“Umbilicus, navel, belly button-Vitruvian guide for esthetic cosmetics: A da Vinci code for beautiful informed consent.”
Agarwal, B. B. (2010).
Surgical Endoscopy and Other Interventional Techniques 24(1): 236-238.
“Robot-Assisted Laparoscopic Skills Development: Formal Versus Informal Training.”
Benson, A. D., B. A. Kramer, et al. (2010).
Abstract Introduction: The learning curve for robotic surgery is not completely defined, and ideal training components have not yet been identified. We attempted to determine whether skill development would be accelerated with formal, organized instruction in robotic surgical techniques versus informal practice alone. Materials and Methods: Forty-three medical students naive to robotic surgery were randomized into two groups and tested on three tasks using the robotic platform. Between the testing sessions, the students were given equally timed practice sessions. The formal training group participated in an organized, formal training session with instruction from an attending robotic surgeon, whereas the informal training group participated in an equally timed unstructured practice session with the robot. The results were compared based on technical score and time to completion of each task. Results: There was no difference between groups in prepractice testing for any task. In postpractice testing, there was no difference between groups for the ring transfer tasks. However, for the suture placement and knot-tying task, the technical score of the formal training group was significantly better than that of the informal training group (p < 0.001), yet time to completion was not different. Conclusion: Although formal training may not be necessary for basic skills, formal instruction for more advanced skills, such as suture placement and knot tying, is important in developing skills needed for effective robotic surgery. These findings may be important in formulating potential skills labs or training courses for robotic surgery.
“The Minailo knot: a time-saving and cost-saving technique.”
Brown, J. V., E. J. Tinnerman-Minailo, et al. (2010).
Journal of Robotic Surgery: 1-3.
Endoscopic knot tying during minimally invasive surgery can be complicated, time consuming, and associated with a protracted learning curve. The Minailo knot seems to be a reasonable option because the technique does not require any specialized instrumentation or skill to perform. In particular, vaginal closure is obtained with the placement of a single intra-corporeal knot. Our initial and successful experience with this knot-tying technique during robotic hysterectomy for treatment of gynecologic disease suggests that the method is safe and feasible. © 2010 Springer-Verlag London Ltd.
“Telementoring and Telerobotics in Urological Surgery.”
Challacombe, B. and S. Wheatstone (2010).
Current Urology Reports: 1-7.
For more than 150 years, doctors have had the ability to transmit medical information to advise and assist their colleagues in remote locations via teleconsultation using a variety of communication modalities. In surgery this has evolved into the telementoring of minimally invasive procedures, particularly, robotic surgery, which have become relatively commonplace in urology. The ultimate progression to true telerobotic surgery, in which remote surgeons independently perform complex and fundamental parts of procedures at long range, is starting to occur. This article discusses the current state of telementoring and telerobotics in urology and examines the pros and cons of this technology at the present time. © 2010 Springer Science+Business Media, LLC.
“A comparison of laparoscopic and robotic assisted suturing performance by experts and novices.” Chandra, V., D. Nehra, et al. (2010).
