“Laparoscopic radical prostatectomy: Transfer validity.”
Erdogru, T., S. Yucel, et al. (2010).
International Journal of Urology 17(5): 476-482.
Objectives: The impact of a formal fellowship training program on the independent practice of the trainees (i.e. transfer validity) has not been evaluated. We analyzed the transfer validity of a structured curriculum in an in-door as well as an out-door setting. Methods: After completing their training, two fourth generation laparoscopic surgeons who started at the same time compared operative parameters and oncological outcomes in their independent practice, prospectively analyzing the next 100 patients in each. One surgeon continued laparoscopic radical prostatectomy (LRP) in the same center of excellence (Group-In), whereas the other implemented the procedure in a separate academic center (Group-Out). Results: The demographics for both groups (Group-In vs Group-Out) were similar regarding age, prostate volume and preoperative prostate-specific antigen levels. Mean operation times (214.8 vs 224.2 min; P = 0.494) and estimated blood loss (472.4 vs 402.6 mL; P = 0.109) did not differ significantly in both groups as well as complication rate (20 vs 24%), median catheter time (8 vs 8.5 days) and continence rates at 12 months (95 vs 95.5%). According to the pathological stages, the rates of positive surgical margins were similar for pT2 (3.2 vs 4.3%) and pT3 (42.8 vs 45.2%), respectively. Conclusions: With a well designed, long-term preclinical and clinical fellowship training program, LRP techniques can be efficiently transferred from the center of excellence to other centers with no significant impact on surgical, functional and oncological outcomes. © 2010 The Japanese Urological Association.
“Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis.”
Giannopoulos, G. A., N. E. Tzanakis, et al. (2010).
Surgical Endoscopy: 1-7.
Background: Staple line leaks represent a major concern in all laparoscopic operations but are particularly important in bariatric surgery, where leak complications carry significant morbidity and mortality. Therefore, several means of staple line reinforcement have been described, but none is totally accepted. In this study, we attempt to illuminate any clear benefit of staple line reinforcement through a systematic review and meta-analysis of reported articles. Methods: Two major databases (PubMed and Cochrane) were searched and assessed by two reviewers. Inclusion criteria were: detailed description of operative technique, especially concerning staple line reinforcement, and possible existence of proven staple line leak. Selected studies were evaluated by systematic review and meta-analysis according to their eligibility. The study population was finally divided into two groups: reinforcement (of any type) and no reinforcement. Results: In the initial search, 126 studies were obtained. Then, 17 full papers, both randomised controlled trials (RCTs) and non-RCTs, were included in the systematic review. Seven studies, comprising 3,299 patients, were examined for evaluation of population odds of leak (7.69), which was considered clinically significant. Meta-analysis of three studies comprising 1,899 patients revealed no clear benefit of reinforcement group, though with marginal significance. Conclusions: Although several drawbacks exist, this study illustrates two important aspects: that current staplers may not be uniformly reliable, and that staple line reinforcement does not seem to have any clear benefit, at least concerning leak rate. © 2010 Springer Science+Business Media, LLC.
“Population based time trends and socioeconomic variation in use of radiotherapy and radical surgery for prostate cancer in a UK region: Continuous survey.”
Lyratzopoulos, G., J. M. Barbiere, et al. (2010).
BMJ: British Medical Journal 340(7753): 961.
