Clinical Outcome of Endoscopic Enucleation of the Prostate Compared With Robotic-Assisted Simple Prostatectomy for Prostates Larger Than 80 cm3 in Aging Male

This study investigated and compared the surgical outcomes of using endoscopic enucleation (thulium: YAG laser and bipolar plasma; ThuLEP) with robotic-assisted simple prostatectomy (RASP) in the treatment of prostates larger than 80 cm3. Records were obtained for the period from January 2014 to December 2020 for selected patients with BPO who underwent RASP, ThuLEP, or bipolar transurethral enucleation of the prostate (B-TUEP). Patients were excluded if they had active malignant disease, neurogenic bladder, lower urinary tract syndrome for reasons other than BPO, and a history of prostate surgery. Data of 396 patients who underwent B-TUEP, ThuLEP, and RASP were examined. A total of 112 patients met the including criteria, 85 of whom (B-TUEP: 29; ThuLEP: 41; RASP: 15) completed the final visit. The mean operation time and duration of postoperative hospital stays in the RASP group were significantly longer than those of the B-TUEP and ThuLEP groups. Only 1 patient in the RASP group required blood transfusion. The RASP group was superior to the other groups in voiding improvement including Qmax and IPSS voiding score. The pain score of the ThuLEP group after surgery was significantly lower than that of the other two groups during hospitalization, whereas the QoL scores were identical between the three groups at 2 weeks, 3 months, and 6 months post operation. The rates of returning to ER within the first postoperative month did not differ significantly between the three groups, and all the reasons for return involved minor complications that required no additional invasive treatment. These three surgical methods (B-TUEP, ThuLEP, and RASP) are all effective and safe for treating prostates larger than 80 cm3, with each having its particular advantages. B-TUEP requires the shortest operation time, ThuLEP causes the lowest postoperative pain, and RASP results in superior voiding function improvement.

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Current status on robotic assisted myomectomy

Mini-invasive Surgery ◽

10.20517/2574-1225.2021.70 ◽

2021 ◽

Author(s):

Imrich Kiss ◽

Pavla Svobodova ◽

Lubos Karasek ◽

Bohuslav Svoboda

Keyword(s):

Open Surgery ◽

Surgical Techniques ◽

Operation Time ◽

Current Status ◽

Robot Assisted ◽

Robotic Assisted ◽

Alternative Treatment Option ◽

Fertility Sparing ◽

Surgical Methods ◽

Robotic Myomectomy

Uterine leiomyomas are common benign solid tumors of the uterus. While the presence of fibroids is rarely life threatening, they are associated with symptoms affecting quality of life and fertility. Myomectomy is a standard fertility-sparing surgery which should be considered for women suffering from fibroid-related symptoms who do not desire hysterectomy or any alternative treatment option. While open surgery is thought to be reserved for large and numerous myomas, mini-invasive methods as laparoscopy and robot-assisted surgery have evolved in the hands of experienced surgeons to also deal with these more complex cases. Robotic myomectomy has its advantages in lower blood loss, fewer complications, and shorter hospital stay over open surgery, whereas the comparison outcomes with laparoscopic myomectomy are still uncertain. Advantages of the wristed instruments, three-dimensional vision along with the incorporation of correct surgical techniques could emphasize the benefits of the robotic assisted approach in large and numerous myoma cases. Careful and detailed assessment should precede the surgery to recognize risks and steps to reduce operation time, which tends to be the most presented drawback of robotic myomectomy. As the tendency of robot-assisted surgeries is growing, many authors share their experience or publish comparison studies with other surgical methods. Our article describes the current status concerning robotic myomectomy, reviewing publications from the past five years (2016-2021).

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Robotic-Assisted Simple Prostatectomy: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm9061798 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1798

Author(s):

Yakup Kordan ◽

Abdullah Erdem Canda ◽

Ersin Köseoğlu ◽

Derya Balbay ◽

M. Pilar Laguna ◽

...

