Case series: Inflammatory myofibroblastic bladder tumor in regional Australia.

INTRODUCTION AND IMPORTANCE: Inflammatory myofibroblastic tumor (IMT) is a rare tumor subtype that affects multiple organ systems. This case series adds a regional perspective to the literature, demonstrating rare urological cancers can be managed excellently in regional settings. CASE PRESENTATION: We report a case series of two patients in regional Australia who were diagnosed with IMT of the urinary bladder. Both patients received computed tomography (CT) and ultrasound (US) imaging to investigate lower urinary tract symptoms (LUTS). Following initial diagnosis of a bladder tumor, both patients underwent surgery, one having a transurethral resection of bladder tumor (TURBT) with the other receiving a partial cystectomy. Histology from both surgeries revealed IMT of the urinary bladder, with the first case going on to receive a partial cystectomy to ensure clear surgical margins. Both patients recovered well post-operatively, with CT cystograms revealing water-tight bladders. Initial follow up reveals no recurrence of disease. CLINICAL DISCUSSION: IMT of the urinary bladder is an exceedingly rare clinical entity which is fortunately benign and can be well managed with appropriate surgical intervention. CONCLUSION: IMT can be well managed in regional hospitals equipped with appropriate surgical, pathological and oncological services.

Robotic and open radical prostatectomy in the public health sector: cost comparison.

BACKGROUND: During 2008, the Royal Brisbane and Women's Hospital became the first public hospital in Australia to have a da Vinci Surgical Robot purchased by government funding. The cost of performing robotic surgery in the public sector is a contentious issue. This study is a single centre, cost analysis comparing open radical prostatectomy (RRP) and robotic-assisted radical prostatectomy (RALP) based on the newly introduced pure case-mix funding model. METHODS: A retrospective chart review was performed for the first 100 RALPs and the previous 100 RRPs. Estimates of tangible costing and funding were generated for each admission and readmission, using the Royal Brisbane Hospital Transition II database, based on pure case-mix funding. RESULTS: The average cost for admission for RRP was A$13 605, compared to A$17 582 for the RALP. The average funding received for a RRP was A$11 781 compared to A$5496 for a RALP based on the newly introduced case-mix model. The average length of stay for RRP was 4.4 days (2-14) and for RALP, 1.2 days (1-4). The total cost of readmissions for RRP patients was A$70 487, compared to that of the RALP patients, A$7160. These were funded at A$55 639 and A$7624, respectively. CONCLUSIONS: RALP has shown a significant advantage with respect to length of stay and readmission rate. Based on the case-mix funding model RALP is poorly funded compared to its open equivalent. Queensland Health needs to plan on how robotic surgery is implemented and assess whether this technology is truly affordable in the public sector.

Robotic-assisted laparoscopic pyeloplasty: initial Australasian experience.

Laparoscopic dismembered pyeloplasty has a success rate in excess of 90% for the treatment of uretero-pelvic junction (UPJ) obstruction. Laparoscopic intracorporeal suturing, however, remains technically challenging and may lead to prolonged operating times. Robotic-assisted suturing using the da Vinci(®) surgical system (Intuitive Surgical, CA, USA) may reduce the difficulty associated with intra-corporeal suturing. The da Vinci(®) surgical system was used to facilitate intra-corporeal suturing in adults undergoing trans-peritoneal robotic-assisted laparoscopic pyeloplasty (RALPY) at our institution. Initially, the robot was only docked for the anastomosis, but in the later part of the series the robot was used for all parts of the dissection and reconstruction. Peri-operative and outcome data were recorded prospectively. Twenty-four patients underwent RALPY over a 4-year period. The mean age was 46.6 (range 18-76) years. The mean total operative time was 211 min (range 150-317 min) with an anastomotic time of 44 min (range 30-55 min). The mean estimated blood loss was 56 ml (10-150 ml) and there was one temporary urine leak managed by 24 h of urethral catheterization. The median length of stay was 4 (2-10) days. Patients underwent diuretic renography at 6 months post surgery, and satisfactory renal drainage was demonstrated in all cases. RALPY is a feasible and safe option for the management of UPJ obstruction. This technology may reduce the difficulty associated with complex laparoscopic suturing and facilitate shorter operative times with excellent outcomes. This is now our preferred approach for all patients opting for surgical management of UPJ obstruction.

Robotic technology in surgery: current status in 2008.

There is increasing patient and surgeon interest in robotic-assisted surgery, particularly with the proliferation of da Vinci surgical systems (Intuitive Surgical, Sunnyvale, CA, USA) throughout the world. There is much debate over the usefulness and cost-effectiveness of these systems. The currently available robotic surgical technology is described. Published data relating to the da Vinci system are reviewed and the current status of surgical robotics within Australia and New Zealand is assessed. The first da Vinci system in Australia and New Zealand was installed in 2003. Four systems had been installed by 2006 and seven systems are currently in use. Most of these are based in private hospitals. Technical advantages of this system include 3-D vision, enhanced dexterity and improved ergonomics when compared with standard laparoscopic surgery. Most procedures currently carried out are urological, with cardiac, gynaecological and general surgeons also using this system. The number of patients undergoing robotic-assisted surgery in Australia and New Zealand has increased fivefold in the past 4 years. The most common procedure carried out is robotic-assisted laparoscopic radical prostatectomy. Published data suggest that robotic-assisted surgery is feasible and safe although the installation and recurring costs remain high. There is increasing acceptance of robotic-assisted surgery, especially for urological procedures. The da Vinci surgical system is becoming more widely available in Australia and New Zealand. Other surgical specialties will probably use this technology. Significant costs are associated with robotic technology and it is not yet widely available to public patients.