Background: Surgical robotics has been promoted as an enabling technology. This study tests the hypothesis that use of the robotic surgical system can significantly improve technical ability by comparing the performance of both experts and novices on a complex laparoscopic task and a robotically assisted task. Methods: Laparoscopic experts (LE) with substantial laparoscopic and robotic experience (n = 9) and laparoscopic novices (LN) (n = 20) without any robotic experience performed sequentially 10 trials of a suturing task using either robotic or standard laparoscopic instrumentation fitted to the ProMISTM surgical simulator. Objective performance metrics provided by ProMISTM (total task time, instrument pathlength, and smoothness) and an assessment of learning curves were analyzed. Results: Compared with LNs, the LEs demonstrated significantly better performance on all assessment measures. Within the LE group, there was no difference in smoothness (328 ± 159 vs 355 ± 174; P = .09) between robot-assisted and standard laparoscopic tasks. An improvement was noted in total task time (113 ± 41 vs 132 ± 55 sec; P < .05) and instrument pathlengths (371 ± 163 vs 645 ± 269 cm; P < .05) when using the robot. This advantage in terms of total task time, however, was lost among the LEs by the last 3 trials (114 ± 40 vs 118 ± 49 s; P = .84), while instrument pathlength remained better consistently throughout all the trials. For the LNs, performance was significantly better in the robotic trials on all 3 measures throughout all the trials. Conclusion: The ProMIS surgical simulator was able to distinguish between skill levels (expert versus novice) on robotic suturing tasks, suggesting that the ProMISTM is a valid tool for measuring skill in robot-assisted surgery. For all the ProMISTM metrics, novices demonstrated consistently better performance on a suturing task using robotics as compared to a standard laparoscopic setup. This effect was less evident for experts who demonstrated improvements only in their economy of movement (pathlength), but not in the speed or smoothness of performance. Robotics eliminated the early learning curve for novices, which was present when they used standard laparoscopic tools. Overall, this study suggests that, when performing complex tasks such as knot tying, surgical robotics is most useful for inexperienced laparoscopists who experience an early and persistent enabling effect. For experts, robotics is most useful for improving economy of motion, which may have implications for the highly complex procedures in limited workspaces (eg, prostatectomy). © 2009 Mosby, Inc. All rights reserved.
“Mitral Valve Repair for Degenerative Disease: A 20-Year Experience.”
Daneshmand, M. A., C. A. Milano, et al. (2009).
Annals of Thoracic Surgery 88(6): 1828-1837.
Background: Recent advances in surgical technique allow repair of most mitral valves with degenerative disease. However, few long-term data exist to support the superiority of repair versus prosthetic valve replacement, and repair could be limited by late durability or other problems. This study was designed to compare survival characteristics of mitral valve repair versus prosthetic replacement for degenerative disorders during a 20-year period. Methods: From 1986 to 2006, 2,580 patients underwent isolated mitral valve procedures (with or without coronary artery bypass grafting), with 989 classified as having degenerative origin. Of these, 705 received valve repair, and 284 had prosthetic valve replacement. Differences in baseline characteristics between groups were assessed, and unadjusted survival estimates were generated using Kaplan-Meier methods. Survival curves were examined after adjustment for differences in baseline profiles using a Cox model, and average adjusted survival differences were quantified by area under the curve methodology. Survival differences during 15 years of follow-up also were assessed with propensity matching. Results: Baseline characteristics were similar, except for (variable: repair, replacement) age: 62 years, 68 years; concomitant coronary artery bypass grafting: 24%, 32%; ejection fraction: 0.51, 0.55; congestive heart failure: 68%, 43%; and preoperative arrhythmia: 11%, 7% (all p < 0.05). Long-term survival was significantly better in the repair group, both for unadjusted data (p < 0.001) and for risk-adjusted results (p = 0.040). Patient survival in the course of 15 years averaged 7.3% better with repair, and increased with time of follow-up: 0.7% better for 0 to 5 years, 4.9% better for 5 to 10 years, and 21.3% better for 10 to 15 years. Treatment interaction between repair or replacement and age was negative (p = 0.66). In the propensity analysis, survival advantages of repair versus replacement were similar in magnitude with a p value of 0.046. Conclusions: As compared with prosthetic valve replacement, mitral repair is associated with better survival in patients with degenerative disease, especially after 10 to 15 years. This finding supports the current trend of increasing repair rates for degenerative disorders of the mitral valve. © 2009 The Society of Thoracic Surgeons.
“An Update of the Gleason Grading System.”
Epstein, J. I. (2010).
Journal of Urology 183(2): 433-440.
