonly miss prostate cancer when present within the gland, with the majority of prostate biopsies negative for cancer. Enhanced ultrasound (US) modalities may improve the visualization of the prostate and better detect foci of prostate cancer.

Face, content, and construct validation of the da Vinci Skills Simulator.

Objective: To report on assessments of face, content, and construct validity for the commercially available da Vinci Skills Simulator (dVSS).

Methods: A total of 38 subjects participated in this prospective study. Participants were classified as novice (0 robotic cases performed), intermediate (1-74 robotic cases), or expert (≥ 75 robotic cases).