Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 717
Filtrar
1.
Urology ; 135: 171-172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589882

RESUMO

OBJECTIVE: To demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely. METHODS: Enucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance. RESULTS: The distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder. CONCLUSION: This video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Terapia a Laser/métodos , Morcelação/métodos , Prostatectomia/métodos , Bexiga Urinária/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/etiologia , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Masculino , Morcelação/efeitos adversos , Morcelação/instrumentação , Estudo de Prova de Conceito , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Hiperplasia Prostática/cirurgia , Ultrassonografia , Bexiga Urinária/lesões
2.
J Urol ; 202(4): 795-800, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31009288

RESUMO

PURPOSE: We report our experience with long-term outcomes of holmium laser enucleation of the prostate during a period of 18 years. MATERIALS AND METHODS: We reviewed a prospectively collected database from March 1998 through June 2016 for patients who underwent holmium laser enucleation of the prostate for symptomatic benign prostatic hyperplasia as performed or supervised by a single expert surgeon. Demographic and perioperative data were collected, including scores on the I-PSS (International Prostate Symptom Score), quality of life, peak flow rate, post-void residual urine and prostate specific antigen. Perioperative and late adverse events were also assessed. RESULTS: At a median followup of 9.1 years 1,476 patients with a mean age of 70.7 years were included in study. Mean catheter time and hospital stay were 1.2 and 1.3 days, respectively. Mean ± SD I-PSS and quality of life scores (15.9 ± 6.5 vs 6.8 ± 5.6 and 3.1 ± 1.4 vs 1.5 ± 1.4, respectively, each p <0.001) were significantly improved after holmium laser enucleation of the prostate compared to preoperative values. Likewise the mean peak flow rate and post-void residual urine were significantly improved (mean 7.2 ± 4.0 vs 17.7 ± 10.4 ml per second and 204 ± 258 vs 43 ± 73 ml, respectively, each p <0.001) in the 132 patients who could be followed more than 10 years. Perioperative blood transfusion was required in 0.8% of patients. Prostate specific antigen was significantly reduced by 66.7% at the most recent followup (p <0.001). Postoperative complications included urethral stricture and bladder neck contracture in 21 (1.4%) and 30 patients (2.1%), respectively. Repeat holmium laser enucleation of the prostate was required in 21 patients (1.4%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, effective and durable procedure to treat benign prostatic hyperplasia during long-term followup.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Retenção Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Próstata/efeitos da radiação , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Hiperplasia Prostática/complicações , Qualidade de Vida , Estudos Retrospectivos , Fatores de Tempo , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia
3.
Khirurgiia (Mosk) ; (1): 89-94, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30789615

RESUMO

Robotic surgery is a future method of minimal invasive surgery. Robot-assisted radical prostatectomy (RARP) is a common method of surgical treatment of prostate cancer. Due to significant differences of the surgical technique of RARP compared to open or laparoscopic radical prostatectomy (LRP) new methods of training are needed. At the moment there are many opinions how to train physicians best. Which model is the most effective one remains nowadays controversial. OBJECTIVE: Analyze currently available data of training methods of RARP. Determine the most effective training model and evaluate its advantages and disadvantages. Establish a standardized plan and criteria for proper training and certification of the entire surgical team. MATERIAL AND METHODS: Literature review based on PubMed database, Web of Science and Scopus by keywords: robot-assisted radical prostatectomy, training of robot-assisted prostatectomy, training in robot-assisted operations, a learning curve of robot-assisted prostatectomy, virtual reality simulators (VR-simulators) in surgery. RESULTS: According to the literature in average 18 to 45 procedures are required for a surgeon to achieve the plateau of the learning curve of the RARP. Parallel training, pre-operative warm-up and the use of virtual reality simulators (VR-simulators) can significantly increase the learning curve. There are many described models of RARP training. CONCLUSIONS: The absence of accepted criteria of evaluation of the learning curve does not allow to use this parameter as a guide for the surgeon's experience. Proper training of robotic surgeons is necessary and requires new methods of training. There are different types of training programs. In our opinion the most effective training program is when a surgeon observes the performance of tasks or any steps of operation on the VR-simulator, then he performs them and analyzes mistakes by video recording. Then the surgeon observes real operations and performs some steps of the operation which are already leant on the simulator under supervision of the mentor and analyzes mistakes by video recording. Thus, mastering first the simple stages under supervision of a mentor, the surgeon effectively adopts the surgical experience from him. It is necessary to train not only the surgeons but also the entire surgical team.