Purpose: An update is provided of the Gleason grading system, which has evolved significantly since its initial description. Materials and Methods: A search was performed using the MEDLINE® database and referenced lists of relevant studies to obtain articles concerning changes to the Gleason grading system. Results: Since the introduction of the Gleason grading system more than 40 years ago many aspects of prostate cancer have changed, including prostate specific antigen testing, transrectal ultrasound guided prostate needle biopsy with greater sampling, immunohistochemistry for basal cells that changed the classification of prostate cancer and new prostate cancer variants. The system was updated at a 2005 consensus conference of international experts in urological pathology, under the auspices of the International Society of Urological Pathology. Gleason score 2-4 should rarely if ever be diagnosed on needle biopsy, certain patterns (ie poorly formed glands) originally considered Gleason pattern 3 are now considered Gleason pattern 4 and all cribriform cancer should be graded pattern 4. The grading of variants and subtypes of acinar adenocarcinoma of the prostate, including cancer with vacuoles, foamy gland carcinoma, ductal adenocarcinoma, pseudohyperplastic carcinoma and small cell carcinoma have also been modified. Other recent issues include reporting secondary patterns of lower and higher grades when present to a limited extent, and commenting on tertiary grade patterns which differ depending on whether the specimen is from needle biopsy or radical prostatectomy. Whereas there is little debate on the definition of tertiary pattern on needle biopsy, this issue is controversial in radical prostatectomy specimens. Although tertiary Gleason patterns are typically added to pathology reports, they are routinely omitted in practice since there is no simple way to incorporate them in predictive nomograms/tables, research studies and patient counseling. Thus, a modified radical prostatectomy Gleason scoring system was recently proposed to incorporate tertiary Gleason patterns in an intuitive fashion. For needle biopsy with different cores showing different grades, the current recommendation is to report the grades of each core separately, whereby the highest grade tumor is selected as the grade of the entire case to determine treatment, regardless of the percent involvement. After the 2005 consensus conference several studies confirmed the superiority of the modified Gleason system as well as its impact on urological practice. Conclusions: It is remarkable that nearly 40 years after its inception the Gleason grading system remains one of the most powerful prognostic factors for prostate cancer. This system has remained timely because of gradual adaptations by urological pathologists to accommodate the changing practice of medicine. © 2010 American Urological Association.
“Robot-assisted laparoscopic repair of renal artery aneurysms.”
Giulianotti, P. C., F. M. Bianco, et al. (2010).
Journal of Vascular Surgery.
Objective: The aim of this article is to report our experience in the repair of renal artery aneurysms using robot-assisted surgery. Methods: Between December 2002 and March 2009, five women with a mean age of 63.8 years (range, 57-78 years) underwent robot-assisted laparoscopic repair of renal artery aneurysms by the same surgeon at two different institutions, the Department of General Surgery, Misericordia Hospital, Grosseto, Italy (three patients) and the Division of Minimally Invasive and Robotic Surgery at the University of Illinois, Chicago (two patients). The mean size of the lesions was 19.4 mm (range, 9-28 mm). Four of the lesions were complex aneurysms involving the renal artery bifurcation. Two patients were symptomatic and three had hypertension. In situ repair by aneurysmectomy was performed in all cases, followed by revascularization. In complex aneurysms, an autologous saphenous vein graft was used for the reconstruction. Results: The mean operative time was 288 minutes (range, 170-360 min) and the estimated surgical blood loss was 100 ml (range, 50-300 ml). Warm ischemia time was 10 minutes in the patient treated by aneurysmectomy, followed by direct reconstruction. The average warm ischemia time was 38.5 minutes (range, 20-60 min) for patients treated with saphenous vein graft interposition. The mean time to resume a regular diet was 1.6 days (range, 1-2 days). The mean postoperative length of hospital stay was 5.6 days (range, 3-7 days). No postoperative morbidity was noted. The mean follow-up time for the entire series was 28 months (range, 6-48 months). Color Doppler ultrasonography examination showed patency in all reconstructed vessels. One patient had stenosis of one of the reconstructed branches, which was treated with percutaneous angioplasty. Conclusions: Robot-assisted laparoscopic repair of renal artery aneurysms is feasible, safe and effective. The technical advantages of the robotic system allows for microvascular reconstruction to be performed using a minimally invasive approach, even in complex cases. This approach may also allow for improved postoperative recovery and reduce the morbidity correlated with open repair of renal artery aneurysms. Although more experience and technical refinements are necessary, robot-assisted laparoscopic repair of renal artery aneurysms represents a valid alternative to open surgery.
