Quantification of Long-term Stability and Specific Relief of Lower Urinary Tract Symptoms (LUTS) After Robot-assisted Radical Prostatectomy.

Objective: To assist in preoperative counseling by assessing long-term changes in American Urological Association symptom scores (AUAss) and lower urinary tract symptom (LUTS)-related quality of life (QOL) in patients undergoing robot-assisted radical prostatectomy (RARP).

Materials And Methods: RARP was performed on 666 men by one surgeon from 2002 to 2007 at a single institution. AUAss and QOL were queried preoperatively and at 3, 9, 15, 24-48, 60-84, and 96+ months postoperatively.

Preventing perioperative complications of robotic-assisted radical prostatectomy.

Objective: To report the change in complication rates after the identification and modification of technique to reduce their incidence during robot-assisted radical prostatectomy (RARP).

Methods: This study retrospectively reviewed 1000 consecutive patients who underwent RARP from June 2002 to June 2011. A number of technical changes were made after complications were noted and changes in technique were documented.

The impact of robotics on treatment of localized prostate cancer and resident education in Rochester, New York.

Background And Purpose: Robot-assisted radical prostatectomy (RARP) has been performed in Rochester, NY, since 2003. Currently, 10 area urologists perform RARP, and robotic training has become an important component of the residency. We present data describing the timeline for adoption, both in clinical practice and in the residency program.

Outcomes of laparoscopic partial nephrectomy after fellowship training.

Background And Objectives: Experienced surgeons at select high-volume centers have reported favorable outcomes of laparoscopic partial nephrectomy (LPN) in their contemporary experience. However, it is unclear whether recently fellowship-trained surgeons can replicate such outcomes. We evaluated LPNs performed by 3 surgeons in their initial years of independent practice following laparoscopic fellowship training.

Evaluation of long-term thermal injury using cautery during nerve sparing robotic prostatectomy.

Objective: In our initial 125 cases, we used cautery during preservation of the neurovascular bundles (NVBs). We previously reported the short-term benefit of a cautery-free versus cautery technique. To assess long-term consequences of cautery, we report 2-year potency outcomes for these robot-assisted laparoscopic radical prostatectomies (RLP).

Effects of commonly used hemostatic agents on the porcine collecting system.

Purpose: Topical hemostatic agents have been particularly useful for preventing bleeding in tubeless percutaneous nephrolithotomy. In the present study, we investigated the effect of gelatin matrix hemostatic sealant (FloSeal), fibrin glue (Tisseel,), polyethylene glycol polymers (CoSeal), and bovine serum albumin/ glutaraldehyde (BioGlue) in the pig urinary collecting system after injection through a percutaneous nephrostomy (PCN) tract.

Materials And Methods: Percutaneous nephrostomy was performed in 40 kidneys in 24 domestic pigs.

Short-term impact of a robot-assisted laparoscopic prostatectomy 'mini-residency' experience on postgraduate urologists' practice patterns.

Introduction: To assist practising urologists acquire and incorporate robot-assisted laparoscopic prostatectomy (RALP) into their practice, a 5 day mini-residency (M-R) programme with a mentor, preceptor and potential proctor experience was established at the University of California, Irvine, Yamanouchi Center for Urological Education. The follow-up results from the initial 21 RALP M-R participants are presented.

Methods: Between September 2003 and September 2004, 21 urologists from six states and four countries underwent a RALP M-R.

Transition from open to robotic-assisted radical prostatectomy is associated with a reduction of positive surgical margins amongst private-practice-based urologists.

Several recent studies have suggested that thought leaders in radical prostatectomy have decreased their own positive margin rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has not been determined if this phenomenon exists amongst non-fellowship-trained urologists in private practice.

The use of robotically assisted surgery for treating urachal anomalies.

Objective: To report the management of urachal anomalies using a robotically assisted approach.

Patients And Methods: Between January 2005 and February 2006, five patients (mean age 51 years, range 24-68) were diagnosed with urachal anomalies. Two basic robot-assisted surgical approaches were used for excising the urachal anomalies: excision of the urachal remnant via partial cystectomy, and radical cystectomy for excision of urachal adenocarcinoma.

Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy.

Objectives: Robotic-assisted surgery using the da Vinci Surgical System is gaining popularity among urologists. However, training residents to use this system presents new challenges for surgical educators. We describe a method for training residents to perform robotic-assisted radical prostatectomy.

Initial comparison of robotic-assisted laparoscopic versus open pyeloplasty in children.

Objectives: To compare the initial results of robotic-assisted laparoscopic versus open pyeloplasty in children with ureteropelvic junction obstruction.

Methods: From June 2002 to July 2004, 8 pediatric patients underwent robotic-assisted laparoscopic pyeloplasty and were matched by age group with patients undergoing conventional open pyeloplasty. The mean age was 11.

Third Prize: Comparison of radical nephrectomy, laparoscopic microwave thermotherapy, cryotherapy, and radiofrequency ablation for destruction of experimental VX-2 renal tumors in rabbits.

Background And Purpose: Currently available minimally invasive renal tumor-ablation procedures include cryotherapy, radiofrequency ablation, and microwave thermotherapy. In this study, we investigated the ability of these three approaches to destroy experimental renal tumors in rabbits. The mechanism of potential tumor metastasis was also explored.

Effect of holmium:YAG laser pulse width on lithotripsy retropulsion in vitro.

Background And Purpose: The effect of laser pulse width on calculus retropulsion during ureteroscopic lithotripsy is poorly defined because of the limited availability of variable pulse-width lasers. We used an adjustable pulse-width Ho:YAG laser to test the effect of pulse width on in vitro phantom-stone retropulsion and fragmentation efficiency.