Assuntos
Prostatectomia/educação , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/educação , Simulação por Computador , Educação/normas , Humanos , Curva de Aprendizado , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Modelos Educacionais , Equipe de Assistência ao Paciente/normas , Prostatectomia/instrumentação , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Realidade Virtual
4.
J Robot Surg ; 13(2): 215-226, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30019228

RESUMO

To describe the evolution of robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) performed with the daVinci Single-Site Platform® and a home-made multiport aimed to overcome classical drawbacks of LESS, still present with this platform. Between 09/2015 and 06/2017 12 patients underwent R-LESS RP for clinical localized prostate cancer. Following a "phase 1 (development-stage)" innovation, development, exploration, assessment, long-term study (IDEAL) framework, different solutions were drawn to overcome drawbacks of daVinci Single-Site Platform®, included 3 (A, B, and C) multi-ports developed and evaluated in term of advantages/drawbacks concerning ergonomy. The end points of this study were: feasibility, safety, efficacy, by reporting rational description of multiports configuration, demographics, perioperative variables, functional and oncological results. Semi-flexible robotic 5-mm needle-holder instead of Maryland forceps, 30° lenses up and barbed-suture allowed overcoming limits of robotic-platform. Multiport-C (GelPOINT Advanced-Access® and an extra 8-mm robotic trocar outside the multiport) showed the best compromise to ensure both surgeon and bed-side assistant to reproduce a standard robotic procedure. No conversion to either standard robotic or open technique or intraoperative complications occur in any case. Two patients experienced "high-grade" Clavien-Dindo complications. After 12.4 months follow-up, all patients were continent without any sign of biochemical relapse and among 5 preoperative potent patients submitted to nerve-sparing dissection, 4 reported good erectile-function. R-LESS-RP is feasible and safe in the hands of experienced minimally-invasive surgeons. Do date, we recommend a hybrid solution with a home-made multiport and use of an additional standard robotic trocar which allows the use endowrist® technology instruments.


Assuntos
Laparoscopia/instrumentação , Laparoscopia/métodos , Prostatectomia/instrumentação , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Estudos de Viabilidade , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Segurança , Resultado do Tratamento
5.
J Robot Surg ; 13(4): 599-603, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30402726

RESUMO

Minimally invasive radical prostatectomy has rapidly been adopted as the primary means of surgical intervention for prostate cancer. Intraoperative tissue retraction relies on either gravity (via positioning) or use of additional ports and instrumentation. We report the use of a novel trocar-less magnetic retractor system to aid with tissue retraction. Three patients underwent robotic-assisted radical prostatectomy in the treatment of prostatic adenocarcinoma at a single tertiary care institution. All surgeries utilized the Levita™ Magnetic Surgical System (San Mateo, CA) without the use of a fourth robotic arm. The magnetic grasper was used to manipulate the bowel, peritoneum, seminal vesicles, and prostatic capsule. Demographic, pre-operative, and perioperative information were collected. No cases required placement of any additional ports. No intraoperative or immediate post-operative complications occurred. No tissue tearing or subjective tissue damage was noted by placement or removal of the magnetic retractor. Mean operative time was 216 ± 17 min and mean blood loss was 333 ± 57 mL. All patients were discharged to home on post-operative day 1. Robotic prostatectomy utilizing a magnetically anchored tissue grasper appears to be safe and effective while reducing the number of ports (fourth robotic arm) needed. Further investigation is warranted.


Assuntos
Magnetismo , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Humanos , Magnetismo/instrumentação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Próstata/cirurgia , Prostatectomia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação
6.
J Robot Surg ; 13(2): 253-260, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30006861

