BACKGROUND: Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective... more BACKGROUND: Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective, it must be timely and address the patient's needs for blood volume, oxygen transport, and hemostasis. STUDY DESIGN AND METHODS: A review was performed on all activations of the massive transfusion protocol (MTP) in a hospital with large emergency medicine, trauma, and vascular surgery programs. Indications, transfused amounts, and outcomes were determined for each MTP event to determine appropriateness of MTP use. Results are presented as descriptive statistics, categorical associations, and simple linear trend relationships. RESULTS: The MTP was activated 309 times in 2016. Of these episodes, 237 were for trauma, 29 for gastrointestinal bleeding, 16 for ruptured abdominal aortic aneurisms, and 25 for a variety of other causes. Trauma-related MTP activations had a mean injury severity score of 32. Blood use averaged 6.6 units of red blood cells (RBCs), 6.5 units of plasma, and 1.2 units of apheresis platelets. Fourteen activations ended without the administration of any blood products, and 45 (14%) did not meet the critical administration threshold of three components. Only 60 (19%) activations met the historic definition of massive with at least 10 units of RBCs administered. Mortality was 15% for the trauma-related activations. CONCLUSIONS: Massive transfusion protocol activations were frequent and conducted with high fidelity to the 1:1:1 unit ratio standard. Making blood components available quickly was associated with low rates of total component usage and low mortality for trauma patients and was not associated with overuse.
There were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female)... more There were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female). Mean scores on the PAT were 43.0% in Group I and 67.5% in Group II (pϽ0.001). Mean scores on the simulator were significantly higher for Group II than Group I on 4 of the scoring metrics (time to completion, economy of motion, excessive instrument force, work space range) and showed a statistical trend toward significant superiority on the remaining 3 metrics, including overall score. (Table 1) CONCLUSIONS: Group II outperformed Group I on all measured scoring metrics on the daVinci Skills Simulator, with differences in 4 out of 7 metrics achieving statistical significance. Increased spatial visualization ability as measured using the PAT correlated with better performance on the da Vinci Skills Simulator for novice robotic console users.
Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after r... more Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after robotic-assisted radical prostatectomy (RARP). However, large symptomatic inguinal lymphoceles after RARP have hitherto not been reported. Case Description: We present the case of a 71-year-old morbidly obese man who developed large, symptomatic, bilateral inguinal lymphoceles after RARP and pelvic lymph node dissection. The surgery itself was uneventful, as was the hospital stay. The patient returned 3 weeks postoperatively with bilateral inguinal pain and swelling, which was confirmed on imaging to be bilateral inguinal lymphoceles. These were initially treated with bilateral percutaneous pigtail catheter drainage, but this treatment was complicated by repeated tube blockages, fever, and conversion of the lymphoceles into multiloculated abscesses. Definitive treatment consisted of open left lymphocele excision first. After excision of the left inguinal lymphocele, the right lymphocele became infected and formed a large inflammatory phlegmon, necessitating open right inguinal lymphocele excision with right orchiectomy. Culture demonstrated gram-negative Prevotella bivia. Discussion: This case was unique because the patient presented with bilateral, large, symptomatic, recurrent inguinal lymphoceles, as opposed to the more common pelvic lymphoceles. To our knowledge, this is the first reported case of bilateral, symptomatic inguinal lymphoceles after RARP with pelvic lymph node dissection.
Avaliação de fatores psicossociais no controle pressórico de pacientes hipertensos durante a pand... more Avaliação de fatores psicossociais no controle pressórico de pacientes hipertensos durante a pandemia de COVID-19 Evaluation of psychosocial factors in the pressure control of hypertensive patients during the pandemic of COVID-19
Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective, it must be... more Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective, it must be timely and address the patient's needs for blood volume, oxygen transport, and hemostasis. A review was performed on all activations of the massive transfusion protocol (MTP) in a hospital with large emergency medicine, trauma, and vascular surgery programs. Indications, transfused amounts, and outcomes were determined for each MTP event to determine appropriateness of MTP use. Results are presented as descriptive statistics, categorical associations, and simple linear trend relationships. The MTP was activated 309 times in 2016. Of these episodes, 237 were for trauma, 29 for gastrointestinal bleeding, 16 for ruptured abdominal aortic aneurisms, and 25 for a variety of other causes. Trauma-related MTP activations had a mean injury severity score of 32. Blood use averaged 6.6 units of red blood cells (RBCs), 6.5 units of plasma, and 1.2 units of apheresis platelets. Fourteen activati...
