Effectiveness of fosfomycin-based antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: A Korean multicenter study.

PURPOSE: Recent studies have highlighted increasing infectious complications due to fluoroquinolone (FQ)-resistant organisms in men undergoing transrectal ultrasound-guided prostate biopsy (TRUSPB). This study investigated whether fosfomycin (FM)-based antibiotic prophylaxis reduces infections after TRUSPB and identified risk factors for infective complications. MATERIALS AND METHODS: A multicenter study was conducted in the Republic of Korea from January 2018 to December 2021. Patients undergoing prostate biopsy with FQ or FM-based prophylaxis were included. The primary outcome was the post-biopsy infectious complication rate after FQ (group 1) or FM-based antibiotic prophylaxis with FM alone (group 2) or FQ and FM (group 3). Risk factors for infectious complications after TRUSPB were secondary outcomes. RESULTS: Patients (n=2,595) undergoing prostate biopsy were divided into three groups according to the type of prophylactic antibiotics. Group 1 (n=417) received FQ before TRUSPB. Group 2 (n=795) received FM only and group 3 (n=1,383) received FM and FQ before TRUSPB. The overall post-biopsy infectious complication rate was 1.27%. The infectious complication rates were 2.4%, 1.9%, and 0.5% in groups 1, 2, and 3, respectively (p=0.002). In multivariable analysis, predictors of post-biopsy infectious complications included an association with health care utilization (adjusted odds ratio [OR], 4.66; 95% confidence interval [CI], 1.74-12.4; p=0.002) and combination antibiotic prophylaxis (FQ and FM) (adjusted OR, 0.26; 95% CI, 0.09-0.69; p=0.007). CONCLUSIONS: In comparison with monotherapy with FM or FQ, combination antibiotic prophylaxis (FQ and FM) showed a lower rate of infectious complications after TRUSPB. Utilization of health care was an independent risk factor for infectious complications after TRUSPB.

The Positive Effects of Cancer Survivor Support Service on Distress in South Korea: A Nationwide Prospective Study.

BACKGROUND AND AIM: Cancer survivors are gradually increasing, however, they suffer from various difficulties. We aimed to investigate the characteristics of cancer survivors and the effects of the services of the Korean Cancer Survivorship Center Pilot Project launched by the South Korean government on distress. METHODS: A prospective observational cohort study was performed on cancer survivors who completed primary treatment. Cancer survivors' distress and symptoms such as fatigue, pain, depressive mood, anxiety, and insomnia were evaluated by well-trained nurses. Regarding their needs, medical and psychosocial support services were provided. RESULTS: This study included 1,921 cancer survivors, with a mean age of 57.3 years (68.7% females). Breast cancer was most common, followed by stomach and colorectal cancer. Psychosocial and medical support decreased the percentage of the high-distress group from 50.9 to 30.5% and decreased the percentage of cancer survivors with high scores in fatigue, pain, anxiety, depressive mood, and insomnia. The independent predictors of a low distress level after the use of the services were older age, the relief of fatigue, pain, and insomnia. CONCLUSION: This study showed that psychosocial and medical support is associated with the lower distress and physical and mental symptoms of cancer survivors. Psychosocial and medical support could contribute to distress relief in cancer survivors. Further management strategies for fatigue, pain and insomnia are required.

Community Care for Cancer Patients in Rural Areas: An Integrated Regional Cancer Center and Public Health Center Partnership Model.

Purpose: The accessibility of medical facilities for cancer patients affects both their comfort and survival. Patients in rural areas have a higher socioeconomic burden and are more vulnerable to emergency situations than urban dwellers. This study examined the feasibility and effectiveness of a cancer care model integrating a regional cancer center (RCC) and public health center (PHC). Methods: This study analyzed the construction of a safety care network for cancer patients that integrated an RCC and PHC. Two public health institutions (an RCC in Gyeongnam and a PHC in Geochang County) collaborated on the development of the community care model. The study lasted 13 months beginning in February 2019 to February 2020. Results: The RCC developed the protocol for evaluating and measuring 27 cancer-related symptoms, conducted education for PHC nurses, and administered case counseling. The staff at the PHC registered, evaluated, and routinely monitored patients through home visits. A smartphone application and regular video conferences were incorporated to facilitate mutual communication. In total, 177 patients (mean age 70.9 years; men 59%) were enrolled from February 2019 to February 2020. Patients' greatest unmet need was the presence of a nearby cancer treatment hospital (83%). In total, 28 (33%) and 44 (52%) participants answered that the care model was very helpful or helpful, respectively. Conclusion: We confirmed that a combined RCC-PHC program for cancer patients in rural areas is feasible and can bring satisfaction to patients as a safety care network. This program could mitigate health inequalities caused by accessibility issues.