Methods And Materials: An Odyssey 30 Ho:YAG laser (Convergent Laser Technologies, Oakland, CA) with adjustable pulse width (350 or 700 microsec) was used to treat spherical 10-mm plaster calculi in a model ureter (N = 40) and calix (N = 16) utilizing 200- and 400-microm fibers (10 Hz, 1.

Ureteral pseudodiverticulum associated with absorbable suture clips after laparoscopic pyeloplasty: case report.

A 48 year-old woman with pyelonephritis was found to have bilateral ureteropelvic junction (UPJ) obstruction and a nonfunctioning right kidney. She initially underwent a laparoscopic left nondismembered pyeloplasty using absorbable polydioxanone Lapra-Ty suture clips (Ethicon Endosurgery, Cincinnati, OH) to secure the anastomosis. An antegrade endopyelotomy was later necessitated.

Rapid communication: early potency outcomes with cautery-free neurovascular bundle preservation with robotic laparoscopic radical prostatectomy.

Purpose: To report short-term potency outcomes with a cautery-free technique (CFT) to preserve the neurovascular bundles (NVB) during robotic laparoscopic radical prostatectomy (LRP).

Patients And Methods: All men were <66 years of age and had a Sexual Health Inventory in Men (SHIM) score of 22 to 25. They underwent unilateral or bilateral dissections.

Tubeless percutaneous nephrolithotomy using hemostatic gelatin matrix.

We describe using hemostatic gelatin matrix (FloSeal; Baxter Inc., Irvine, CA) to provide hemostasis of the tract after percutaneous nephrolithotomy, thereby obviating a nephrostomy tube. For patients who are rendered stone free, a 7F, 11.

Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation.

Introduction: Efforts continue to develop techniques that maintain the neurovascular bundles and minimize trauma for robotic laparoscopic radical prostatectomy. We evaluated the feasibility of preserving the nerve bundles without cautery or surgical clips.

Technical Considerations: The seminal vesicles were dissected using scissors and bipolar cautery.

Comparison of flexible ureteroscopes: deflection, irrigant flow and optical characteristics.

Purpose: We measured and compared the deflection, irrigation flow rates, distortion, resolution and light transmission of new generation flexible ureteroscopes.

Materials And Methods: Multiple characteristics of 5 flexible ureteroscopes (ACMI DUR-8 Elite, Olympus URF-P3, Storz 11278AU1 [Flex-X], Wolf 7330.072 and Wolf 7325.

Initial impact of a dedicated postgraduate laparoscopic mini-residency on clinical practice patterns.

Background And Purpose: Laparoscopic surgical techniques are difficult to master, especially for surgeons who did not receive this type of training during their residencies. We have established a 5-day mentor-preceptor- proctor-guided postgraduate "mini-residency" (M-R) experience in minimally invasive surgery. The initial results from the first 16 participants in the laparoscopic M-R modules are presented.

What happens to hemostatic agents in contact with urine? An in vitro study.

Background And Purpose: As the indications for topical hemostatic agents increase in urology, the question arises: what happens to these agents when they enter the urinary collecting system? To answer this question, we performed a series of in-vitro experiments mixing three hemostatic agents with normal and sanguineous urine.

Materials And Methods: Four commercially available topical hemostatic products: oxidized regenerated cellulose (Surgicel; Ethicon, Somerville, NJ), fibrin sealant (Tisseel VH Kit; Baxter Health Care Corporation, Irvine, CA), gelatin matrix hemostatic sealant (FloSeal; Baxter Health Care), and polyethylene glycol (CoSeal; Cohesion Technologies, Palo Alto, CA) were studied. Human urine (10 mL) was added to samples of each substance; this was done in triplicate.

Impact of obesity on clinical outcomes in robotic prostatectomy.

Objectives: To assess the preoperative parameters and clinical outcomes of patients undergoing robotic laparoscopic radical prostatectomy with specific attention to the body mass index (BMI). Little is known about the impact of obesity (BMI greater than 30) on the clinical outcomes of patients undergoing radical prostatectomy.

Methods: The data of 100 men undergoing robotic laparoscopic radical prostatectomy between June 2002 and October 2003 were prospectively entered into a database.

Fibrin glue-oxidized cellulose sandwich for laparoscopic wedge resection of small renal lesions.

Purpose: We present our experience with standard laparoscopic wedge resection of small renal tumors using a fibrin glue-oxidized cellulose sandwich for hemostasis.

Materials And Methods: From May 2002 to December 2003, 15 patients underwent laparoscopic wedge resection for a total of 15 nonhilar renal masses. Renal hilar clamping was performed in 1 patient and no sutures were placed.

Effect of urine specific gravity on effectiveness of shockwave lithotripsy.

Purpose: To determine the effect of urine specific gravity (SG) and radiographic contrast medium on the efficiency of extracorporeal shockwave lithotripsy (SWL) fragmentation using a previously published in vitro model.

Materials And Methods: Artificial kidney stones (BegoStone [BEGO USA, Smithfield, RI]) of a standard size (10 x 10 mm) and weight (mean 1.90 g; range 1.

Current trends in urologic laparoscopic surgery.

Purpose: We examined the status of laparoscopy in urology and the impact of residency and fellowship training on the performance of laparoscopy as primary surgeon. We also examined whether performing nonsurgical tasks requiring two-handed dexterity had any link to the adoption of laparoscopic techniques by urologists.

Materials And Methods: A total of 8760 laparoscopy questionnaires containing 135 queries were mailed to urologists listed on the American Urological Association practicing urologists mailing list.