“Set-up and docking of the da Vinci((R)) surgical system: prospective analysis of initial experience.”
Iranmanesh, P., P. Morel, et al. (2010).
Int J Med Robot.
BACKGROUND: Set-up and docking of the da Vinci((R)) surgical system are assumed to extend overall operating times. We hypothesized that these tasks could be achieved in adequate times. Therefore, a prospective analysis of set-up and docking times of the da Vinci((R)) Surgical System was conducted. METHODS: We prospectively analysed set-up and docking times with the da Vinci surgical system in our division. RESULTS: Ninety-six patients were operated on over 30 months in our institution. Median set-up time was 22 (range 9-50) min and median docking time was 10 (range 2-70) min. Surgeons with previous docking experience were significantly faster than inexperienced surgeons: 8 (range 2-50) vs. 17.5 (range 10-70) min. Both set-up and docking showed a fast learning curve. CONCLUSION: The data support the conclusion that both set-up and docking of the robot can be achieved in adequate times and have a low impact on overall operating time. Copyright (c) 2009 John Wiley & Sons, Ltd.
Jones, A. and K. Sethia (2010).
Ann R Coll Surg Engl 92(1): 5-8.
“Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy.”
Kimura, M., V. Mouraviev, et al. (2010).
BJU International 105(2): 191-201.
We reviewed the current salvage methods for patients with local recurrent prostate cancer after primary radiotherapy (RT), using a search of relevant Medline/PubMed articles published from 1982 to 2008, with the following search terms: ‘radiorecurrent prostate cancer, local salvage treatment, salvage radical prostatectomy (RP), salvage cryoablation, salvage brachytherapy, salvage high-intensity focused ultrasound (HIFU)’, and permutations of the above. Only articles written in English were included. The objectives of this review were to analyse the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. There are four whole-gland re-treatment options (salvage RP, salvage cryoablation, salvage brachytherapy, salvage HIFU) for RT failure, although others might be in development or investigations. Salvage RP has the longest follow-up with acceptable oncological results, but it is a challenging technique with a high complication rate. Salvage cryoablation is a feasible option, especially using third-generation technology, whereby the average biochemical disease-free survival rate is 50-70% and there are fewer occurrences of severe complications such as recto-urethral fistula. Salvage brachytherapy, with short-term cancer control, is comparable to other salvage methods but depends on cumulative dosage limitation to target tissues. HIFU is a relatively recent option in the salvage setting. Both salvage brachytherapy and HIFU require more detailed studies with intermediate and long-term follow-up. As these are not prospective, randomized studies and the definitions of biochemical failure varied, there are limited comparisons among these different salvage methods, including efficacy. In the focal therapy salvage setting, the increased use of thermoablative methods for eligible patients might contribute to reducing complications and maintaining quality of life. The problem to effectively salvage patients with locally recurrent disease after RT is the lack of diagnostic examinations with sufficient sensitivity and specificity to detect local recurrence at an early curable stage. Therefore, a more strict definition of biochemical failure, improved imaging techniques, and accurate specimen mapping are needed as diagnostic tools. Furthermore, universal selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological efficacy and least comorbidity. © 2009 BJU International.
“Robotics in nursing – Development trends and potentials.”
Klein, B. and G. Cook (2009).
Robotik in der pflege entwicklungstendenzen und potenziale 17(4).