The Effectiveness of Cystography-Measured Bladder Neck Elevation at Predicting the Return of Continence After Robot-Assisted Radical Prostatectomy.

PURPOSE: To analyze the clinical parameters correlated with early recovery of urinary continence after radical prostatectomy, with a focus on urethral mobility during pelvic contraction at catheter removal. METHODS: We prospectively analyzed 67 patients who underwent prostatectomy for prostate cancer at Jeju National University Hospital from January 2015 to June 2018. At the time of catheter removal, a cystography was performed in 67 men (median age, 65 years; range, 55-76 years) who had undergone robot-assisted laparoscopic prostatectomy. The vertical length of bladder neck movement between relaxing and contracting the pelvic muscles was measured. The correlation between the rate of continence recovery and the length of urethral movement was also assessed. All participants were divided into 2 groups according to the length of bladder neck elevation. Group 1 had ≥0.6 cm of elevation, while group 2 demonstrated <0.6 cm of elevation. RESULTS: A reverse correlation existed between the length of urethral movement and the recovery rate of urinary continence (r=-0.488, P<0.001). The optimal cutoff value for length of urethral movement was found to be 0.6 cm among patients (area under the curve, 0.703). A statistically significant difference was observed between group 1 (length≥0.6 cm) and group 2 (<0.6 cm) (P<0.05). Multivariate regression analysis showed that urethral movement predicted the postoperative urinary incontinence. CONCLUSION: The extent of bladder neck elevation after robot-assisted laparoscopic prostatectomy, which can be easily evaluated using cystography, may be a good predictor of the recovery of urinary continence.

Effectiveness of Bi-Parametric MR/US Fusion Biopsy for Detecting Clinically Significant Prostate Cancer in Prostate Biopsy Naïve Men.

PURPOSE: To explore the effect of bi-parametric MRI-ultrasound (MR/US) fusion prostate biopsy on the detection of overall cancer and significant prostate cancer (sPCa). MATERIALS AND METHODS: We examined 140 patients with suspected prostate cancer lesions on MRI from August 2016 to March 2018. All patients had undergone 3T pre-biopsy bi-parametric (T2 weighted and diffusion-weighted) prostate MRI (bpMRI), and their MRI images were evaluated with Prostate Imaging Reporting and Data System (PI-RADS) version 2.0. MR/US fusion targeted prostate biopsy was performed for lesions with a PI-RADS score ≥3 before systemic biopsy. The results of targeted and systemic biopsy were evaluated in regards to detection rate according to PI-RADS score. RESULTS: Of the patients (mean age=67.2 years, mean prostate-specific antigen level=8.1 ng/mL), 66 (47.1%) and 37 (26.4%) patients were diagnosed with cancer and significant prostate cancer, respectively. The rate of positive targeted biopsy increased with higher PI-RADS score (3: 40.4%, 4: 56.7%, 5: 90.0%). The proportion of significant prostate cancer among positive target lesions was 65.3% (32/49). CONCLUSION: bpMRI is a feasible tool with which to identify sPCa. MR/US fusion biopsy, rather than systemic biopsy, can help identify sPCa. We recommend using supplemental tools to increase prostate cancer detection in patients with PI-RADS 3 lesions.

SIRT-1 regulates TGF-ß-induced dermal fibroblast migration via modulation of Cyr61 expression.

SIRT1 is a NAD-dependent protein deacetylase that participates in cellular regulation. The increased migration of fibroblasts is an important phenotype in fibroblast activation. The role of SIRT1 in cell migration remains controversial as to whether SIRT1 acts as an activator or suppressor of cell migration. Therefore, we have established the role of SIRT1 in the migration of human dermal fibroblasts and explored targets of SIRT1 during dermal fibroblast migration. SIRT1 and Cyr61 were expressed in human dermal fibroblasts and the stimulation with TGF-ß further induced their expression. Treatment with resveratrol (RSV), a SIRT1 agonist, or overexpression of SIRT1 also promoted the expression Cyr61 in human dermal fibroblasts, whereas the inhibition of SIRT1 activity by nicotinamide or knockdown of SIRT1 decreased the level of Cyr61, as well as TGF-ß or RSV-induced Cyr61 expression. Blocking of ERK signaling by PD98509 reduced the expression of Cyr61 induced by TGF-ß or RSV. TGF-ß, RSV, or SIRT1 overexpression enhanced ß-catenin as well as Cyr61 expression. This stimulation was reduced by the Wnt inhibitor XAV939. RSV increased migration and nicotinamide attenuated RSV-induced migration of human dermal fibroblasts. Furthermore, SIRT1 overexpression promoted cell migration, whereas blocking Cyr61 attenuated SIRT1-stimulated migration of human dermal fibroblasts. SIRT1 increased cell migration by stimulating Cyr61 expression and the ERK and Wnt/ß-catenin signaling. SIRT1-induced Cyr61 activity is very important for human dermal fibroblasts migration.