Keyword(s):

Systematic Review ◽

Treatment Options ◽

Case Series ◽

Operation Time ◽

Published Data ◽

Large Sample Size ◽

Robotic Assisted ◽

Simple Prostatectomy ◽

Wide Range ◽

Laser Enucleation

Contemporary minimally invasive surgical (MIS) treatment options of patients with male Lower Urinary Tract Symptoms (LUTS) in men with prostate glands >80 mL include Holmium Laser Enucleation Prostate (HoLEP), Thulium laser VapoEnucleation Prostate (ThuVEP), and Laparoscopic (LSP) or Robotic-Assisted Simple Prostatectomy (RASP). Implementing new laser technologies is costly, and the steep learning curve of these laser techniques limit their wide range use. This promoted the use of LSP and RASP in centers with readily established laparoscopy or robotic surgery programs. The aim of this study is to review case and comparative series of RASP. We systematically reviewed published data from 2008 to 2020 on RASP and have identified 26 non-comparative and 9 comparative case series. RASP has longer operation time but less time spent in hospital and less blood loss. The outcomes of improvements in symptom score, post-voiding residual urine (PVR), postoperative PSA decline, complications, and cost are similar when compared to open and laser enucleation techniques. These outcomes position RASP as a viable MIS treatment option for patients with male LUTS needing surgical treatment for enlarged prostates. Nevertheless, prospective, randomized controlled trials (RCTs) with multicenter and large sample size are needed to confirm the findings of this systematic review.

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Robotic Simple Prostatectomy: Why and How?

International Neurourology Journal ◽

10.5213/inj.2040018.009 ◽

2020 ◽

Vol 24 (1) ◽

pp. 12-20 ◽

Cited By ~ 1

Author(s):

Jeong Man Cho ◽

Kyong Tae Moon ◽

Tag Keun Yoo

Keyword(s):

Surgical Treatment ◽

Benign Prostatic Hyperplasia ◽

Prostatic Hyperplasia ◽

Treatment Results ◽

Invasive Treatment ◽

Simultaneous Treatment ◽

Short Learning Curve ◽

Simple Prostatectomy ◽

Surgical Methods ◽

Bladder Diverticula

Increasingly many studies have presented robotic simple prostatectomy (RSP) as a surgical treatment option for large benign prostatic hyperplasia (BPH) weighing 80–100 g or more. In this review, some frequently used RSP techniques are described, along with an analysis of the literature on the efficacy and complications of RSP and differences in treatment results compared with other surgical methods. RSP has the advantage of a short learning curve for surgeons with experience in robotic surgery. Severe complications are rare in patients who undergo RSP, and RSP facilitates the simultaneous treatment of important comorbid diseases such as bladder stones and bladder diverticula. In conclusion, RSP can be recommended as a safe and effective minimally invasive treatment for large BPH.

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Clinical Evaluation of Microendoscopy-Assisted Oblique Lateral Interbody Fusion

Medicina ◽

10.3390/medicina57020135 ◽

2021 ◽

Vol 57 (2) ◽

pp. 135

Author(s):

Tomohide Segawa ◽

Hisashi Koga ◽

Masahito Oshina ◽

Katsuhiko Ishibashi ◽

Yuichi Takano ◽

...

Keyword(s):

Interbody Fusion ◽

Outcome Measure ◽

Operation Time ◽

Secondary Outcome ◽

Invasive Technique ◽

Lateral Interbody Fusion ◽

Surgical Methods ◽

Significant Difference ◽

Oblique Lateral Interbody Fusion ◽

Lateral Interbody

Background and objectives: Oblique Lateral Interbody Fusion (OLIF) is a widely performed, minimally invasive technique to achieve lumbar lateral interbody fusion. However, some complications can arise due to constraints posed by the limited surgical space and visual field. The purpose of this study was to assess the short-term postoperative clinical outcomes of microendoscopy-assisted OLIF (ME-OLIF) compared to conventional OLIF. Materials and Methods: We retrospectively investigated 75 consecutive patients who underwent OLIF or ME-OLIF. The age, sex, diagnosis, and number of fused levels were obtained from medical records. Operation time, estimated blood loss (EBL), and intraoperative complications were also collected. Operation time and EBL were only measured per level required for the lateral procedure, excluding the posterior fixation surgery. The primary outcome measure was assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The secondary outcome measure was assessed using the Oswestry Disability Index (ODI) and the European Quality of Life–5 Dimensions (EQ-5D), measured preoperatively and 1-year postoperatively. Results: This case series consisted of 14 patients in the OLIF group and 61 patients in the ME-OLIF group. There was no significant difference between the two groups in terms of the mean operative time and EBL (p = 0.90 and p = 0.50, respectively). The perioperative complication rate was 21.4% in the OLIF group and 21.3% in the ME-OLIF group (p = 0.99). In both groups, the postoperative JOABPEQ, EQ-5D, and ODI scores improved significantly (p < 0.001). Conclusions: Although there was no significant difference in clinical results between the two surgical methods, the results suggest that both are safe surgical methods and that microendoscopy-assisted OLIF could serve as a potential alternative to the conventional OLIF procedure.

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Treatment of inflammatory diseases of the female genitalia with iontophoresis

Kazan medical journal ◽

10.17816/kazmj76684 ◽

1927 ◽

Vol 23 (4) ◽

pp. 425-429

Author(s):

N. S. Utochnikova

Keyword(s):

Young Women ◽

Surgical Intervention ◽

Inflammatory Diseases ◽

The Other ◽

Female Genitalia ◽

Physical Methods ◽

Surgical Methods ◽

The One ◽

Methods Of Treatment ◽

Female Genital

The treatment of inflammatory diseases of the female genitalia has long been one of the most important tasks of the gynecologist. With the development of surgery, surgical methods of treatment began to be applied: exudates were removed, the uterus and inflamed appendages were extirpated, etc.; but the danger of surgical intervention on the one hand, and on the other - the severe consequences of removal of organs such as ovaries, especially in young women - forced gynecologists to spend much effort in discovering and improving non-operative methods of treatment of inflammatory diseases of the female genital parts. Among these methods, physical methods such as water, mud, light baths, massage, etc., as well as those related to electricity have long been prominent.

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Comparison of Sleeve Lobectomy for Lung Cancer Using Mini-Thoracotomy and an Optimized Robot-Assisted Technique

Technology in Cancer Research & Treatment ◽

10.1177/15330338211051547 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110515

Author(s):

Tao Shaolin ◽

Feng Yonggeng ◽

Kang Poming ◽

Mei Longyong ◽

Shen Cheng ◽

...

Keyword(s):

Clinical Outcomes ◽

Operation Time ◽

Intercostal Space ◽

Large Sample Size ◽

Sleeve Lobectomy ◽

Term Survival ◽

Robotic Assisted ◽

Posterior Axillary Line ◽

Pain Scores ◽

Mini Thoracotomy

Objective: To evaluate the clinical significance of an optimized approach to improve surgical field visualization and simplify anastomosis techniques using robotic-assisted sleeve lobectomy for lung or bronchial carcinoma. Method: A total of 26 consecutive patients who underwent sleeve lobectomy between January 2017 and April 2020 were enrolled in the study. The cohort included 11 cases of robotic-assisted surgery (RAS group) and 15 cases of mini-thoracotomy (MT group). RAS was performed via an exclusive optimized approach utilizing the “3 to 4-6 to 8/9” four-port technique. Retrieved demographical and clinical data included operation time, anastomosis time, blood loss, chest drainage time and volume, postoperative pain scores, complications, white blood cell (WBC) levels, and duration of hospital stay and follow-up. Results: No cases of perioperative death were recorded. Compared to MT group, the RAS group had a similar anastomosis time (30.82 ± 6.08 vs 33.20 ± 7.73 min, respectively, p > 0.05) and shorter operation time (189.73 ± 36.41 vs 225.33 ± 38.19 min, respectively, p < 0.05). The RAS group had lower pain scores (4.23 ± 0.26 vs 4.91 ± 0.51, p < 0.05), lower levels of WBC (p < 0.05), and no anastomotic complications postoperatively. The RAS and MT groups demonstrated a successful bronchus reconstruction with low risk of angulation (1/11 vs 1/15, p > 0.05) and satisfactory disease-free survival (eight cases, 72.73% and 12 cases, 80%, respectively). Conclusion: The optimized approach to RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes. Further study with a large sample size and evaluation of long-term survival are warranted. Key points: (i) we present a novel, convenient, and efficient approach for robotic-assisted sleeve lobectomy, ie, “3 to 4-6 to 8/9” four-port technique. The optimized approach for RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes; (ii) details for the “3 to 4-6 to 8/9” four-port method: the assistant port was located at the fourth intercostal space. The 1-cm camera port was inserted at the sixth intercostal space in the posterior axillary line. The 0.5-cm da Vinci ports of the instrument arms were placed at the third intercostal space in the anterior axillary line and the eighth or ninth intercostal space in the posterior axillary line. The patient cart was inserted from the back of the patient's head and shoulders at 75° to the longitudinal line.

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Ultrasound-Guided Moving Shot Radiofrequency Ablation of Benign Soft Tissue Neoplasm

Medicina ◽

10.3390/medicina57080830 ◽

2021 ◽

Vol 57 (8) ◽

pp. 830

Author(s):

Wei-Che Lin ◽

Yi-Fan Tai ◽

Meng-Hsiang Chen ◽

Sheng-Dean Luo ◽

Faye Huang ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Soft Tissue ◽

General Anesthesia ◽

Local Anesthesia ◽

Venous Malformation ◽

Volume Reduction ◽

The Other ◽

Invasive Treatment ◽

Soft Tissue Neoplasm

Background and Objective: To evaluate the effectiveness of radiofrequency ablation (RFA) using the moving-shot technique for benign soft tissue neoplasm. Materials and Methods: This retrospective study reviewed eight patients with benign soft tissue neoplasm presenting with cosmetic concerns and/or symptomatic issues who refused surgery. Six patients had vascular malformation, including four with venous malformation and two with congenital hemangioma. The other two patients had neurofibroma. All patients underwent RFA using the moving-shot technique. Imaging and clinical follow-up were performed in all patients. Follow-up image modalities included ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. The volume reduction ratio (VRR), cosmetic scale (CS), and complications were evaluated. Results: Among the seven patients having received single-stage RFA, there were significant volume reductions between baseline (33.3 ± 21.2 cm3), midterm follow-up (5.1 ± 3.8 cm3, p = 0.020), and final follow-up (3.6 ± 1.4 cm3, p = 0.022) volumes. The VRR was 84.5 ± 9.2% at final follow-up. There were also significant improvements in the CS (from 3.71 to 1.57, p = 0.017). The remaining patient, in the process of a scheduled two-stage RFA, had a 33.8% VRR after the first RFA. The overall VRR among the eight patients was 77.5%. No complications or re-growth of the targeted lesions were noted during the follow-up period. Of the eight patients, two received RFA under local anesthesia, while the other six patients were under general anesthesia. Conclusions: RFA using the moving-shot technique is an effective, safe, and minimally invasive treatment for benign soft tissue neoplasms, achieving mass volume reduction within 6 months and significant esthetic improvement, either with local anesthesia or with general anesthesia under certain conditions.

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Robotic-assisted versus open simple prostatectomy: Results from a systematic review and meta-analysis of comparative studies

Investigative and Clinical Urology ◽

10.4111/icu.20210297 ◽

2021 ◽

Vol 62 ◽

Author(s):

Simone Scarcella ◽

Daniele Castellani ◽

Vineet Gauhar ◽

Jeremy Yuen-Chun Teoh ◽

Carlo Giulioni ◽

...

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Meta Analysis ◽

Robotic Assisted ◽

Simple Prostatectomy

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Covered Stents for True Subclavian Aneurysms in Patients with Degenerative Connective Tissue Disorders

Journal of Endovascular Therapy ◽

10.1177/152660280301000335 ◽

2003 ◽

Vol 10 (3) ◽

pp. 647-652 ◽

Cited By ~ 20

Author(s):

Karthikeshwar Kasirajan ◽

Brian Matteson ◽

John M. Marek ◽

Mark Langsfeld

Keyword(s):

Connective Tissue ◽

Stent Graft ◽

Subclavian Artery ◽

Case Reports ◽

The Other ◽

Long Term Results ◽

Covered Stents ◽

Connective Tissue Disorders ◽

Invasive Treatment ◽

Cystic Medial Necrosis

Purpose: To report the endovascular repair of rare true aneurysms of the subclavian artery in patients with degenerative connective tissue disorders. Case Reports: Two patients, one with Marfan syndrome and the other with idiopathic cystic medial necrosis, presented with 3 subclavian artery aneurysms. A Wallgraft and 2 Viabahn covered stents were used to successfully exclude these aneurysms. After 3 months, the Wallgraft thrombosed, but the contralateral Viabahn remained patent at the most recent examination 13 months after treatment. The other patient with the unilateral aneurysm had a patent Viabahn stent-graft at 10 months. Conclusions: Patients with degenerative connective tissue disorders may benefit from less invasive treatment with stent-grafts. The more flexible Viabahn stent-graft may be better able to adapt to arterial tortuosity. However, the long-term results of this new technique have not yet been established.

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