Objectives: For over 60 years, Harborview Medical Center (HMC) in Seattle has received its blood ... more Objectives: For over 60 years, Harborview Medical Center (HMC) in Seattle has received its blood components and pretransfusion testing from a centralized transfusion service operated by the regional blood supplier. In 2011, a hospital-based transfusion service (HBTS) was activated. Methods: After 5 years of operation, we evaluated the effects of the HBTS by reviewing records of hospital blood use, quality system events, blood product delivery times, and costs. Furthermore, the effects of in-house expertise on laboratory medicine resident and medical laboratory scientist student training, as well as regulatory and accrediting agency concerns, were reviewed. Results: Blood use records from 2003 to 2015 demonstrated large reductions in blood component procurement, allocation, transfusion, and wastage with decreases in costs temporally related to the change in service. The turnaround time for thawed plasma for trauma patients decreased from 90 to 3 minutes. Transfusion medicine education metrics for residents and laboratory technology students improved significantly. HMC researchers brought in $2 million in transfusion research funding. Conclusions: HMC successfully transitioned to an HBTS, providing world-class primary transfusion support to a level 1 trauma center. Near-term benefits in patient care, education, and research resulted. Blood support became faster, safer, and cheaper.
Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after r... more Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after robotic-assisted radical prostatectomy (RARP). However, large symptomatic inguinal lymphoceles after RARP have hitherto not been reported. Case Description: We present the case of a 71-year-old morbidly obese man who developed large, symptomatic, bilateral inguinal lymphoceles after RARP and pelvic lymph node dissection. The surgery itself was uneventful, as was the hospital stay. The patient returned 3 weeks postoperatively with bilateral inguinal pain and swelling, which was confirmed on imaging to be bilateral inguinal lymphoceles. These were initially treated with bilateral percutaneous pigtail catheter drainage, but this treatment was complicated by repeated tube blockages, fever, and conversion of the lymphoceles into multiloculated abscesses. Definitive treatment consisted of open left lymphocele excision first. After excision of the left inguinal lymphocele, the right lymphocele became infected and formed a large inflammatory phlegmon, necessitating open right inguinal lymphocele excision with right orchiectomy. Culture demonstrated gram-negative Prevotella bivia. Discussion: This case was unique because the patient presented with bilateral, large, symptomatic, recurrent inguinal lymphoceles, as opposed to the more common pelvic lymphoceles. To our knowledge, this is the first reported case of bilateral, symptomatic inguinal lymphoceles after RARP with pelvic lymph node dissection.
To evaluate the safety and efficacy of a novel robotic tissue ablation system (PROCEPT Aquablatio... more To evaluate the safety and efficacy of a novel robotic tissue ablation system (PROCEPT Aquablation(™) System), in performing prostate ablation in a survival canine model. This novel technology uses a high-velocity saline stream that aims to selectively ablate prostatic glandular tissue while sparing collagenous structures such as blood vessels and capsule. Once the ablation is complete, a laser beam is captured by a low-pressure water jet to produce surface hemostasis. The extent and depth of ablation is predetermined by endoscopic and transrectal ultrasonography guidance. The procedure was performed in eight noncastrated male beagles aged 6 years or older (Acute 2, Chronic 6) through a previously created perineal urethrostomy. Aquablation time ranged from 40 to 84 seconds (mean 60.5 sec). There was no active bleeding in any of the dogs during or after Aquablation. Water jet-guided laser coagulation was used for purposes of monitoring its safety and efficacy. Five of the six dogs reached the predetermined 6-week mark. Complications included two dogs with infection successfully treated with antibiotics, a false passage created during catheter placement, and two bladder neck perforations (from mechanical insertion), one leading to euthanasia. Histologic evaluation at 6 weeks revealed a normal cellular architecture and full reepithelialization of the treatment cavity. We report the initial survival data in the animal model of a novel robotic device developed for managing symptomatic benign prostatic hyperplasia (BPH). Aquablation produces ablation of adenomatous elements while preserving collagenous structures and is a promising technology for surgical management of symptomatic BPH.