A Study of Clinical Predictors Associated With Intrinsic Sphincter Deficiency in Women With Stress Urinary Incontinence.

PURPOSE: Recently, intrinsic sphincter deficiency (ISD) has been identified as one important factor in the outcome of stress urinary incontinence (SUI) related surgery. Clinical factors that can predict ISD are uncommon. The aim of this study was to determine predictive clinical factors for ISD in female patients with SUI. METHODS: The patients were classified into 3 groups according to the value of Valsalva leak point pressure (VLPP)>90 cm H2O (anatomical incontinence, AI), between 61 and 90 cm H2O (equivocal, EV), and <60 cm H2O (ISD). All groups underwent a full examination, history evaluation, physical examination, uroflowmetry, and complete urodynamic study. Univariate analysis was performed by chi-square or t-test for categorical variables, respectively. A multivariate study was performed by Pearson correlation analysis in order to get clinical predictors of VLPP<60 cm H2O. Statistical significance was set at P<0.05. RESULTS: There were 3 groups with a total of 189 patients: 56 patients (AI, 29.7%), 64 patients (EV, 33.8%), and 69 patients (ISD, 36.5%). The univariate analysis revealed a significant difference associated with maximal urethral closing pressure (P=0.03) and Stamey classification (P=0.006) between ISD and AI. The more severe the urinary symptom grade, the higher the frequency of ISD. However, the multivariate analysis showed the independent predictor of ISD is only present in grades II and III symptoms in the Stamey classification (P=0.001). CONCLUSIONS: It was found that the more severe the symptoms of urinary incontinence, the higher the possibility of ISD. In other words, the degree of urinary incontinence was found to be one relevant clinical factor in predicting ISD. This finding may help in evaluating and identifying the appropriate surgical technique for EV. Currently, absolute cutoff value to diagnose ISD has not yet been determined. More research is needed to identify clinical factors that can predict ISD.

TMF and glycitin act synergistically on keratinocytes and fibroblasts to promote wound healing and anti-scarring activity.

Keratinocyte-fibroblast interactions are critical for skin repair after injury. During the proliferative phase of wound healing, proliferation, migration and differentiation of these cells are the major mechanisms leading to tissue remodeling. We have previously reported that glycitin, a major soy isoflavone, stimulates dermal fibroblast proliferation; and the phytochemical, 4',6,7-trimethoxyisoflavone (TMF), induces migration of HaCaT keratinocyte cells. We therefore investigated whether these compounds display synergistic effects on skin cells during wound healing in vitro and in vivo. Co-treatment with TMF and glycitin synergistically promotes the proliferation and migration of both keratinocytes and dermal fibroblasts, with a 1:1 ratio of these compounds showing the greatest efficacy in our co-culture system. This keratinocyte-fibroblast interaction occurred via the secretion of TGF-ß, and the induction of differentiation and proliferation was confirmed in both indirect and direct co-culture assays. In an excisional and burn wound animal model, mice treated with a 1:1 ratio of TMF and glycitin showed faster wound closure, regeneration and scar reduction than even the positive control drug. These data indicate that two isoflavones, TMF and glycitin, act synergistically to promote wound healing and anti-scarring and could potentially be developed together as a bioactive therapeutic for wound treatment.

Attitudes towards second opinion services in cancer care: a nationwide survey of oncologists in Korea.