RESUMO

PURPOSE: Prospective randomized trial to compare standard vs delayed approach to dorsal vascular complex (s-DVC vs d-DVC) in robot-assisted radical prostatectomy (RARP). METHODS: Patients scheduled for RARP were randomized into a 1:1 ratio to receive either s-DVC or d-DVC by two experienced surgeons. In s-DVC arm an eight-shaped single stitch was given at the beginning of the procedure and the DVC was subsequently cut at time of apical dissection; in d-DVC arm the plexus was transected at the end of prostatectomy, prior to apex dissection and then sutured. Primary endpoint was difference in estimated blood loss (EBL) and a sample size of 226 cases was calculated; ad interim analysis was planned after 2/3 of recruitment. RESULTS: Endpoint was reached at ad interim analysis after 162 cases (81 s-DVC, 81 d-DVC) and recruitment was, therefore, interrupted. Baseline and tumor characteristics were overlapping. EBL was significantly higher in d-DVC arm (mean EBL 107 vs 65 ml, p = 0.003), but without differences in post-operative hemoglobin, transfusions and complications. Overall PSM rate was higher in d-DVC arm (21.0 vs 14.8%, p = 0.323), with statistical significance relatively to organ-confined disease (15.5 vs 3.6%, p = 0.031). Apical involvement was instead significantly higher in s-DVC arm (prevalence in PSM patients 66.7 vs 23.5%, p = 0.020). Post-operative PSA, continence and potency rates were similar between groups. CONCLUSIONS: Standard and delayed approaches to DVC are safe and lead to similar functional outcomes. A delayed approach exposes to a higher risk of PSM in organ-confined disease but with a lower risk of apical involvement.


Assuntos
Ligadura/métodos , Próstata/cirurgia , Prostatectomia/instrumentação , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Risco , Fatores de Tempo , Resultado do Tratamento
7.
Transplant Proc ; 50(10): 3978-3983, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577300

RESUMO

OBJECTIVE: Our aim was to evaluate the general applicability, feasibility, and safety of robot-assisted radical prostatectomy (RARP) in Chinese renal allograft patients for prostate cancer removal. PATIENTS AND METHODS: A 62-year-old patient diagnosed as having biopsy-proven localized prostate cancer in March 2016 who had undergone renal transplant 12 years ago was studied. The preoperative prostate-specific antigen value was determined to be 11.82 ng/mL and the Gleason score was determined to be 3 + 3. The RARP was carried out using a transperitoneal and posterior approach with 5 ports in May 2016. The most important technique was ensuring that the transplanted kidney and ureter remained untouched during the surgery. Only the right obturator lymph nodes were dissected because the renal allograft was overlying the iliac vessels. RESULTS: The RARP was successfully concluded following 230 minutes with an estimated blood loss of 200 mL. There were no postoperative complications. Final pathology was T2cN0M0, Gleason 3 + 3. Following catheter removal, the patient was completely continent and was discharged with no change in serum creatinine or glomerular filtration rate levels. During a 21-month follow-up, unobstructed urination, no incontinence, no biochemical recurrence, and normal kidney function were observed. CONCLUSION: RARP in Chinese renal allograft patients is a feasible method that can be accomplished with no injuries to the transplanted kidney or ureter and is achieved with favorable oncological and functional outcomes. In addition, post-kidney transplant male patients are recommended to have routine prostate-specific antigen screening for the early detection of prostate cancer.


Assuntos
Transplante de Rim , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , China , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Antígeno Prostático Específico/sangue , Prostatectomia/instrumentação , Neoplasias da Próstata/complicações , Neoplasias da Próstata/patologia , Procedimentos Cirúrgicos Robóticos/instrumentação , Transplante Homólogo
8.
Sci Rep ; 8(1): 16352, 2018 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-30397236

RESUMO

The present study seeks to present a single-blind, randomized control trial of a hypothermic anti-inflammatory device, the endorectal cooling balloon (ECB), to assess whether regional hypothermia could improve 90-day and time to pad-free continence following robot-assisted radical prostatectomy (RARP). Five high-volume surgeons at three institutions had patients randomized (1:1) to regional hypothermia with ECB versus control. Patients were blinded to device use, as it was inserted and removed intraoperatively. Knowledge of device use was restricted to the operating room personnel only; recovery room and ward nursing staff were not informed of device use and instructed to indicate such if a patient inquired. An independent and blinded data acquisition contractor assessed outcomes via components of the EPIC and IPSS. The primary outcome was categorical pad-free continence at 90-days and the secondary outcome was a Kaplan-Meier time-to pad-free continence at 90 days. 100 hypothermia and 99 control patients were included. The primary outcome of 90-day pad-free continence was 50.0% (27.8-70.0%) in the hypothermia group versus 59.2% (33.3-78.6%) in the control (p = 0.194). The secondary outcome of Kaplan Meier analysis for time to 90-day continence was not statistically significant. At one year, there were also no statistically significant differences in continence recovery. Post-hoc analysis revealed a trend towards improvement in continence in one of three sites. Overall, the trial demonstrated no benefit to regional hypothermia either in our primary or secondary outcomes. It is suggested that surgical technique and prevention of surgical trauma may be more advantageous to improving continence recovery.