The American Cancer Society estimated that Ͼ51 000 new cases of kidney cancer were diagnosed in t... more The American Cancer Society estimated that Ͼ51 000 new cases of kidney cancer were diagnosed in the United States in 2007, with 13 000 deaths predicted. Classically, renal cell carcinoma (RCC) was diagnosed by the presence of an abdominal mass, flank pain, or hematuria. However, with increased use of cross-sectional imaging, Ͼ50% of new cases of RCC are found incidentally. 1 This large number of incidentally found tumors has led to stage migration, and, subsequently, the average size of renal tumors at presentation has decreased. 2 Although the mainstay of treatment of suspected RCC has traditionally been radical nephrectomy, partial nephrectomy has become increasingly used with incidental diagnoses of smaller tumors at earlier stages. Historically, partial nephrectomy was only indicated for a select subgroup of patients. However, stage migration, in addition to the results of numerous studies during the past few years, suggests that nephron-sparing surgery (NSS) might be appropriate for a larger, less-restricted patient population. We review the current status of NSS, including its presently accepted indications, pertinent clinical outcomes, complication rates, and cost. Finally, we explore the current usage practices of this technique and assess whether its use is commensurate with its efficacy.
There were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female)... more There were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female). Mean scores on the PAT were 43.0% in Group I and 67.5% in Group II (pϽ0.001). Mean scores on the simulator were significantly higher for Group II than Group I on 4 of the scoring metrics (time to completion, economy of motion, excessive instrument force, work space range) and showed a statistical trend toward significant superiority on the remaining 3 metrics, including overall score. (Table 1) CONCLUSIONS: Group II outperformed Group I on all measured scoring metrics on the daVinci Skills Simulator, with differences in 4 out of 7 metrics achieving statistical significance. Increased spatial visualization ability as measured using the PAT correlated with better performance on the da Vinci Skills Simulator for novice robotic console users. scoring on baseline clinical skills correlated with prior robotic experience for both basic and advanced steps of RP, thus supporting its relevance in clinical assessment.
expert panel Delphi study to finalize the inventory, develop a psychometrically sound intraoperat... more expert panel Delphi study to finalize the inventory, develop a psychometrically sound intraoperative RALP assessment tool that will be validated and implemented in urology education curricula.
ObjectivesTo evaluate robotic dry laboratory (dry lab) exercises in terms of their face, content,... more ObjectivesTo evaluate robotic dry laboratory (dry lab) exercises in terms of their face, content, construct and concurrent validities.To evaluate the applicability of the Global Evaluative Assessment of Robotic Skills (GEARS) tool to assess dry lab performance.Materials and MethodsParticipants were prospectively categorized into two groups: robotic novice (no cases as primary surgeon) and robotic expert (≥30 cases).Participants completed three virtual reality (VR) exercises using the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA, USA), as well as corresponding dry lab versions of each exercise (Mimic Technologies, Seattle, WA, USA) on the da Vinci Surgical System.Simulator performance was assessed by metrics measured on the simulator. Dry lab performance was blindly video‐evaluated by expert review using the six‐metric GEARS tool.Participants completed a post‐study questionnaire (to evaluate face and content validity).A Wilcoxon non‐parametric test was used to compare...
were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female). Mean... more were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female). Mean scores on the PAT were 43.0% in Group I and 67.5% in Group II (pϽ0.001). Mean scores on the simulator were significantly higher for Group II than Group I on 4 of the scoring metrics (time to completion, economy of motion, excessive instrument force, work space range) and showed a statistical trend toward significant superiority on the remaining 3 metrics, including overall score. (Table ) CONCLUSIONS: Group II outperformed Group I on all measured scoring metrics on the daVinci Skills Simulator, with differences in 4 out of 7 metrics achieving statistical significance. Increased spatial visualization ability as measured using the PAT correlated with better performance on the da Vinci Skills Simulator for novice robotic console users.