OBJECTIVE: Second opinion is a common phenomenon in many health systems, especially in the care of patients with cancer. However, it is not clear whether second opinion seeking should be promoted or discouraged and how second opinion services and policies can be better formalized to maximize the benefits and minimize the disadvantages. METHODS: A nationwide survey was conducted with a representative sample of 678 physicians involved in cancer care (75.5% participation rate) recruited in 13 cancer centres. RESULTS: Most physicians involved with cancer care perceived patients' second opinion seeking as a legitimate right (96.0%) and they acknowledged the need for second opinion services under certain conditions (98.2%). Many believed that second opinions can enhance patient satisfaction (77.3%) and quality of care (74.3%), but they also had concerns about increase in healthcare and societal costs (91.3%) and concentration in a high-volume centre (90.7%). While the majority agreed with the involvement of the first opinion physicians in the second opinion services (69.5%), there were mixed opinions regarding the desirability of remote (teleconsultation) second opinion services (49.0%) and coverage by national health insurance (51.9%). CONCLUSION: Physicians were generally positive to second opinion services and expected positive consequences in terms of patient satisfaction and quality of care. However, they had concerns about the consequences regarding cost and equity, and disagreements were observed regarding the way to improve second opinion services. The physicians' opinions revealed in our study will be helpful in developing clearer guidelines used to maximize the benefits of second opinion services.

The Testis Completely Replaced by a Huge Epidermal Cyst in an Older Man.

Epidermal cysts are commonly encountered, slow-growing superficial cysts in the hair-bearing areas of the body, and are usually discovered in the second and fourth decades of life. These cysts tend to be superficial, meaning that they can be easily found by ultrasound and digital palpation at a moderate degree of growth. However, we found a huge testicular cyst that went undetected until old age. In this report, we describe the interesting case of a patient in whom the right testis was totally replaced with an epidermal cyst. The cyst was found by ultrasonography and further evaluated with magnetic resonance imaging. We performed orchiectomy under the impression of an epidermal cyst. The pathologic report confirmed this clinical impression. Over 24 months of follow-up, we did not find any recurrence of a growing mass on the testis.

The Practicality of Targeted Prostate Biopsy Procedures on the Dominant Side of the Tumor Determined by Magnetic Resonance Imaging in Elderly Patients with High Serum Levels of Prostate-Specific Antigen.

PURPOSE: To examine the possibility of reducing the number of cores per prostate biopsy in elderly patients with high levels of prostate-specific antigen (PSA) without significantly lowering the detection rate of prostate cancer. MATERIALS AND METHODS: Two hundreds sixteen men with PSA levels >20 ng/mL who underwent prostate biopsies from May 2009 to April 2013 were retrospectively reviewed. With the help of magnetic resonance imaging (MRI), the laterality of the dominant tumor burden in patients was determined. The results of targeted biopsies were compared with those of conventional biopsy procedures. RESULTS: The mean age and PSA level were 79.5 years and 81.3 ng/mL, respectively, and the overall diagnostic rate of sextant biopsies was 81.9% (177/216). MRI was able to show the tumor burden in 189 of the 216 patients. The detection rate of transrectal ultrasonography (TRUS)-guided targeted biopsies was 87.3% (165/189). Detection rates were comparable with conventional biopsies (81.9% [177/216]) (p=0.23). Of the 177 men in whom the results of the sextant biopsy were positive, 12 men (6.8%) with PSA levels <29 ng/mL did not have any cancer cells according to targeted biopsies. However, all other patients were diagnosed with prostate cancer using the abovementioned techniques. CONCLUSIONS: We believe that TRUS-guided targeted biopsies of the prostate in elderly men with high PSA levels could reduce the number of unnecessary cores per biopsy. However, a risk of detection loss remains. Therefore, we recommend that at least a sextant biopsy should be performed, even in elderly patients, in order to detect prostate cancer.

A nationwide epidemiological study of testicular torsion in Korea.

Testicular torsion is a surgical emergency in the field of urology. Knowledge of the epidemiology and pathophysiology is significant to an urologist. However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. From 2006-2011, the Korean Urologic Association began the patient registry service. The annual number of patients with testicular torsion from 2006 to 2011 were 225, 250, 271, 277, 345, and 210, respectively. The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. Adolescents showed the highest incidence. Total testicular salvage rate was 75.7% in this survey. There was no geographic difference of testicular salvage rate. Minimizing the possibility of orchiectomy for testicular torsion is important to improve public awareness to expedite presentation and provider education to improve diagnosis and surgery.

Discordance between perceived and actual cancer stage among cancer patients in Korea: a nationwide survey.

