Hemidiaphragm Paralysis after Robotic Prostatectomy: Medical Malpractice or Unforeseeable Event?

2015 ◽  
Vol 98 (2) ◽  
pp. 241-244
Author(s):  
Martina Focardi ◽  
Aurelio Bonelli ◽  
Vilma Pinchi ◽  
Gianni Vittori ◽  
Federica De Luca ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Medical Malpractice ◽  
Rare Events ◽  
Robotic Prostatectomy ◽  
Point Of View ◽  
Clinical Knowledge ◽  
Review Of The Literature ◽  
Robot Assisted ◽  
Hemidiaphragm Paralysis

The authors present a case of suspected malpractice linked to the onset of hemidiaphragm paralysis after robot-assisted radical prostatectomy (RARP). The approach to the case is shown from a medico-legal point of view. It is demonstrated how, after a thorough review of the literature, this was not a case of medical malpractice but an unforeseeable event. This paper aims at contributing to the very few reports dealing with the onset of hemidiaphragm paralysis after RARP, thus fostering clinical knowledge of these rare events and meanwhile providing useful data for the medico-legal handling in case of alleged negligence of surgeons.

MP45-18 IS RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY THE MORE ANATOMICAL APPROACH? – COMPARISON WITH CONVENTIONAL ROBOTIC PROSTATECTOMY

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Patrick Tuliao ◽  
Christos Komninos ◽  
Kyo Chul Koo ◽  
Chien Hsiang Cheng ◽  
Young Deuk Choi ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Robotic Prostatectomy ◽  
Robot Assisted

scholarly journals Anatomic robotic prostatectomy: current best practice

2019 ◽  
Vol 11 ◽  
pp. 175628721881378 ◽  
Author(s):  
Alberto Martini ◽  
Ashutosh Kumar Tewari
Keyword(s):  
Radical Prostatectomy ◽  
Patient Selection ◽  
Best Practice ◽  
Robotic Prostatectomy ◽  
Anatomical Reconstruction ◽  
Robot Assisted ◽  
Anatomical Studies ◽  
Nerve Preservation ◽  
The Past ◽  
New Evidence

Urologic prostate surgery has changed dramatically over the past decades. Following the introduction of the robot, the surgical approach has been modified and thanks to the magnification allowed by the robot a further level of precision can be achieved. Moreover, advances in the anatomical studies have provided new evidence regarding the periprostatic anatomy. The aim of this review is to describe our approach to robot-assisted radical prostatectomy. Our holistic perspective towards patient selection, pre- and postoperative care is provided. In our center, robot-assisted radical prostatectomy is performed by means of an anterograde approach. A nonbladder-sparing dissection with a graded approach towards nerve preservation is carried out. The procedure is concluded with what we call ‘total anatomical reconstruction’.

scholarly journals A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice

2018 ◽  
Vol 100 (3) ◽  
pp. 226-229 ◽  
Author(s):  
A Jaulim ◽  
A Srinivasan ◽  
S Hori ◽  
N Kumar ◽  
AY Warren ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Learning Curve ◽  
Specific Antigen ◽  
Positive Margin ◽  
Robotic Prostatectomy ◽  
Learning Curves ◽  
Upward Trend ◽  
Robot Assisted ◽  
The Impact

Introduction The aim of this study was to explore the impact of increasing proportions of high risk referrals on surgical margin outcomes of a surgeon’s learning curve in robotic prostatectomy. Methods All patients in this study underwent robot assisted radical prostatectomy (RARP) performed by three different consultant urological surgeons. Data collected included preoperative clinical stage, Gleason score and prostate specific antigen levels, which were used to risk stratify patients according to National Institute for Health and Care Excellence criteria. Oncological clearance was assessed by overall and stage specific positive margin status. Comparisons were made between each surgeon for the first and second 50 consecutive cases. Results For the three surgeons, there was a progressive increase in the proportion of high risk cases referred accompanied by a corresponding decline in low risk disease (p<0.001). Postoperative pathology also showed an upward trend in pT3 cases across the three eras. There was no statistical difference in overall positive margin rates between the surgeons. The overall rates were 12%, 20% and 23% for the first 50 cases, and 32%, 36% and 21% for the second 50 cases for the three surgeons respectively. Conclusions Our series demonstrates an upward trend in the risk profile of men referred for robotic prostatectomy over a nine-year period. Despite this, there was minimal impact on pathological and surgical outcomes among our surgeons, who were at the initial stages of their RARP learning curve. Our results suggest that there is no requirement for an active case selection bias against patients with high risk disease for surgeons newly embarking on their RARP learning experience.

V327: Laparoscopic Nerve Sparing Radical Prostatectomy Using Clips for Haemostasis During Postero-Lateral Dissection: An Unusual “Point of View” of the Surgical Anatomy

2006 ◽  
Vol 175 (4S) ◽  
pp. 107-107
Author(s):  
Georges Fournier ◽  
Antoine Valeri ◽  
Adham Rammal ◽  
Vincent Joulin ◽  
Luc Cormier ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Surgical Anatomy ◽  
Point Of View ◽  
Nerve Sparing
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