Assuntos
Hipotermia Induzida/instrumentação , Prostatectomia/instrumentação , Robótica , Micção , Humanos , Inflamação/prevenção & controle , Pessoa de Meia-Idade , Prostatectomia/efeitos adversos , Recuperação de Função Fisiológica , Método Simples-Cego
9.
Prog Urol ; 28(12): 603-610, 2018 Oct.
Artigo em Francês | MEDLINE | ID: mdl-30243461

RESUMO

OBJECTIVE: To analyse the functional and oncologic outcomes at one year of focal therapy with HIFU compared with total prostatectomy in patients with localised prostate cancer (PCa). PATIENTS AND METHODS: Retrospective and monocentric study from 2008 to 2014 comparing 2 cohorts of patients with localised PCa (T1/T2 clinical stage, Gleason score≤3+4=7 and PSA<15ng/mL), one treated by focal therapy (HIFU-F group), one by robot-assisted total prostatectomy (RATP group). Primary outcome was a trifecta defined as: absence of urinary incontinence, erectile function with sexual relations without treatment, negative PSA with negative surgical margins (RATP group) or negative biopsy cores (HIFU-F group). RESULTS: The 53 patients included in the "HIFU-F" group and the 66 patients in the "RATP" group were similar in terms of preoperative PSA, D'Amico risk group, erectile function but were different in terms of age, prostatic volume, length of cancer, Gleason score. Complication rate was not different. In multivariate analyse with propensity score, "HIFU-F" group achieved a better trifecta score than "RATP" group (OR=8,3, p=0,005). CONCLUSION: In case of low or intermediate risk localised PCa, "HIFU-F" group had better functional outcomes than initial learning curse "RATP" group, at one year. A long-term evaluation by a common endpoint is necessary to judge the oncological equivalence of both techniques. LEVEL OF EVIDENCE: 3.


Assuntos
Próstata/fisiopatologia , Próstata/cirurgia , Prostatectomia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Ultrassom Focalizado Transretal de Alta Intensidade , Idoso , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/patologia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Prostatectomia/métodos , Prostatectomia/estatística & dados numéricos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Ultrassom Focalizado Transretal de Alta Intensidade/efeitos adversos , Ultrassom Focalizado Transretal de Alta Intensidade/instrumentação , Ultrassom Focalizado Transretal de Alta Intensidade/métodos , Ultrassom Focalizado Transretal de Alta Intensidade/estatística & dados numéricos , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
10.
Prog Urol ; 28(16): 906-914, 2018 Dec.
Artigo em Francês | MEDLINE | ID: mdl-30219645

RESUMO

INTRODUCTION: Anthropometric data report that pelvic bone of African subjects are narrower and the pelvic cavity is deeper. The aim of the study was to evaluate the influence of pelvic dimensions (PD) on Positive surgical margins (PSM) rate in Afro-Caribbean population after robot-assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS: Preoperative pelvic MRI of all patients who have had RALP at the University Hospital Center of Guadeloupe between January 2013 and December 2015 was retrospectively analyzed. PD, including the Height of the upper edge of the prostate (HP), the Apical Depth (AD) and Ischial Spines Distance (ISD), and indexes (prostate volumetric index [ISD/VP], apical depth index [ISD/AD] and prostate depth index [ISD/(AD/HP)]) were compared according to the presence or absence of PSM with uni and multivariate analysis. RESULTS: One hundred and seventy-eight patients were included in the study, of whom 60 (33.7%) presented PSM. In univariate analysis, significant differences between the presence or absence of PSM were observed on the AD (30.3±8.7mm versus 24.8±8.0mm, P<0.001), the HP (9.5±8.5mm versus 16.8±11.9mm, P<0.001) and the ISD (89.6±8.8mm versus 96.1±8.4mm) as well as the indexes of apical depth and prostatic depth. In multivariate logistic regression, the ISD (P<0.001) and HP (P=0.02) were associated with increased likelihood of PSM, but not AD or indexes. CONCLUSION: This study suggests that interspinous distance is the best predictor of PSM during RALP in Afro-Caribbean patients. This measure may be useful to define the therapeutic pattern of patients with prostate cancer. A prospective study with a larger population, comparing RALP in Afro-Caribbean and in caucasians patients, would be needed.