PURPOSE: We assessed the accuracy of communication between doctors and patients by evaluating the consistency between patient perception of cancer stage and the medical records, and analyzed the most influential factors of incongruence among cancer patients at 10 cancer centers across Korea. METHODS: Information was gathered from cancer patients at the National Cancer Center and nine regional cancer centers located in every province of Korea between 1 July 2008 and 31 August 2008. Data were analyzed using Pearson's χ2 test and multivariate logistic regression analysis. RESULTS: The stages of cancer reported by the 1,854 patients showed a low degree of congruence with the stages given in medical records (k = 0.35, P<0.001). Only 57.1% of the patients had accurate knowledge of their cancer stage. In total, 18.5% underestimated their stage of disease, and the more advanced the cancer stage, the more likely they were to underestimate it, in order of local (14.2%), regional (23.7%), and distant (51.6%). Logistic regression analysis showed that congruence was lower in patients with cervical cancer (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.30-0.87), recurrence (OR = 0.64, 95% CI = 0.50-0.83), and treatment at the National Cancer Center (OR = 0.53, 95% CI = 0.39-0.72). CONCLUSION: There are knowledge gaps between patients' perceived and actual stage of cancer. Patients with cervical cancer, recurrence, and who received treatment at a regional cancer center showed less understanding of their cancer stage.

Diagnosis of a gastrointestinal stromal tumor presenting as a prostatic mass: a case report.

Gastrointestinal stromal tumors (GISTs) are an unusual and heterogeneous group of spindle cell tumors that can also appear on the exterior of the gastrointestinal tract (extra-GISTs). Despite the fact that extra-GISTs or large rectal GISTs can lead to the clinical impression of a prostatic mass, these tumors are, in general, excluded in the differential diagnosis of spindle cell tumors observed on prostate needle biopsy. Here, we present, in detail, a case of an extra-GIST identified on prostatic biopsy; the tumor was previously believed to be a primary prostatic stromal sarcoma in the differential diagnosis. Every investigator should check for KIT (CD117) in immunohistochemical staining to rule out an extra-GIST prior to diagnosing a solitary prostatic tumor, specialized prostatic stromal tumor, or leiomyosarcoma on prostate needle biopsy.

Intrascrotal and extratesticular multiple schwannoma.

Schwannoma, which may occur in any region of the body, is very rare in the scrotum. Schwannomas are tumors that originate from Schwann cells and, theoretically, could affect any nerve. In spite of the rich innervation of the genital area, these kinds of tumors are not common in the scrotum. A 67-year-old man visited our hospital for investigation of a 2-year episode of multiple slowly growing masses in the scrotum. Testicular tumor markers were within normal range (beta human chorionic gonadotropin <5 mIU, α-fetoprotein : 4.86 ng/ml). Scrotal ultrasonography revealed intrascrotal and extratesticular masses in the mid-scrotal region. Complete excision of the scrotal masses was performed. After surgery there was no testicular invasion. Histological examination of the resected specimen showed them to be schwannomas of the scrotum. We report one case of multiple schwannomas of the scrotum with a review of the literature.

Prevalence of Benign Prostatic Hyperplasia on Jeju Island: Analysis from a Cross-sectional Community-based Survey.

PURPOSE: We report on the prevalence of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among men of Jeju Island, representing a coastal and insular area, using a cross-sectional community-based survey. MATERIALS AND METHODS: A total of 553 participants in a prostate health screening campaign on Jeju Island were subjected to measurements of the International Prostate Symptom Score (IPSS), prostate volume, uroflowmetry, postvoiding residual urine volume, and prostate-specific antigen levels. Eliminating 58 participants who were suspected of having prostate cancer, we analyzed the data from 495 participants. The definition of BPH was a combination of moderate IPSS (8~19) to severe IPSS (>19) and prostate enlargement (>30 g on transrectal ultrasonography). RESULTS: The prevalence of BPH was 21.0% overall: 11.6% among subjects aged 50~59 years, 18.1% for those aged 60~69, 30.8% for those aged 70~79 and 50.8% among those aged 80 years or more. Compared with previous studies in urban or rural areas, the prevalence was slightly lower. The prevalence of BPH and of moderate to severe LUTS increased with age and showed significant differences between age groups (p=0.028 and 0.033, respectively). A positive correlation was found between the IPSS and quality of life score. Among subunits of IPSS, the nocturia score contributed most to the severity of LUTS and had the highest correlation with a quality of life score. CONCLUSIONS: The overall prevalence of BPH in this study was 21.0%, which is slightly lower than in previous studies in urban or rural areas.