Background: Despite significant developments in transurethral surgery for benign prostatic hyperp... more Background: Despite significant developments in transurethral surgery for benign prostatic hyperplasia (BPH), simple prostatectomy remains an excellent option for patients with large glands. Objective: To describe our technique of transvesical robotic simple prostatectomy (RSP). Design, setting, and participants: From May 2011 to April 2013, 25 patients underwent RSP. Surgical procedure: We performed RSP using our technique. Outcome measurements and statistical analysis: Baseline demographics, pathology data, perioperative complications, 90-d complications, and functional outcomes were assessed. Results and limitations: Mean patient age was 72.9 yr (range: 54-88), baseline International Prostate Symptom Score (IPSS) was 23.9 (range: 9-35), prostate volume was 149.6 ml (range: 91-260), postvoid residual (PVR) was 208.1 ml (range: 72-800), maximum flow rate (Q max) was 11.3 ml/s, and preoperative prostate-specific antigen was 9.4 ng/ml (range: 1.9-56.3). Eight patients were catheter dependent before surgery. Mean operative time was 214 min (range: 165-345), estimated blood loss was 143 ml (range: 50-350), and the hospital stay was 4 d (range: 2-8). There were no intraoperative complications and no conversions to open surgery. Five patients had a concomitant robotic procedure performed. Early functional outcomes demonstrated significant improvement from baseline with an 85% reduction in mean IPSS (p < 0.0001), an 82.2% reduction in mean PVR (p = 0.014), and a 77% increase in mean Q max (p = 0.20). This study is limited by small sample size and short follow-up period. One patient had a urinary tract infection; two had recurrent hematuria, one requiring transfusion; one patient had clot retention and extravasation, requiring reoperation. Conclusions: Our technique of RSP is safe and effective. Good functional outcomes suggest it is a viable option for BPH and larger glands and can be used for patients requiring concomitant procedures. Patient summary: We describe the technique and report the initial results of a series of cases of transvesical robotic simple prostatectomy. The procedure is both feasible and safe and a good option for benign prostatic hyperplasia with larger glands.
BACKGROUND: Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective... more BACKGROUND: Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective, it must be timely and address the patient's needs for blood volume, oxygen transport, and hemostasis. STUDY DESIGN AND METHODS: A review was performed on all activations of the massive transfusion protocol (MTP) in a hospital with large emergency medicine, trauma, and vascular surgery programs. Indications, transfused amounts, and outcomes were determined for each MTP event to determine appropriateness of MTP use. Results are presented as descriptive statistics, categorical associations, and simple linear trend relationships. RESULTS: The MTP was activated 309 times in 2016. Of these episodes, 237 were for trauma, 29 for gastrointestinal bleeding, 16 for ruptured abdominal aortic aneurisms, and 25 for a variety of other causes. Trauma-related MTP activations had a mean injury severity score of 32. Blood use averaged 6.6 units of red blood cells (RBCs), 6.5 units of plasma, and 1.2 units of apheresis platelets. Fourteen activations ended without the administration of any blood products, and 45 (14%) did not meet the critical administration threshold of three components. Only 60 (19%) activations met the historic definition of massive with at least 10 units of RBCs administered. Mortality was 15% for the trauma-related activations. CONCLUSIONS: Massive transfusion protocol activations were frequent and conducted with high fidelity to the 1:1:1 unit ratio standard. Making blood components available quickly was associated with low rates of total component usage and low mortality for trauma patients and was not associated with overuse.
There were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female)... more There were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female). Mean scores on the PAT were 43.0% in Group I and 67.5% in Group II (pϽ0.001). Mean scores on the simulator were significantly higher for Group II than Group I on 4 of the scoring metrics (time to completion, economy of motion, excessive instrument force, work space range) and showed a statistical trend toward significant superiority on the remaining 3 metrics, including overall score. (Table 1) CONCLUSIONS: Group II outperformed Group I on all measured scoring metrics on the daVinci Skills Simulator, with differences in 4 out of 7 metrics achieving statistical significance. Increased spatial visualization ability as measured using the PAT correlated with better performance on the da Vinci Skills Simulator for novice robotic console users.
Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after r... more Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after robotic-assisted radical prostatectomy (RARP). However, large symptomatic inguinal lymphoceles after RARP have hitherto not been reported. Case Description: We present the case of a 71-year-old morbidly obese man who developed large, symptomatic, bilateral inguinal lymphoceles after RARP and pelvic lymph node dissection. The surgery itself was uneventful, as was the hospital stay. The patient returned 3 weeks postoperatively with bilateral inguinal pain and swelling, which was confirmed on imaging to be bilateral inguinal lymphoceles. These were initially treated with bilateral percutaneous pigtail catheter drainage, but this treatment was complicated by repeated tube blockages, fever, and conversion of the lymphoceles into multiloculated abscesses. Definitive treatment consisted of open left lymphocele excision first. After excision of the left inguinal lymphocele, the right lymphocele became infected and formed a large inflammatory phlegmon, necessitating open right inguinal lymphocele excision with right orchiectomy. Culture demonstrated gram-negative Prevotella bivia. Discussion: This case was unique because the patient presented with bilateral, large, symptomatic, recurrent inguinal lymphoceles, as opposed to the more common pelvic lymphoceles. To our knowledge, this is the first reported case of bilateral, symptomatic inguinal lymphoceles after RARP with pelvic lymph node dissection.
Avaliação de fatores psicossociais no controle pressórico de pacientes hipertensos durante a pand... more Avaliação de fatores psicossociais no controle pressórico de pacientes hipertensos durante a pandemia de COVID-19 Evaluation of psychosocial factors in the pressure control of hypertensive patients during the pandemic of COVID-19
Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective, it must be... more Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective, it must be timely and address the patient's needs for blood volume, oxygen transport, and hemostasis. A review was performed on all activations of the massive transfusion protocol (MTP) in a hospital with large emergency medicine, trauma, and vascular surgery programs. Indications, transfused amounts, and outcomes were determined for each MTP event to determine appropriateness of MTP use. Results are presented as descriptive statistics, categorical associations, and simple linear trend relationships. The MTP was activated 309 times in 2016. Of these episodes, 237 were for trauma, 29 for gastrointestinal bleeding, 16 for ruptured abdominal aortic aneurisms, and 25 for a variety of other causes. Trauma-related MTP activations had a mean injury severity score of 32. Blood use averaged 6.6 units of red blood cells (RBCs), 6.5 units of plasma, and 1.2 units of apheresis platelets. Fourteen activati...
Objectives: For over 60 years, Harborview Medical Center (HMC) in Seattle has received its blood ... more Objectives: For over 60 years, Harborview Medical Center (HMC) in Seattle has received its blood components and pretransfusion testing from a centralized transfusion service operated by the regional blood supplier. In 2011, a hospital-based transfusion service (HBTS) was activated. Methods: After 5 years of operation, we evaluated the effects of the HBTS by reviewing records of hospital blood use, quality system events, blood product delivery times, and costs. Furthermore, the effects of in-house expertise on laboratory medicine resident and medical laboratory scientist student training, as well as regulatory and accrediting agency concerns, were reviewed. Results: Blood use records from 2003 to 2015 demonstrated large reductions in blood component procurement, allocation, transfusion, and wastage with decreases in costs temporally related to the change in service. The turnaround time for thawed plasma for trauma patients decreased from 90 to 3 minutes. Transfusion medicine education metrics for residents and laboratory technology students improved significantly. HMC researchers brought in $2 million in transfusion research funding. Conclusions: HMC successfully transitioned to an HBTS, providing world-class primary transfusion support to a level 1 trauma center. Near-term benefits in patient care, education, and research resulted. Blood support became faster, safer, and cheaper.
Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after r... more Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after robotic-assisted radical prostatectomy (RARP). However, large symptomatic inguinal lymphoceles after RARP have hitherto not been reported. Case Description: We present the case of a 71-year-old morbidly obese man who developed large, symptomatic, bilateral inguinal lymphoceles after RARP and pelvic lymph node dissection. The surgery itself was uneventful, as was the hospital stay. The patient returned 3 weeks postoperatively with bilateral inguinal pain and swelling, which was confirmed on imaging to be bilateral inguinal lymphoceles. These were initially treated with bilateral percutaneous pigtail catheter drainage, but this treatment was complicated by repeated tube blockages, fever, and conversion of the lymphoceles into multiloculated abscesses. Definitive treatment consisted of open left lymphocele excision first. After excision of the left inguinal lymphocele, the right lymphocele became infected and formed a large inflammatory phlegmon, necessitating open right inguinal lymphocele excision with right orchiectomy. Culture demonstrated gram-negative Prevotella bivia. Discussion: This case was unique because the patient presented with bilateral, large, symptomatic, recurrent inguinal lymphoceles, as opposed to the more common pelvic lymphoceles. To our knowledge, this is the first reported case of bilateral, symptomatic inguinal lymphoceles after RARP with pelvic lymph node dissection.
To evaluate the safety and efficacy of a novel robotic tissue ablation system (PROCEPT Aquablatio... more To evaluate the safety and efficacy of a novel robotic tissue ablation system (PROCEPT Aquablation(™) System), in performing prostate ablation in a survival canine model. This novel technology uses a high-velocity saline stream that aims to selectively ablate prostatic glandular tissue while sparing collagenous structures such as blood vessels and capsule. Once the ablation is complete, a laser beam is captured by a low-pressure water jet to produce surface hemostasis. The extent and depth of ablation is predetermined by endoscopic and transrectal ultrasonography guidance. The procedure was performed in eight noncastrated male beagles aged 6 years or older (Acute 2, Chronic 6) through a previously created perineal urethrostomy. Aquablation time ranged from 40 to 84 seconds (mean 60.5 sec). There was no active bleeding in any of the dogs during or after Aquablation. Water jet-guided laser coagulation was used for purposes of monitoring its safety and efficacy. Five of the six dogs reached the predetermined 6-week mark. Complications included two dogs with infection successfully treated with antibiotics, a false passage created during catheter placement, and two bladder neck perforations (from mechanical insertion), one leading to euthanasia. Histologic evaluation at 6 weeks revealed a normal cellular architecture and full reepithelialization of the treatment cavity. We report the initial survival data in the animal model of a novel robotic device developed for managing symptomatic benign prostatic hyperplasia (BPH). Aquablation produces ablation of adenomatous elements while preserving collagenous structures and is a promising technology for surgical management of symptomatic BPH.
The American Cancer Society estimated that Ͼ51 000 new cases of kidney cancer were diagnosed in t... more The American Cancer Society estimated that Ͼ51 000 new cases of kidney cancer were diagnosed in the United States in 2007, with 13 000 deaths predicted. Classically, renal cell carcinoma (RCC) was diagnosed by the presence of an abdominal mass, flank pain, or hematuria. However, with increased use of cross-sectional imaging, Ͼ50% of new cases of RCC are found incidentally. 1 This large number of incidentally found tumors has led to stage migration, and, subsequently, the average size of renal tumors at presentation has decreased. 2 Although the mainstay of treatment of suspected RCC has traditionally been radical nephrectomy, partial nephrectomy has become increasingly used with incidental diagnoses of smaller tumors at earlier stages. Historically, partial nephrectomy was only indicated for a select subgroup of patients. However, stage migration, in addition to the results of numerous studies during the past few years, suggests that nephron-sparing surgery (NSS) might be appropriate for a larger, less-restricted patient population. We review the current status of NSS, including its presently accepted indications, pertinent clinical outcomes, complication rates, and cost. Finally, we explore the current usage practices of this technique and assess whether its use is commensurate with its efficacy.
There were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female)... more There were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female). Mean scores on the PAT were 43.0% in Group I and 67.5% in Group II (pϽ0.001). Mean scores on the simulator were significantly higher for Group II than Group I on 4 of the scoring metrics (time to completion, economy of motion, excessive instrument force, work space range) and showed a statistical trend toward significant superiority on the remaining 3 metrics, including overall score. (Table 1) CONCLUSIONS: Group II outperformed Group I on all measured scoring metrics on the daVinci Skills Simulator, with differences in 4 out of 7 metrics achieving statistical significance. Increased spatial visualization ability as measured using the PAT correlated with better performance on the da Vinci Skills Simulator for novice robotic console users. scoring on baseline clinical skills correlated with prior robotic experience for both basic and advanced steps of RP, thus supporting its relevance in clinical assessment.
expert panel Delphi study to finalize the inventory, develop a psychometrically sound intraoperat... more expert panel Delphi study to finalize the inventory, develop a psychometrically sound intraoperative RALP assessment tool that will be validated and implemented in urology education curricula.