“Ergonomic Evaluation and Guidelines for Use of the daVinci Robot System.”
Lux, M. M., M. Marshall, et al. (2010).
Abstract Introduction: The daVinci Robot system has been widely lauded for its improved ergonomic characteristics when compared with the pure laparoscopic technique. Our goal in this study was to assess for the existence of guidelines to maximize the ergonomic benefits of the daVinci system. We also compared the surgeon’s console with the recommendations of similar workstations. Methods: A literature review of seated ergonomics was performed to identify recommendations for work areas similar to the robotic system, where prolong seating is necessary. An upper body biomechanics and ergonomic expert was consulted to evaluate the daVinci system and aid in the formation of ergonomic positioning guidelines. Link-length proportions were used to evaluate size constraints of potential robot operators. Results: No published guidelines exist for proper positioning using the daVinci surgeon console. There are, however, several Occupational Safety and Health Administration workstation guidelines as well as microscope ergonomic guidelines. The use of link-length proportions showed that the surgeon console allows a comfortable posture for individuals with height between 64 and 73 inches. Review of the microscope ergonomics literature indicates that a neutral vertical seating position has been associated with decreased strain and musculoskeletal disorders. Conclusions: The body mechanics of the daVinci robot system best mimics that of microscopy. Future surgeon console modifications could emulate those reported in the microscope ergonomic literature, where a neutral vertical position has been recommended. This may help avoid potential musculoskeletal disorders similar to those previously seen with microscopy usage. Guidelines are suggested to optimize the surgeon’s console position.
“Multidisciplinary development of robotic surgery in a University Tertiary Hospital: Organization and outcomes.”
Ortiz Oshiro, E., A. Ramos Carrasco, et al. (2010).
Desarrollo multidisciplinario de la cirugía robótica en un hospital universitario de tercer nivel: organización y resultados.
Background: Da Vinci system (Intuitive Surgical<sup>®</sup>) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation…) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. Material and methods: Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. Results: Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. Conclusion: The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team. © 2009 AEC.
“Outcomes from 3144 adrenalectomies in the United States: Which matters more, surgeon volume or specialty?”
Park, H. S., S. A. Roman, et al. (2009).
Archives of Surgery 144(11): 1060-1067.
Objective: To assess the effect of surgeon volume and specialty on clinical and economic outcomes after adrenalectomy. Design: Population-based retrospective cohort analysis. Setting: Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Participants: Adults (≥18 years) undergoing adrenalectomy in the United States (1999-2005). Patient demographic and clinical characteristics, surgeon specialty (general vs urologist), surgeon adrenalectomy volume, and hospital factors were assessed. Main Outcome Measures: The χ<sup>2</sup> test, analysis of variance, and multivariate linear and logistic regression were used to assess in-hospital complications, mean hospital length of stay (LOS), and total inpatient hospital costs. Results: A total of 3144 adrenalectomies were included. Mean patient age was 53.7 years; 58.8% were women and 77.4% white.Ahigher proportion of general surgeons were high-volume surgeons compared with urologists (34.1% vs 18.2%, P<.001). Low-volume surgeons had more complications (18.2% vs 11.3%, P<.001) and their patients had longer LOS (5.5 vs 3.9 days, P<.001) than did highvolume surgeons; urologists had more complications (18.4% vs 15.2%, P=.03) and higher costs ($13 168 vs $11 732, P=.02) than did general surgeons. After adjustment for patient and provider characteristics in multivariate analyses, surgeon volume, but not specialty, was an independent predictor of complications (odds ratio=1.5, P<.002) and LOS (1.0-day difference, P<.001). Hospital volume was associated only with LOS (0.8-day difference, P<.007). Surgeon volume, specialty, and hospital volume were not predictors of costs. Conclusion: To optimize outcomes, patients with adrenal disease should be referred to surgeons based on adrenal volume and laparoscopic expertise irrespective of specialty practice. ©2009 American Medical Association. All rights reserved.
“Robotics in surgery.”
Patel, V. R., T. Tammela, et al. (2009).
Scandinavian Journal of Surgery 98(2): 71.
“Cancer and sexual problems.”
Sadovsky, R., R. Basson, et al. (2010).
Journal of Sexual Medicine 7(1 PART 2): 349-373.
Introduction: There are many data on sexual problems subsequent to cancer and its treatment, although the likelihood of problems in specific individuals depends on multiple variables. Aims: To gain knowledge about the risks of sexual problems among persons with cancer and to provide recommendations concerning their prevention and optimal treatment. Methods: A committee of multidisciplinary specialists was formed as part of a larger International Consultation working with urologic and sexual medicine societies over a 2-year period to review the result of chronic illness management on sexual function and satisfaction. The aims, goals, data collection techniques, and report format were defined by a central committee. Main Outcomes Measures: Expert consensus was based on evidence-based medical and psychosocial literature review, extensive group discussion, and an open presentation with a substantial discussion period. Results: Cancer and cancer treatments have both direct and indirect effects on physiologic, psychological, and interpersonal factors that can all impact negatively on sexual function and satisfaction. Data on the likelihood of specific sexual problems occurring with cancer and its management vary depending on prediagnosis function, patient response, support from the treatment team, specific treatments used, proactive counseling, and efforts to mitigate potential problems. This summary details available literature concerning the pathophysiologic and psychological impacts of cancer diagnosis and treatment on sexual function, plus recommendations for their prevention and management. Conclusions: Cancer and its management have a significant negative impact on sexual function and satisfaction. These negative effects can be somewhat mitigated by understanding prediagnosis sexual functioning level, counseling, careful treatment choices, and, when indicated, therapy post-treatment using educational, psychological, pharmacologic, and mechanical modalities. © 2010 International Society for Sexual Medicine.
“Future of pain medicine: Computer- and robotic-assisted procedures.”
Shah, V. P., N. L. Shah, et al. (2009).
Techniques in Regional Anesthesia and Pain Management 13(4): 296-298.
In considering the future of pain medicine, it is imperative to consider existing and evolving technologies that can assist in performing complex and challenging procedures. Applications of new technologies are becoming the mainstay in many medical specialties. Computer- and/or robotic-assisted procedures allow clinicians to perform safe and reproducible procedures using minimally invasive techniques. In conjunction with image guidance these procedures are gaining wider acceptance and are becoming welcomed tools in medicine. The field of pain management is ideal for the incorporation of computer and/or robotic assistance in its procedures. Most of the procedures entail delivering the treatment via small access points. The goal of reducing tissue trauma makes it even more challenging to reach the targeted location. The use of computer and/or robotics will allow for precision, accuracy, and reproducibility, factors often unattainable due to the multitude of uncontrolled variables. This is a model that allows physicians to augment their critical thinking with the robot’s ability to promote accurate and efficient procedures. In addition, formal training sessions and multiple hours logged using the system will help with the clinicians’ learning curve. The pain medicine platform will consist of a unit that is mobile, light, and versatile, allowing the use of multiple robotic arms with multiple degrees of freedom. In the future, the platform-specific costs and specialized instrumentation will need to be determined. If the precision of this system allows for no injuries to neurovascular structures, then the financial burden may be well worth considering. © 2009 Elsevier Inc. All rights reserved.
“The impact of environmental noise on robot-assisted laparoscopic surgical performance.”
Siu, K. C., I. H. Suh, et al. (2010).
Surgery 147(1): 107-113.