A case of pediatric paratesticular rhabdomyosarcoma with epididymitis.

Paratesticular rhabdomyosarcoma is a rare malignancy arising from the mesenchymal tissues of the spermatic cord, epididymis, testis, and testicular tunica, and accounts for approximately 7% of all rhabdomyosarcomas. It often occurs in children but is known to have a better prognosis than disease at other urogenital sites. Patients typically present with painless unilateral scrotal swelling like a solid testicular tumor. However, we report an unusual case of delayed diagnosis of paratesticular rhabdomyosarcoma accompanied by epididymitis manifesting an painful scrotal swelling.

Molecular aspects of renal cell carcinoma: a review.

Renal cell carcinoma (RCC) is a disease in which cancer cells form in the tubules of the kidney. RCC, the incidence of which is increasing annually, represents five percent of adult epithelial cancers. Clear cell carcinoma represents the most frequent histological subtype. RCC is characterized by a lack of early warning signs, diverse clinical manifestations. Incidentally detected tumors in asymptomatic individuals have been steadily increasing owing to the increased usage of various imaging technologies. Currently there are no recommendations for screening to detect and make an early diagnosis of renal cancer. But in recent years, the discovery of new molecular and cytogenetic markers has led to the recognition and classification of several novel subtypes of RCC, and the introduction of molecular-targeted therapy for advanced-stage RCC. We performed a literature review using PubMed and discuss current knowledge of epidemiology, pathophysiology, evaluation, treatment, and future research directions of RCC.

Initial experience of a novel ergonomic surgical chair for laparoscopic pelvic surgery.

INTRODUCTION: We present the initial experience of a novel surgical chair for laparoscopic pelvic surgery, the ETHOS™ (Bridge City Surgical, Portland, OR). MATERIALS AND METHODS: The ETHOS chair has an adjustable saddle height that ranges from 0.89 to 1.22 m high, an overall width of 0.89 m, and a depth of 0.97 m. The open straddle is 0.53 m and fits most OR tables. We performed 7 pelvic laparoscopy cases with the 1st generation ETHOS™ platform including 2 laparoscopic ureteral reimplantations, 5 laparoscopic pelvic lymphadenectomies for staging prostate cancer in which one case involved a laparoscopic radical retropubic prostatectomy, performed by 2 different surgeons. RESULTS: All 7 pelvic laparoscopic procedures were successful with the ETHOS™ chair. No conversion to open surgery was necessary. Survey done by surgeons after the procedures revealed minimal stress on back or upper extremities by the surgeons from these operations even when surgery was longer than 120 minutes. Conversely, the surgical assistants still had issues with their positions since they were on either sides of the patient stressing their positions during the procedure. CONCLUSION: The ETHOS chair system allows the surgeon to operate seated in comfortable position with ergonomic chest, arms, and back supports. These supports minimize surgeon fatigue and discomfort during pelvic laparoscopic procedures even when these procedures are longer than 120 minutes without consequence to the patient safety or detrimental effects to the surgical team.

Initial experience of a novel ergonomic surgical chair for laparoscopic pelvic surgery

INTRODUCTION: We present the initial experience of a novel surgical chair for laparoscopic pelvic surgery, the ETHOS TM (Bridge City Surgical, Portland, OR). MATERIALS AND METHODS: The ETHOS chair has an adjustable saddle height that ranges from 0.89 to 1.22 m high, an overall width of 0.89 m, and a depth of 0.97 m. The open straddle is 0.53 m and fits most OR tables. We performed 7 pelvic laparoscopy cases with the 1st generation ETHOS TM platform including 2 laparoscopic ureteral reimplantations, 5 laparoscopic pelvic lymphadenectomies for staging prostate cancer in which one case involved a laparoscopic radical retropubic prostatectomy, performed by 2 different surgeons. RESULTS: All 7 pelvic laparoscopic procedures were successful with the ETHOS TM chair. No conversion to open surgery was necessary. Survey done by surgeons after the procedures revealed minimal stress on back or upper extremities by the surgeons from these operations even when surgery was longer than 120 minutes. Conversely, the surgical assistants still had issues with their positions since they were on either sides of the patient stressing their positions during the procedure. CONCLUSION:The ETHOS chair system allows the surgeon to operate seated in comfortable position with ergonomic chest, arms, and back supports. These supports minimize surgeon fatigue and discomfort during pelvic laparoscopic procedures even when these procedures are longer than 120 minutes without consequence to the patient safety or detrimental effects to the surgical team.