Clinical Use of Expanded Prostate Cancer Index Composite for Clinical Practice to Assess Patient Reported Prostate Cancer Quality of Life Following Robot-Assisted Radical Prostatectomy.

PURPOSE: EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) is a short questionnaire that comprehensively measures patient reported health related quality of life at the point of care. We evaluated the feasibility of using EPIC-CP in the routine clinical care of patients with prostate cancer without research infrastructure. We compared longitudinal patient and practitioner reported prostate cancer outcomes. MATERIALS AND METHODS: We reviewed health related quality of life outcomes in 482 patients who underwent radical prostatectomy at our institution from 2010 to 2014. EPIC-CP was administered and interpreted in routine clinical practice without research personnel. We compared practitioner documented rates of incontinence pad use and functional erections to patient reported rates using EPIC-CP. RESULTS: A total of 708 EPIC-CP questionnaires were completed. Mean urinary incontinence domain scores were significantly higher (worse) than baseline (mean ± SD 0.6 ± 0.2) 3 and 6 months after treatment (mean 3.1 ± 2.3 and 2.2 ± 2.1, respectively, each p <0.05) but they returned to baseline at 12 months (mean 1.6 ± 1.7, p >0.05). Mean sexual domain scores were significantly worse than baseline (mean 2.4 ± 2.8) at all posttreatment time points (each p <0.05). Practitioners significantly overestimated incontinence pad-free rates at 3 months (48% vs 39%) and functional erection rates at 3 months (18% vs 12%), 6 months (38% vs 23%) and 12 months (45% vs 23%, each p <0.05). CONCLUSIONS: EPIC-CP is feasible to use in the routine clinical care of patients with prostate cancer without requiring a research infrastructure. Using EPIC-CP in clinical practice may help practitioners objectively assess and appropriately manage posttreatment side effects in patients with prostate cancer.

Experience with a new energy source for tissue fusion in pediatric patients.

INTRODUCTION: Options for effective techniques for vessel and tissue sealing in infants and children are limited because of the size and limited intracorporeal space of many pediatric patients. We evaluated a new energy source, the ForceTriad (Covidien, West Windsor, NJ) LigaSure, which delivers both mono- and bipolar energy in a 5-mm format and allows for tissue fusion and vessel sealing and division. This report documents our experience with this device. METHODS: A database review was performed, looking for all cases that were performed in children using the ForceTriad LigaSure as the main source of hemostasis and tissue fusion. Two different handpieces were used a fine Maryland dissector-type instrument with no cutting blade, and a sealer/cutter, both in a 5-mm format. RESULTS: A total of 60 cases were performed in children from September 2006 to September 2007, using the ForceTriad. The two most common cases were Nissen fundoplication (40 cases; weight: 8.5-95 kg [average,40.7]; operating room [OR] time: 15-70 min [average, 32]; average days to full feeds: 2) and lung lobectomy (11)cases (weight: 4.6-63 kg [average, 27.3]; OR time: 60-180 min [average, 123]; average hospital days: 3.1). Other procedures included, excision of choledochal cyst (3), aortopexy, closure of bronchopleural fistula, nephrectomy(1), thymectomy (1), parathyroid adenoma excision (1), total colectomy (2), and intestinal duplication resection(2). There were no failures of vessel or tissue fusion and no operative complications. A delayed hydropneumothorax developed in 1 lung resection and spontaneously resolved. CONCLUSION: The ForceTriad provides a safe, effective energy source in a 5-mm format. As compared to previous versions of the LigaSure, there was less sticking, a quicker seal, and no tissue-fusion failures.

Robotic Surgery of the Kidney, Bladder, and Prostate.

Robot-assisted surgery offers the advantages of a minimally invasive approach with greater technical ease and a shorter learning curve than pure laparoscopy. Fueled by the success of the robot-assisted laparoscopic prostatectomy, urologists are increasingly using the robotic platform for other advanced operations involving the kidney, ureters, bladder, and prostate. Robotic surgery has been shown to be safe and effective, with good perioperative, functional, and oncologic outcomes. Although cost continues to be a major concern regarding the use of robotic technology, improved efficiency and reduced hospital stays associated with the minimally invasive approach are allowing for better cost-effectiveness.

Use of operative laparoscopes in single-port surgery: The forgotten tool.

Single-port surgery is an emerging advancement in the field of minimally invasive surgery. Several different techniques and tools have been developed to decrease the invasiveness of various operations. Amongst these new developments, many general surgeons have overlooked an important tool, the operative laparoscope. These telescopes reduce the number of ports placed during minimally invasive operations by providing both visualization and operative channels to accommodate instruments. We have described several simple techniques that employ the operative laparoscope to reduce the number of incisions in laparoscopic surgery with good outcomes. Single-port surgery has been shown to be safe and effective and may someday replace traditional laparoscopy in the performance of minimally invasive operations.

Costal osteochondroma causing pneumothorax in an adolescent: a case report and review of the literature.

Costal osteochondroma is a rare but important condition to recognize because of the possibility of serious consequences if not diagnosed and treated promptly. Patients can present with numerous complications, including hemothorax, pneumothorax, nervous or vascular impingement, and fracture. We report the case of a 17-year-old adolescent boy who presented to the pediatrician with intermittent shortness of breath and pleuritic chest pain. A chest x-ray demonstrated a left-sided pneumothorax and triangular opacity in the left chest. A computed tomographic scan of the chest revealed the cause to be a costal exostosis of the anterior fifth rib. The lesion was excised using video-assisted thoracoscopic surgery, which has become an increasingly popular method for treating these lesions, causing significantly less morbidity and allowing for a faster recovery than a major thoracotomy.

Acute colonic pseudoobstruction in a child with sickle cell disease treated with neostigmine.

Sickle cell disease is a disorder that produces significant morbidity and mortality. Vaso-occlusive pain crises are the most common presenting symptom associated with sickle cell patients. A rare, yet important to recognize, complication of sickle cell disease is acute colonic pseudoobstruction, also known as Ogilvie's syndrome. These patients may present with symptoms that are difficult to distinguish from other etiologies of abdominal pain, but a thorough diagnostic workup can provide important clues. Furthermore, there is no agreement on optimal treatment of pseudoobstruction. We report the first pediatric case of acute pseudoobstruction secondary to sickle cell disease that was treated successfully with neostigmine. Early recognition of this phenomenon is important as it alters patient management, can be treated medically, and may avoid unnecessary surgical intervention.