Assuntos
Pesos e Medidas Corporais/métodos , Margens de Excisão , Pelve/diagnóstico por imagem , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Pesos e Medidas Corporais/normas , Guadalupe , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Neoplasia Residual , Ossos Pélvicos/patologia , Pelve/patologia , Período Pré-Operatório , Prognóstico , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Prostatectomia/métodos , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos
11.
Prog Urol ; 28(16): 921-926, 2018 Dec.
Artigo em Francês | MEDLINE | ID: mdl-30219647

RESUMO

OBJECTIVE: To study the impact of changing the technique of radical prostatectomy [pure laparoscopic radical (PR-Lap) to robot-assisted radical prostatectomy (RP-Rob)] on the rate of secondary procedures for urinary incontinence (UI) and erectile dysfunction (ED). MATERIAL: Retrospective study evaluating the number and type of surgical procedures for post-RP UI and DE between 2008 and 2015, according to the technique of (RP-Lap or RP-Rob). RESULTS: Between 2008 et 2015, 2046 RP were performed in our department including 372 RP-Lap and 1674 RP-Rob. Among these patients, 84 (4%) had a surgical procedure for post-RP UI (18 AMS800, 9 balloons Pro-Act, and 57 male slings) and 15 (0.7%) had implantation of penile prosthesis for post-RP ED; 16 (0.7%) patients had both procedures. The mean delay between RP and UI surgery decrease from 3.2 years in 2008 to 1 year in 2015 and remain stable for penile prosthesis implantation (mean delay: 3.4 years). The overall rates of secondary procedures for UI and DE remained stable and below 5% and 1.7%, respectively, even during the transition period. For each year of PR studied, the rates of secondary procedure were higher in the RP-Lap group. CONCLUSION: Changing the technique of RP from RP-Lap to PR-Rob has a favorable impact on the rate of secondary procedures for UI and ED from the outset.


Assuntos
Disfunção Erétil , Laparoscopia , Complicações Pós-Operatórias , Prostatectomia/métodos , Prostatectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos , Incontinência Urinária , Idoso , Disfunção Erétil/epidemiologia , Disfunção Erétil/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Implante Peniano/estatística & dados numéricos , Prótese de Pênis/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Incontinência Urinária/epidemiologia , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos Masculinos/tendências
12.
Can J Urol ; 25(4): 9384-9388, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30125516

RESUMO

INTRODUCTION: Abdominal wall hematoma (AWH) is a self-resolving, yet common complication from the insertion of trocars during laparoscopic surgery. Particularly, its appearance may increase patient anxiety and may reduce overall surgical satisfaction. MATERIALS AND METHODS: In a retrospective study analyzing data from 724 robot-assisted radical prostatectomy cases (RARP), trocar insertion sites were examined on postoperative day 7 with Foley removal for AWH. AWH was defined by a sizable collection of blood below the skin as a result of the surgery. The AccuVein AV400 system was utilized to generate real-time images of venous structures beneath the skin. Comparative outcomes were performed with a series of 114 men where the AccuVein AV400 device was applied over trocar insertion markings to help modify port placement. RESULTS: The pre-incision imaging of the AccuVein system modified port placement in 74 of 114 cases (65%), and reduced AWH from 8.8% to 2.6% (p = 0.03) as compared to transabdominal illumination. Port placement adjustments were most prevalent in the lateral regions of the abdomen, prompting attention for lateral trocar insertion to avoid vessels such as the thoracoepigastric veins. Notably, the body mass index (BMI) of patients experiencing AWH who received the pre-incision imaging of AccuVein was significantly higher than patients receiving standard transabdominal illumination (34.2 and 27.9 kg/m² respectively; p = 0.02). CONCLUSION: The AccuVein AV400 device appears to be an effective adjuvant for decreasing rates of AWH during lower abdominal wall trocar insertion, though its effectiveness is limited in patients with extreme BMI. Additionally, special attention should be directed towards trocar insertion in the lateral regions of the abdomen.


