Robotic partial nephrectomy without renal ischemia.

Objective: To evaluate our outcomes of robotic partial nephrectomy (RPN) without renal artery clamping (off-clamp), in order to avoid ischemic renal injury, using cold-scissor tumor excision and sutured reconstruction without ablation or other regional hypoperfusion.

Materials And Methods: Between September 2009 and October 2010, patients who underwent off-clamp RPN for ≥1 tumors were reviewed from a prospective database. All procedures were performed by a single surgeon experienced in RPN.

Quality of lymphadenectomy is equivalent with robotic and open cystectomy using an extended template.

Purpose: Extended lymph node dissection for bladder cancer provides better staging, cancerous node removal and potentially survival. Minimally invasive techniques have been criticized about the ability to adequately perform extended lymph node dissection. We compared the extended lymph node dissection quality of robotic and open cystectomy by assessing node yield and positivity.

Clinical pathway for 3-day stay after robot-assisted cystectomy.

Background And Purpose: Typical lengths of stay after open cystectomy are 5 to 7 days, without dramatic differences reported for laparoscopic or robot-assisted cystectomy. We developed a clinical pathway for early discharge after robot-assisted cystectomy, attempting to take advantage of potentially decreased morbidity with this minimally invasive procedure and analyzed our initial outcomes.

Patients And Methods: The initial 30 consecutive patients undergoing robot-assisted cystectomy who were treated on a clinical pathway developed at our institution were reviewed.

Zoledronic acid preserves bone mineral density in premenopausal women who develop ovarian failure due to adjuvant chemotherapy: final results from CALGB trial 79809.

Background: Chemotherapy-induced ovarian failure (CIOF) is a frequent side-effect of adjuvant chemotherapy that results in rapid bone loss. We hypothesised that zoledronic acid (ZA), a third-generation amino bisphosphonate, would prevent bone loss in premenopausal women who developed CIOF.

Methods: Women (439) were randomised to intravenous (i.

Robotic extended pelvic lymphadenectomy for bladder cancer with increased nodal yield.

Study Type: Therapy (case series).

Level Of Evidence: 4. What's known on the subject? and What does the study add? The standard of care for invasive bladder cancer is open radical cystectomy with the extent of pelvic lymph node dissection impacting oncological outcomes.

Robotic repair of access-related aortic injuries: unexpected complication of robot-assisted prostatectomy.

Robot-assisted surgery is becoming more widespread, but despite adoption by most academic institutions, curricula for training residents in robotics have yet to be developed fully. Even after teaching surgeons have mastered robotic techniques, an inherent risk of avoidable injuries may persist as they seek to impart their knowledge of this relatively new surgical modality to trainees. Two cases of aortic injury during access for robot-assisted prostatectomy are described along with their successful robotic repair with root-cause analysis of the events.

Prevention and treatment of transitional cell carcinomatosis with intraperitoneal chemotherapy in a rat model.

Purpose: Tumor spillage from bladder perforation during transurethral bladder tumor resection or cystectomy risks seeding the peritoneum with transitional cell carcinoma. We determined the lowest effective mitomycin C dose to prevent tumor implantation and the potential efficacy of delayed therapy. Additionally, we investigated the effect of tumor debulking combined with intraperitoneal mitomycin C.

Aggressive papillary glioneuronal tumor: case report and literature review.

Papillary glioneuronal tumors (PGNT) are a rare, recently described form of mixed neoplasm composed of glial and neuronal components. PGNT usually occur in children and young adults, and typically demonstrate low-grade pathology, with a low proliferative index of 1-3%. Here we describe a newly diagnosed case of PGNT with a more aggressive phenotype that required irradiation and chemotherapy.

A novel technique for laparoscopic or robotic partial nephrectomy: feasibility study.

Objective: Laparoscopic partial nephrectomy is a technically challenging procedure with concern over limiting warm ischemia time in order to prevent irreversible injury. We investigate the feasibility of a novel approach with the potential to minimize ischemia time as well as maximize precision of tumor excision.

Materials And Methods: Seven partial nephrectomies were performed in 45-50 kg female pigs with excisions ranging in size from 2 x 2 cm to 5 x 3 cm using the following technique.

Neurological decompression illness and hematocrit: analysis of a consecutive series of 200 recreational scuba divers.

Neurological complications are common in recreational divers diagnosed with decompression illness (DCI). Prior reports suggest that hemoconcentration, with hematocrit values of 48 or greater, increase the risk for more severe and persistent neurological deficits in divers with DCI. Herein we describe our experience with neurological DCI and hematocrit values in a large series of consecutively treated divers.

Prognosis of refractory neurosarcoidosis altered by thalidomide: a case report.

Introduction: Sarcoidosis is a multisystem disease characterized by noncaseating granulomas in the lungs, skin, lymph nodes, and, rarely, the nervous system. Granuloma formation in sarcoidosis is mediated by increased secretion of interferon-gamma, interleukin-2, and tumor necrosis factor-alpha. 25% of patients with neurosarcoidosis are steroid resistant and another 20-40% are resistant to any conventional immunosuppression, but the typical agents suppress the immune system in a non-specific fashion.

Incidence of infusion plan alterations after angiography in patients undergoing intra-arterial chemotherapy for brain tumors.

During intra-arterial (IA) chemotherapy of brain tumors, the initial vessels chosen for infusion are based on the vascular distribution of the tumor as revealed by CT or MR imaging. However, angiography may reveal details of vascular anatomy that require an alteration of the vessel infusion plan. The incidence of infusional alterations and the underlying vascular anatomy involved remains unknown in patients with brain tumors undergoing IA chemotherapy.

Intra-arterial chemotherapy of primary brain tumors.

Intra-arterial (IA) chemotherapy is a form of regional delivery to brain tumors, designed to enhance the intra-tumoral concentrations of a given drug, in comparison with the intravenous route. Drugs that are likely to benefit from IA delivery have a rapid systemic clearance and include carmustine and other nitrosoureas, cisplatin, carboplatin, etoposide, and methotrexate. Clinical studies have demonstrated activity of IA chemotherapy approaches for low- and high-grade gliomas, and for cerebral lymphomas.

Chemotherapy for the treatment of metastatic brain tumors.

Metastatic brain tumors are the most common complication of systemic cancer and affect 20-40% of all adult cancer patients. Whole-brain radiotherapy and surgical resection of accessible, solitary lesions have been the mainstay of treatment. Recently, chemotherapy has become a more viable treatment option for metastatic brain tumors.

Intra-arterial carboplatin and intravenous etoposide for the treatment of recurrent and progressive non-GBM gliomas.

Recurrent and progressive non-GBM gliomas are a diverse group of brain tumors that often respond poorly to adjuvant chemotherapy treatment. Regional intra-arterial (IA) administration of chemotherapy may result in increased tumor uptake of drug, with improvement in response rates and time to progression (TTP). Twenty-five patients with recurrent or progressive non-GBM gliomas were treated with IA carboplatin (200 mg/m2/d) and intravenous (IV) etoposide (100 mg/m2/d) for 2 days every 4 weeks.

Brain metastases from fallopian tube carcinoma responsive to intra-arterial carboplatin and intravenous etoposide: a case report.

Fallopian tube carcinoma is the least common neoplasm of the female genital tract. Although rare, neurological complications such as brain metastases can develop. It remains unclear, however, what role chemotherapy has in the treatment of these patients and what route of administration is most effective.