Background: An operating room is a noisy environment. How noise affects performance during robotic surgery remains unknown. We investigated whether noise during training with the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA) would affect the performance of simple operative tasks by the surgeon. Methods: Twelve medical students performed 3 inanimate operative tasks (bimanual carrying, suture tying, and mesh alignment) on the da Vinci Surgical System with or without the presence of noise. Prerecorded noise from an actual operating room was used. The kinematics of the robotic surgical instrument tips and the muscle activation patterns of the subjects were evaluated. Results: We found noise effects for all 3 tasks with increases in the time to task completion (23%; P = .046), the total distance traveled (8%; P = .011) of the surgical instrument tips, and the muscle activation volume (87%; P = .015) with the presence of noise. We confirmed that the mesh alignment task was the most difficult task with the greatest time to task completion and the greatest muscle activation volume, whereas the suture tying task and the bimanual carrying could be considered the intermediate and the least difficult task, respectively. The noise effects were significantly greater while performing more difficult tasks. Conclusion: Our findings demonstrated that noise degraded robotic surgical performance; however, the impact of noise on robotic surgery will depend on the level of difficulty of the task. Subsequent research is required to identify how different types of noise, such as random or rhythmic sounds, affect the performance of operative tasks using robots such as the da Vinci. © 2010 Mosby, Inc. All rights reserved.
“Clinical outcomes after Hybrid coronary revascularization versus off-pump coronary artery bypass: A prospective evaluation.”
Vassiliades, T. A., P. D. Kilgo, et al. (2009).
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 4(6): 299-306.
OBJECTIVE: Hybrid coronary revascularization is offered as an alternative strategy for patients with multivessel coronary artery disease (CAD). We present our experience and provide a comparative analysis to off-pump coronary artery bypass grafting (OPCAB). METHODS: Ninety-one patients with multivessel CAD underwent minimally invasive left internal mammary artery to left anterior descending grafting in combination with percutaneous coronary intervention of nonleft anterior descending targets (HYBRID). The primary end point of this study was major adverse cardiac and cerebrovascular events (MACCE), defined as death, stroke, and nonfatal myocardial infarction. MACCE in the HYBRID group were compared with 4175 contemporaneously performed OPCAB operations by logistic (30-day outcomes) and Cox proportional hazards (long-term survival) regression methods. Propensity scoring was used to adjust for potential selection bias. RESULTS: The 30-day MACCE (death/stroke/nonfatal myocardial infarction) rate was 1.1% for the HYBRID group (0%/0%/1.1%) and 3.0% for the OPCAB group (1.8%/1.1%/0.5%) (odds ratio = 0.47, P = 0.48). Angiographic left internal mammary artery evaluation was obtained in 95.6% of patients (87 of 91) revealing FitzGibbon A patency in 98.0% (96 of 98). The reintervention rate at 1 year for the HYBRID group was 5.5% (5 of 91) and was limited to repeat percutaneous coronary intervention. Three-year survival was statistically similar for the two groups (hazard ratio = 0.44, P = 0.18, see Kaplan-Meier figure). CONCLUSIONS: Hybrid coronary revascularization may be noninferior to OPCAB with respect to early MACCE and 3-year survival in the treatment of multivessel CAD. Copyright © 2009 by the International Society for Minimally Invasive Cardiothoracic Surgery.
“Sexual dysfunction after radical prostatectomy.”
Wagner, L., A. Faix, et al. (2009).
Dysfonctions sexuelles après prostatectomie totale 19(SUPPL. 4).
Erectile dysfunction is not the only sexual dysfunction that impact quality of life of patients following radical prostatectomy for prostate cancer. Patients must be informed about these consequences and also about the prevention and treatment modalities that could be proposed after surgery. Preoperative erectile function and couple motivation are predictive of the quality of the sexual relationship after radical prostatectomy. A preoperative erectile dysfunction must be investigated as well as if it was the main symptom (evaluation of comorbidities, cardiovascular and psychological risk factors). The quality of the preservation of the neurovascular bundles is the other main determinant that must be decided according to cancer characteristics and performed according to a mastered surgical technic. © 2009 Elsevier Masson SAS. All rights reserved.