Objective: To examine variation in the management of prostate cancer in patients with different socioeconomic status. Design: Survey using UK regional cancer registry data. Setting: Regional population based cancer registry. Participants: 35 171 patients aged ≥51 with a diagnosis of prostate cancer, 1995-2006. Main outcome measures: Use of radiotherapy and radical surgery. Socioeconomic status according to fifths of small area deprivation index. Results: Over nine years of the study, information on stage at diagnosis was available for 15 916 of 27 970 patients (57%). During the study period, the proportion of patients treated with radiotherapy remained at about 25%, while use of radical surgery increased significantly (from 2.9% (212/7201) during 1995-7 to 8.4% (854/10 211) during 2004-6, P<0.001). Both treatments were more commonly used in least deprived compared with most deprived patients (28.5% v 21.0% for radiotherapy and 8.4% v 4.0% for surgery). In multivariable analysis, increasing deprivation remained strongly associated with lower odds of radiotherapy or surgery (odds ratio 0.92 (95% confidence interval 0.90 to 0.94), P<0.001, and 0.91 (0.87 to 0.94), P<0.001, respectively, per incremental deprivation group). There were consistently concordant findings with multilevel models for clustering of observations by hospital of diagnosis, with restriction of the analysis to patients with information on stage, and with sequential restriction of the analysis to different age, stage, diagnosis period, and morphology groups. Conclusions: After a diagnosis of prostate cancer, men from lower socioeconomic groups were substantially less likely to be treated with radical surgery or radiotherapy. The causes and impact on survival of such differences remain uncertain.
“The quality-of-life impact of prostate cancer treatments.”
Singh, J., E. J. Trabulsi, et al. (2010).
Current Urology Reports 11(3): 139-146.
Many options exist for the treatment of localized prostate cancer. In the decision to choose a therapeutic option for localized disease, many variables need to be considered such as tumor characteristics, clinical stage, the patient’s overall health and life expectancy, and preferences of both the physician and patient. Another important consideration is the health-related quality of life (HRQOL) implications of a given treatment option. The importance of HRQOL relative to the potential side effects of prostate cancer treatments has grown over the past few years. Although our collective awareness has increased, objective data on HRQOL for prostate cancer treatment are lacking due to a paucity of prospective clinical trial data. This review defines the concept of HRQOL, discusses what is currently known about the impact of various treatments on HRQOL, and summarizes the recent literature in this area relating to the management of localized prostate cancer. © 2010 Springer Science+Business Media, LLC.
“Best practices for minimally invasive procedures.”
Ulmer, B. C. (2010).
AORN Journal 91(5): 558-572; quiz 573-555.
Techniques and instrumentation for minimally invasive surgical procedures originated in gynecologic surgery, but the benefits of surgery with small incisions or no incisions at all have prompted the expansion of these techniques into numerous specialties. Technologies such as robotic assistance, single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and video-assisted thoracoscopic surgery have led to the continued expansion of minimally invasive surgery into new specialties. With this expansion, perioperative nurses and other members of the surgical team are required to continue to learn about new technology and instrumentation, as well as the techniques and challenges involved in using new technology, to help ensure the safety of their patients. This article explores the development of minimally invasive procedures and offers suggestions for increasing patient safety.
“Use of Anti-Skid Material and Patient-Positioning To Prevent Patient Shifting during Robotic-Assisted Gynecologic Procedures.”
Klauschie, J., M. E. Wechter, et al. (2010).
Journal of Minimally Invasive Gynecology.
STUDY OBJECTIVE: To estimate patient shifting with the current practice of use of an antiskid material and patient positioning during robotic procedures in gynecology. DESIGN: Pilot observational study (Canadian Task Force classification). SETTING: Tertiary referral center. PATIENTS: Twenty-two women undergoing robotic-assisted gynecologic procedures. INTERVENTION: Antiskid material (egg-crate pink foam) was placed beneath patients and patient positioning was used during robotic-assisted procedures. MEASUREMENTS AND MAIN RESULTS: Patient position was marked before and after surgery. Measurements of shift distance before and after surgery were determined for each patient. Median (range) shift distance was 1.3 (0-7.5) cm. There was no significant association between shift in position and either body mass index or duration of the Trendelenburg position. No shoulder neuropathic injuries were observed during the study. CONCLUSION: Minimal patient shifting is observed with the use of an antiskid material and patient positioning described, without the use of shoulder braces and straps.
“Legal and ethical issues in robotic surgery.”
Mavroforou, A., E. Michalodimitrakis, et al. (2010).