Assuntos
Parede Abdominal/diagnóstico por imagem , Hematoma/etiologia , Hematoma/prevenção & controle , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Prostatectomia/instrumentação , Índice de Massa Corporal , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação
13.
Fed Regist ; 83(116): 27895-8, 2018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30019883

RESUMO

The Food and Drug Administration (FDA or we) is classifying the fluid jet system for prostate tissue removal into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the fluid jet system for prostate tissue removal's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.


Assuntos
Prostatectomia/classificação , Prostatectomia/instrumentação , Segurança de Equipamentos/classificação , Humanos , Masculino , Estados Unidos , Água
15.
J Endourol ; 32(S1): S93-S96, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29774808

RESUMO

The envelope is constantly being pushed to minimize the invasiveness of prostate cancer surgery without compromising oncologic or functional outcomes. Transperitoneal robot-assisted radical prostatectomy has certainly accomplished these goals. However, it is our intent to push the envelope even further, that is, to minimize the invasiveness of already minimally invasive surgery. To accomplish this lofty goal, we borrowed the transperineal approach from open surgery and fused it with the latest robotic technology to innovate an extraperitoneal robotic prostatectomy technique that is less invasive than the traditional robotic technique.


Assuntos
Excisão de Linfonodo , Prostatectomia/instrumentação , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos , Cadáver , Humanos , Masculino , Posicionamento do Paciente , Períneo/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Neoplasias da Próstata/cirurgia
17.
BJU Int ; 122(3): 520-524, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29533505

RESUMO

OBJECTIVES: To evaluate the feasibility of robot-assisted single-port (SP) transvesical partial prostatectomy (TVPP) using a novel purpose-built SP surgical platform in a pre-clinical model. METHODS: The cadavers were placed in the lithotomy position. A 3-cm midline incision was made in the suprapubic area 4-cm from the symphisis pubis. After opening the Retzius space, an access mini device (GelPOINT; Applied Medical, Rancho Margarita, CA, USA) was introduced percutaneously directly into the bladder. The da Vinci SP1098 robotic platform (Intuitive Surgical, Sunnyvale, CA, USA) was docked to the GelPOINT by inserting a novel SP cannula through the GelSeal Cap. The surgical steps for en bloc anterior prostatectomy were performed in the following order: (i) antegrade dissection of the transition zone at the bladder neck; (ii) lateral excision of the peripheral zone; and (iii) urethrovesical anastomosis. Primary outcomes, such as intra-operative complications, rate of conversion to standard techniques and operating times, were recorded. RESULTS: The SP-TVPP procedure was technically completed in three male cadavers. All cases were completed successfully using the da Vinci SP1098 surgical system without conversion or the need for additional ports. There were no intra-operative complications. The mean total operating time was 49.3 min. CONCLUSION: Robot-assisted TVPP is feasible using a novel purpose-built SP surgical platform in a cadaver model. Future clinical evaluation in humans is needed for assessment on patients with anterior localized prostate cancer. Prospective comparison with other surgical platforms and standard techniques is warranted.


Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Robótica/instrumentação , Cadáver , Estudos de Viabilidade , Humanos , Masculino , Próstata/patologia , Próstata/cirurgia , Prostatectomia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Robótica/métodos
18.
Curr Opin Urol ; 28(3): 301-308, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29538164

RESUMO

PURPOSE OF REVIEW: Holmium laser enucleation of the prostate (HoLEP) has been a mainstay therapy for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) for nearly 20 years. We briefly review current and sentinel publications that provide outcomes data after HoLEP. RECENT FINDINGS: Current literature continues to support HoLEP as a versatile and durable surgical option for men with LUTS secondary to BPH. Despite evidence supporting durable symptom relief beyond 10 years even in large prostate glands, HoLEP is still not widely available to all patients. Concerns surrounding the learning curve of the procedure, high rates of retrograde ejaculation, and transient urinary incontinence seem to persist and limit the adoption of HoLEP by established urologists and residency training programs. SUMMARY: Recent publications continue to show excellent short-term and long-term outcomes after HoLEP, in the categories of voiding function and patient satisfaction. Continued attempts to demonstrate equivalent outcomes of alternate-BPH surgical techniques are being met with renewed efforts by those performing HoLEP to demonstrate equivalent outcomes and patient safety during the learning phase of HoLEP for both mentored and self-directed surgical training.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Ejaculação , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Segurança do Paciente , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Hiperplasia Prostática/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento
19.
Eur Urol Focus ; 4(5): 677-685, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29402756

