Is Urethral Catheterization Necessary in Retzius-sparing Robot-assisted Radical Prostatectomy?

Objective: To analyze whether urethral catheter (UC)-free anastomosis during Retzius-sparing radical prostatectomy (RP) results in worsening immediate perioperative and postoperative complications.

Methods: We retrospectively reviewed records of patients undergoing robotic-assisted RP with or without indwelling UC placement by a single surgeon between January 2020 and March 2022. Clinical and pathological characteristics were evaluated.

Strangulated Internal Hernia Behind the Common Iliac Artery Following Pelvic Lymph Node Dissection.

We report a rare case of a strangulated internal hernia behind the common iliac artery after robot-assisted pelvic lymph node dissection. Internal hernias involving the retroperitoneal vascular axis have been reported four times in medical literature. This is the first time it has been seen after robotic surgery.

The impact of financial interest in intensity-modulated radiation therapy on the utilization of radiation therapy for treatment of newly diagnosed prostate cancer: a single center experience.

Objective. As recent participants in an integrated prostate cancer (PCa) care center, we sought to evaluate whether financial investment in an intensity-modulated radiation therapy (IMRT) center resulted in an increased utilization of radiation therapy in our patients with newly diagnosed PCa. Materials & Methods.

Emerging biomarkers for prostate cancer diagnosis, staging, and prognosis.

The introduction and widespread adoption of PSA has revolutionized the way prostate cancer is diagnosed and treated. However, the use of PSA has also led to over-diagnosis and overtreatment of prostate cancer resulting in controversy about its use for screening. PSA also has limited predictive accuracy for predicting outcomes after treatment and for making clinical decisions about adjuvant and salvage therapies.

Do silver alloy-coated catheters increase risk of urethral strictures after robotic-assisted laparoscopic radical prostatectomy?

Objectives: To evaluate whether the use of silver-coated catheters increased the risk of developing urethral stricture disease after robotic-assisted laparoscopic radical prostatectomy (RALP). Recently, silver alloy-coated Foley catheters have been shown to decrease the risk of catheter-associated urinary tract infections. Other than the increased cost, no disadvantages to the use of these catheters have been reported.

General anesthesia and contrast-enhanced computed tomography to optimize renal percutaneous radiofrequency ablation: multi-institutional intermediate-term results.

Introduction: Percutaneous renal ablation is often performed under conscious sedation and without contrast-enhanced imaging. We evaluated intermediate-term outcomes of patients undergoing percutaneous contrast-enhanced computed tomography (CT)-guided radiofrequency ablation (RFA) under general anesthesia (GA) at two high-volume centers.

Materials And Methods: Prospectively maintained Institutional Regulatory Board-approved databases were searched to identify patients treated with percutaneous RFA using contrast-enhanced CT under GA.

A comparison of kidney oxygenation profiles between partial and complete renal artery clamping during nephron sparing surgery in a porcine model.

Objective: To compare kidney oxygenation profiles between partial and complete renal artery clamping during nephron sparing surgery (NSS) in a porcine model.

Materials And Methods: Twelve female farm pigs underwent a laparoscopic nephrectomy. Subsequently, an open partial nephrectomy was performed on the remaining kidney using either total (n = 6, TC) or partial (n = 6, PC) clamping of the renal artery.

Training on a virtual reality laparoscopic simulator improves performance of an unfamiliar live laparoscopic procedure.

Purpose: Virtual reality simulators provide a safe and efficient means of acquiring laparoscopic skills. We evaluated whether training on a virtual reality laparoscopic cholecystectomy simulator (Lap Mentor) improves the performance of a live, unrelated laparoscopic urological procedure.

Materials And Methods: A total of 32 medical students with no previous laparoscopic experience were oriented to the Lap Mentor, and then performed virtual reality laparoscopic cholecystectomy which was assessed by 2 experienced laparoscopists using the previously validated Objective Structured Assessment of Technical Skills scoring.

Optical reflectance spectroscopy to differentiate benign from malignant renal tumors at surgery.

Objectives: Optical reflectance spectrophotometry (ORS) is part of a group of novel techniques that have demonstrated promise for the assessment and differentiation of various solid tumors. In this study, we evaluated the ability of ORS to differentiate malignant from benign kidney tumors at surgery.

Methods: From January to April 2007, we completed optical spectroscopy measurements (OSM) at several standardized tumoral and normal parenchymal locations immediately after specimen removal during radical or partial nephrectomy.

Virtual reality training improves simulated laparoscopic surgery performance in laparoscopy naïve medical students.

Purpose: With the expanding role of laparoscopy in urologic practice, efficient and safe training has become paramount. Virtual reality simulation may potentially aid training, but it requires validation before it can be incorporated into training programs. The objective of this study was to assess whether training on a virtual reality (VR) laparoscopy simulator (LAP Mentor) can improve performance of virtual laparoscopic procedures.

Does topical haemostatic agent have an adverse effect on the function of the prostatic neurovascular bundle?

Objective: To assess the functional and histological effects of a bovine thrombin topical haemostatic agent used clinically to aid in surgical haemostasis (FloSeal(TM), Baxter International Inc., Deerfield, IL, USA) on the cavernous nerves in a canine model of survival, as there are concerns that the fibrotic/inflammatory response to this product could affect neural function.

Materials And Methods: In phase I, nine adult male dogs had the bilateral neurovascular bundles (NVBs) dissected.

Focal radiofrequency coagulation-assisted laparoscopic partial nephrectomy: a novel nonischemic technique.

Objective: HABIB 4X is a laparoscopic focal radiofrequency-coagulation (FRFC) device utilized in liver and kidney resections to facilitate dissection while minimizing blood loss. We evaluated the ergonomics and safety of a laparoscopic FRFC device for a non-ischemic laparoscopic partial nephrectomy (LPN) in a survival porcine model.

Methods: Five female pigs (10 renal units) underwent 14 laparoscopic transperitoneal partial nephrectomies using the laparoscopic FRFC device without hilar clamping.

Phase one pilot study using magnetic resonance spectroscopy to predict the histology of radiofrequency-ablated renal tissue.

Introduction And Objective: Recent advances in magnetic resonance (MR) technology have allowed for high-resolution ex vivo spectroscopy on small, intact tissue samples. We examined the capability of (1)H magnetic resonance magic angle spinning (MR-MAS) to correctly characterize post-radiofrequency ablation (RFA) renal biopsies from human samples, compared with standard histology and cross-sectional imaging.

Methods: A minimum of two, 18G, percutaneous renal biopsies were obtained from ten biopsy-confirmed renal tumors at a mean 26.

Absence of viable renal carcinoma in biopsies performed more than 1 year following radio frequency ablation confirms reliability of axial imaging.

Purpose: Radio frequency ablation is an emerging nephron sparing treatment option in select patients with small renal tumors. Some have questioned the completeness of cell death and the reliability of axial imaging for radio frequency ablation followup. We present results in patients with no evidence of radiographic active disease who underwent biopsy more than 1 year following ablation.

A novel magnetic anchoring and guidance system to facilitate single trocar laparoscopic nephrectomy.

A transabdominal magnetic anchoring and guidance system (MAGS) deploys multiple instruments through a single 15-mm diameter, transabdominal trocar. These instruments are positioned in the peritoneal cavity and controlled by externally placed magnets to reduce the need for multiple transabdominal trocars. To assess the feasibility of MAGS technology in a single keyhole, complex laparoscopic procedure, nonsurvival porcine nephrectomies were completed without complications via a single 15-mm transumbilical trocar using a prototype MAGS camera and a magnetically anchored, robotic arm cauterizer.

Optical reflectance spectroscopy to differentiate renal tumor from normal parenchyma.

Purpose: Optical spectroscopy has been evaluated as an innovative technique for the ex vivo study of renal and prostate tumors. In this pilot study we assessed the ability of optical reflectance spectroscopy to reliably differentiate tumor and normal tissue in renal specimens.

Materials And Methods: From January to April 2007 we completed optical reflectance spectroscopy measurements at several standardized tumor and normal parenchymal locations immediately after kidney tumor removal.

Renal function outcomes in patients treated for renal masses smaller than 4 cm by ablative and extirpative techniques.

Purpose: We examined the effect of radical nephrectomy, partial nephrectomy and radio frequency ablation on renal function in patients with stage T1a renal masses.

Materials And Methods: A total of 242 consecutive patients from July 1995 to March 2005 undergoing primary treatment for unilateral renal masses smaller than 4 cm and a normal contralateral kidney were identified. Renal function was calculated using the modified Modification of Diet in Renal Disease equation.

Evaluation of costs and morbidity associated with laparoscopic radiofrequency ablation and laparoscopic partial nephrectomy for treating small renal tumours.

Objective: To compare the costs and morbidity of laparoscopic radiofrequency ablation (LRFA) and laparoscopic partial nephrectomy (LPN) for treating small localized renal tumours.

Patients And Methods: We retrospectively analysed the outcomes of 88 patients treated at our institution for a renal tumour either by LPN (50) or LRFA (38) between March 2000 and May 2006. Patients with multiple tumours, combined LRFA and LPN, and those who had other simultaneous surgical procedures were excluded.

A randomized comparison of conventional vs articulating laparoscopic needle-drivers for performing standardized suturing tasks by laparoscopy-naive subjects.

Objectives: To compare the efficacy of conventional and articulating laparoscopic needle-drivers for performing standardized laparoscopic tasks by medical students with no previous surgical experience.

Subjects And Methods: Twenty medical students with no surgical experience were randomly assigned to two equal groups, one using a conventional laparoscopic needle-holder (Karl Storz, Tuttlingen, Germany) and the other using a first-generation articulating laparoscopic needle-holder (Cambridge Endo, Framingham, MA, USA). Each student performed a series of four standardized laparoscopic tasks, during which speed and accuracy were assessed.

Intermediate-term prospective results of radiofrequency-assisted laparoscopic partial nephrectomy: a non-ischaemic coagulative technique.

OBJECTIVE To report the first intermediate-term oncological outcomes of laparoscopic radiofrequency coagulation followed by laparoscopic partial nephrectomy (RF-LPN) to treat small renal masses, as LPN is limited by the technical difficulty of efficient tumour resection and parenchymal repair during warm ischaemia of the kidney. PATIENTS AND METHODS A prospective database was searched to identify patients treated with RF-LPN; in each case the tumour was first RF coagulated with a margin of normal parenchyma, and then excised. Only fibrin glue was applied to the haemostatic resection site to prevent urinary leaks.

Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments.

Introduction: Natural orifice translumenal endoscopic surgery (NOTES) is an evolving field and suitable instruments are lacking. The purpose of this study was to perform transvaginal cholecystectomies using instruments incorporated into a magnetic anchoring and guidance system (MAGS).

Methods: Non-survival procedures were conducted in pigs (n = 4).

Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model.

Purpose: We assessed the feasibility of single keyhole laparoscopic surgery using a novel transabdominal magnetic anchoring and guidance system platform in the porcine model.

Materials And Methods: A collaborative research group was formed to build a prototype system of magnetically anchored instruments for trocar-free laparoscopy. The design mandate was that the developed technology should be able to deploy into the insufflated abdomen through an existing 12 mm diameter trocar and then be moved into position in the peritoneum by manipulating external magnets.