International Angiology 29(1): 75-79.
Aim. With the rapid introduction of revolutionary technologies in surgical practice, such as computer-enhanced robotic surgery, the complexity in various aspects, including medical, legal and ethical, will increase exponentially. Our aim was to highlight important legal and ethical implications emerged from the application of robotic surgery. Methods. Search of the pertinent medical and legal literature. Results. Robotic surgery may open new avenues in the near future in surgical practice. However, in robotic surgery, special training and experience along with high quality assessment are required in order to provide normal conscientious care and state-of-the-art treatment. While the legal basis for professional liability remains exactly the same, litigation with the use of robotic surgery may be complex. In case of an undesirable outcome, in addition to physician and hospital, the manufacturer of the robotic system may be sued. In respect to ethical issues in robotic surgery, equipment safety and reliability, provision of adequate information, and maintenance of confidentiality are all of paramount importance. Also, the cost of robotic surgery and the lack of such systems in most of the public hospitals may restrict the majority from the benefits offered by the new technology. Conclusion. While surgical robotics will have a significant impact on surgical practice, it presents challenges so much in the realm of law and ethics as of medicine and health care.
“The decisive role of the patient-side surgeon in robotic surgery.”
Sgarbura, O. and C. Vasilescu (2010).
Surgical Endoscopy.
INTRODUCTION: Minimally invasive technology literature is mainly concerned about the feasibility of the robotic procedures and the performance of the console surgeon. However, few of these technologies could be applied without a well-trained team. Our goal was to demonstrate that robotic surgery depends more on the patient-side assistant surgeon’s abilities than has been previously reported. METHODS: In our department, 280 interventions in digestive, thoracic, and gynecological surgery were performed since the acquisition of the robotic equipment. There are three teams trained in robotic surgery with three console surgeons and four certified patient-side surgeons. Four more patient-side assistants were trained at our center. Trocar placement, docking and undocking of the robot, insertion of the laparoscopic instruments, and hemostatic maneuvers with various devices were quantified and compared. RESULTS: Assistants trained by using animal or cadaver surgery are more comfortable with the robotic instruments handling and with docking and undocking of the robot. Assistants who finalized their residency or attend their final year are more accurate with the insertion of the laparoscopic instrument to the targeted organ and more skillful with LigaSure or clip applier devices. Interventions that require vivid participation of the assistants have shorter assistant-depending time intervals at the end of the learning curve than at the beginning. CONCLUSIONS: Robotic surgery is a team effort and is greatly dependant on the performance of assistant surgeons. Interventions that have the benefit of a trained team are more rapid and secure.
“Best practices for minimally invasive procedures.”
Ulmer, B. C. (2010).
AORN Journal 91(5): 558-572; quiz 573-555.
Techniques and instrumentation for minimally invasive surgical procedures originated in gynecologic surgery, but the benefits of surgery with small incisions or no incisions at all have prompted the expansion of these techniques into numerous specialties. Technologies such as robotic assistance, single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and video-assisted thoracoscopic surgery have led to the continued expansion of minimally invasive surgery into new specialties. With this expansion, perioperative nurses and other members of the surgical team are required to continue to learn about new technology and instrumentation, as well as the techniques and challenges involved in using new technology, to help ensure the safety of their patients. This article explores the development of minimally invasive procedures and offers suggestions for increasing patient safety.
“Are you ready to take off as a robo-surgeon?”
Watanabe, G. (2010).
Surgery Today 40(6): 491-493.
Robotic-assisted surgery is the latest iteration toward less invasive techniques. Surgeons have slowly adapted minimally invasive and robotics techniques into their armamentarium. We have developed a robotic cardiac surgery program in Japan that utilizes the da Vinci Surgical System, allowing the surgeon to perform complex procedures through 5-mm port sites rather than a traditional median sternotomy. In this rapidly evolving field, we review the evolution and clinical results of roboticassisted surgery and take a look at the other general surgical procedures for which da Vinci currently being used.