ObjectivesTo evaluate robotic dry laboratory (dry lab) exercises in terms of their face, content,... more ObjectivesTo evaluate robotic dry laboratory (dry lab) exercises in terms of their face, content, construct and concurrent validities.To evaluate the applicability of the Global Evaluative Assessment of Robotic Skills (GEARS) tool to assess dry lab performance.Materials and MethodsParticipants were prospectively categorized into two groups: robotic novice (no cases as primary surgeon) and robotic expert (≥30 cases).Participants completed three virtual reality (VR) exercises using the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA, USA), as well as corresponding dry lab versions of each exercise (Mimic Technologies, Seattle, WA, USA) on the da Vinci Surgical System.Simulator performance was assessed by metrics measured on the simulator. Dry lab performance was blindly video‐evaluated by expert review using the six‐metric GEARS tool.Participants completed a post‐study questionnaire (to evaluate face and content validity).A Wilcoxon non‐parametric test was used to compare...
were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female). Mean... more were 12 subjects in group I (7 male/5 female) and 13 subjects in Group II (6 male/7 female). Mean scores on the PAT were 43.0% in Group I and 67.5% in Group II (pϽ0.001). Mean scores on the simulator were significantly higher for Group II than Group I on 4 of the scoring metrics (time to completion, economy of motion, excessive instrument force, work space range) and showed a statistical trend toward significant superiority on the remaining 3 metrics, including overall score. (Table ) CONCLUSIONS: Group II outperformed Group I on all measured scoring metrics on the daVinci Skills Simulator, with differences in 4 out of 7 metrics achieving statistical significance. Increased spatial visualization ability as measured using the PAT correlated with better performance on the da Vinci Skills Simulator for novice robotic console users.
Background: Despite significant developments in transurethral surgery for benign prostatic hyperp... more Background: Despite significant developments in transurethral surgery for benign prostatic hyperplasia (BPH), simple prostatectomy remains an excellent option for patients with large glands. Objective: To describe our technique of transvesical robotic simple prostatectomy (RSP). Design, setting, and participants: From May 2011 to April 2013, 25 patients underwent RSP. Surgical procedure: We performed RSP using our technique. Outcome measurements and statistical analysis: Baseline demographics, pathology data, perioperative complications, 90-d complications, and functional outcomes were assessed. Results and limitations: Mean patient age was 72.9 yr (range: 54-88), baseline International Prostate Symptom Score (IPSS) was 23.9 (range: 9-35), prostate volume was 149.6 ml (range: 91-260), postvoid residual (PVR) was 208.1 ml (range: 72-800), maximum flow rate (Q max) was 11.3 ml/s, and preoperative prostate-specific antigen was 9.4 ng/ml (range: 1.9-56.3). Eight patients were catheter dependent before surgery. Mean operative time was 214 min (range: 165-345), estimated blood loss was 143 ml (range: 50-350), and the hospital stay was 4 d (range: 2-8). There were no intraoperative complications and no conversions to open surgery. Five patients had a concomitant robotic procedure performed. Early functional outcomes demonstrated significant improvement from baseline with an 85% reduction in mean IPSS (p < 0.0001), an 82.2% reduction in mean PVR (p = 0.014), and a 77% increase in mean Q max (p = 0.20). This study is limited by small sample size and short follow-up period. One patient had a urinary tract infection; two had recurrent hematuria, one requiring transfusion; one patient had clot retention and extravasation, requiring reoperation. Conclusions: Our technique of RSP is safe and effective. Good functional outcomes suggest it is a viable option for BPH and larger glands and can be used for patients requiring concomitant procedures. Patient summary: We describe the technique and report the initial results of a series of cases of transvesical robotic simple prostatectomy. The procedure is both feasible and safe and a good option for benign prostatic hyperplasia with larger glands.
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