RESUMO

BACKGROUND: Apical dissection in robot-assisted radical prostatectomy (RARP) affects not only cancer control, but also continence recovery. OBJECTIVE: To describe a novel approach for apical dissection, the collar technique, to reduce apical positive surgical margins (PSMs). DESIGN, SETTING, AND PARTICIPANTS: A total of 189 consecutive patients (81 in the control group, 108 in the collar technique group) underwent RARP at a single center. PRIMARY OUTCOME: rates of apical PSMs; secondary outcome: urinary continence. INTERVENTION: The urethral sphincter complex is incised 2-3mm distally to the apex, to stay farther from it and reduce PSMs; the underlying smooth muscle is exposed and incised closer to the apex to preserve the maximal length of the lissosphincter. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Mann-Whitney U and chi-square tests compared median and proportions between the two groups, respectively. Univariate logistic regression tested the association between technique employed and risk of apical PSMs. RESULTS AND LIMITATIONS: Fourteen patients (7.4%) revealed apical PSMs (9.9% in the control group, 5.6% in the collar group; p=0.7). When the collar technique was used, significantly lower rates of apical PSMs occurred in pT2 disease (0% vs 7.1%; p=0.03). In case of apical tumor at preoperative magnetic resonance imaging (MRI; n=43), the collar technique determined significantly lower overall (9.7% vs 42%) and apical (3.2% vs 42%) PSMs (all p≤0.02). Continence recovery in the collar and control groups was similar. When preoperative MRI showed an apical tumor, the collar technique had a significantly lower risk of apical PSMs (odds ratio: 0.05, p=0.009). CONCLUSIONS: The collar technique reduces the rates of apical PSMs in case of apical tumor, preserving the length of the lissosphincter. PATIENT SUMMARY: We describe a novel approach for apical dissection during robot-assisted radical prostatectomy. Our technique reduces the rates of apical surgical margins in case of apical tumor at preoperative magnetic resonance imaging and leads to optimal continence recovery.


Assuntos
Dissecação/métodos , Prostatectomia/instrumentação , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Incontinência Urinária/complicações , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Gradação de Tumores , Complicações Pós-Operatórias , Período Pré-Operatório , Antígeno Prostático Específico/sangue , Prostatectomia/efeitos adversos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Recuperação de Função Fisiológica , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Uretra/cirurgia
20.
Curr Opin Urol ; 28(2): 102-107, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29300208

RESUMO

PURPOSE OF REVIEW: Robotic-assisted radical prostatectomy has been rapidly adopted and is now the standard of care in the surgical management of prostate cancer. Since the initial description in 2001, the technique has evolved to optimize oncological functional outcomes. Herein, we review key techniques for the robotic-assisted radical prostatectomy. RECENT FINDINGS: With the current influx of new technology such as focal therapy, stereotactic body radiation therapy and prostate-sparing treatments, there is greater emphasis on maximizing outcomes of robotic-assisted radical prostatectomy. The evidence-based techniques of optimizing oncological outcomes including the lymph node dissection and improving cancer control through minimizing positive surgical margins are reviewed. Improvements in functional recovery has also been seen with technical modifications such as nerve sparing, preservation of the urethral support structures and the bladder neck and the urethra-vesical reconstruction. SUMMARY: Robotic prostatectomy has demonstrated adequate long-term oncologic success and satisfactory functional recovery. As technology and techniques in robotic-assisted surgery evolve, surgeons will continue to optimize techniques to maximize functional outcome recovery and cancer control. Further studies are actively being conducted to provide level one evidence in multiple aspects of the robotic-assisted radical prostatectomy.


Assuntos
Laparoscopia/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Excisão de Linfonodo/instrumentação , Excisão de Linfonodo/métodos , Masculino , Margens de Excisão , Próstata/inervação , Próstata/patologia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Neoplasias da Próstata/patologia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Resultado do Tratamento , Uretra/cirurgia , Bexiga Urinária/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA