Thulium Laser Vaporization versus  Vapoenucleation (without morcellation) Technique for BPH: Do We Have a Winner?

Background and ObjectiveThe thulium laser surgery is a relatively new approach in which a wavelength of approximately 2 μm is emitted in continuous-wave mode, thus enabling the precise incision of tissue by using a wavelength that matches the water absorption peak of 1.92 μm in tissue. However, no published multinational study or other evidence definitively declares the superiority of thulium vaporization (ThuVAP) over thulium vapoenucle-ation (ThuVEP) without morcellator for better management of bothersome benign prostatic hyperplasia. The present study aims to evaluate the efficacy of vaporization and vapoenucleation (without a morcellator) in thulium laser prostatectomy for the treatment of benign prostatic hyperplasia.MethodsA retrospective analysis of 82 patients who underwent thulium laser prostatectomy between February 2017 and January 2018 with ThuVAP and ThuVEP techniques was done and outcome measures analyzed were International Prostate Symptom Score (IPSS), quality-of-life score (QoL), maximum ﬂow rate (Q max), post-void residual (PVRU), total operating time, laser time and resected tissue weight.ResultsNo significant differences were noted between ThuVAP and ThuVEP in terms of post-operative prostate volume (22.4 vs. 21.7 mL) and post-operative prostate specific antigen (PSA) (2.54 vs. 1.85 ng/mL). Nonetheless, there were differences between the groups in total lasing time (56.5 vs. 44.8 min, p = 0.001) and total operative time (88.5 vs. 71.5 min, p= 0.001). There was also a significant difference in IPSS, QoL score, Q max, and PVRU at 6 weeks, 3 months, 6 months and 9 months after surgery.

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Prostate-Specific Antigen Velocity Predicts Surgical Outcome of Thulium Laser Enucleation of the Prostate

Frontiers in Medicine ◽

10.3389/fmed.2021.783221 ◽

2022 ◽

Vol 8 ◽

Author(s):

Po-You Chen ◽

Shao-Ming Chen ◽

Horng-Heng Juang ◽

Chen-Pang Hou ◽

Yu-Hsiang Lin ◽

...

Keyword(s):

Prostate Specific Antigen ◽

Surgical Outcome ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

Area Under The Curve ◽

Maximum Flow ◽

Thulium Laser ◽

Laser Enucleation ◽

Male Patients

Background: We determined the effect of prostate-specific antigen velocity (PSAV) on the surgical outcome of thulium laser enucleation of the prostate (ThuLEP) in patients with benign prostatic hyperplasia (BPH).Methods: A retrospective review was performed of prospectively collected data of patients with BPH who underwent ThuLEP at any time from 2017 to 2019. Patients who had undergone BPH surgery or had prostate cancer previously were excluded, and patients with prostate-specific antigen (PSA) > 4 ng/ml were examined through transrectal ultrasound-guided prostate biopsy to rule out prostatic malignancy. Furthermore, patients were excluded if prostatic malignancy was diagnosed during postsurgery follow-up.Results: The PSA level, International Prostate Symptom Score (IPSS), and quality of life (QoL) of 27 male patients at 3 and 15 months postsurgery differed significantly from those at presurgery; the maximum flow rate (Qmax) and postvoid residual (PVR) significantly differed between 3 months postsurgery and presurgery; and 22 and 5 patients had good to excellent and fair to poor outcomes, respectively, at 15 months postsurgery. Patients were divided into two groups (fair and poor vs. good and excellent outcomes at 15 months postsurgery), which significantly differed with respect to PSAV at 3 months postsurgery (P = 0.04), IPSS presurgery (P < 0.02), surgical length (P = 0.01), and hospitalization duration (P = 0.04). In a receiver operating characteristic (ROC) analysis, the optimal cutoff value of PSAV of −0.52 ng/ml characterized effectiveness at 15 months after ThuLEP, and the area under the curve (AUC), sensitivity, and specificity were 0.82 (P < 0.02), 0.80, and 0.82, respectively. For PSAV < -0.52 and ≥-0.52 ng/ml, the percentages of reduction for IPSS, QoL, Qmax, and PVR were −78.6 and −71.4%, −33.3 and 0.0%, 94.4 and 40.0%, and −85.1 and −38.7%, respectively.Conclusions: Postsurgical PSAV was positively correlated with surgical success, and the PSAV cutoff was −0.52 ng/ml. PSAV can, thus, be used to guide the postsurgical follow-up treatment at 3 months after BPH surgery.

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Comparison of GreenLight 180-W XPS laser vaporization versus transurethral resection of the prostate: Outcomes of a single regional center

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.3.169 ◽

2020 ◽

Vol 92 (3) ◽

Author(s):

Daniele Mattevi ◽

Lorenzo Luciani ◽

Rosa Spina ◽

Claudio Divan ◽

Stefania Cicuto ◽

...

Keyword(s):

Transurethral Resection ◽

Functional Outcomes ◽

Prostate Volume ◽

Specific Antigen ◽

Perioperative Outcomes ◽

Laser Vaporization ◽

Regional Center ◽

Significant Difference ◽

Single Centre Study

Background: To evaluate the intermediate perioperative outcomes, rate of complications and functional data after XPS 180-W Greenlight photoselective laser vaporization (PVP) compared with transurethral resection of the prostate (TURP) in a prospective non-randomized single centre study. Methods: We analyzed a prospectively-maintained database collecting data on 100 patients undergoing surgical treatment of BPH (50 consecutive PVP and 50 consecutive TURP). All complications, recorded and graduated according to the Clavien Dindo system and the clinical, operative, perioperative variables were compared. The functional outcomes, International Prostate Symptom Score (IPSS), max flow rate (Qmax) and Prostate Specific Antigen (PSA), were recorded preoperatively and at 1 year of follow up. Results: Age, prostate volume, use of anticoagulants or antiplatelets, ASA score and operative time were comparable in the two groups. The reduction in the hemoglobin levels (0.46 vs 1.8 g/dL), the catheterization time (1.2 vs 3.2 days), the hospital stay (1.7 vs 3.8 days) and rate of transfused patients (0 vs 8%), were significantly lower for PVP. Transient re-catherization (6 vs 26%) was significantly lower for PVP. The IPSS and Qmax at 1 year showed no significant difference. The rate of repeat TURP/PVP was higher in the TURP group (0 vs 10%). Reduction of PSA, that reflects the major reduction of prostate volume, was statistically greater in PVP group respect TURP group (p = 0.001). Conclusions: PVP has advantages in terms of perioperative safety and major complications than TURP. Functional outcomes at 1 year of follow-up were comparable.

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PROSTATE VAPORIZATION BY DIODE LASER FOR PATIENTS WITH BENIGN PROSTATIC ENLARGEMENT

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i12.29572 ◽

2018 ◽

Vol 11 (12) ◽

pp. 523

Author(s):

Falah Mahdi Ali ◽

Ahmed Ali Obaid

Keyword(s):

Diode Laser ◽

Specific Antigen ◽

Digital Rectal Examination ◽

Maximum Flow ◽

Prospective Clinical Study ◽

Benign Prostatic Enlargement ◽

Laser Prostatectomy ◽

Prostatic Enlargement ◽

Duration Of Operation ◽

Median Maximum

Objectives: The objectives of this study were to study the efficacy of diode laser prostatectomy in patients infected with benign prostatic enlargement.Methods: A total of 62 men were included in our prospective clinical study from August 2017 to January 2018. The size of their prostates (ml) was ranged from 38 to 65, digital rectal examination for all patients was revealed the features of benign prostatic enlargement, prostate-specific antigen was ranged from 0.3 to 14 ng/ml, underwent laser prostatectomy (Diode laser).Results: The study included 62 men with 67.82±7.57 years. After the operation, the median maximum flow rate (Qmax) was increased 11–22 ml/s and the increment was highly significant (p<0.001), and median international prostate symptom score was highly significantly reduced from 19 to 10 (p<0.001). In addition, median residual volume was highly significantly reduced from 169.5 to 77 ml (p<0.001). Mean duration of operation was 67.82±7.57 min. The duration of catheterization with a mean of 1.16±0.45 days. Most patients required only 1 day of hospital stay postoperatively. No one developed post-operative bleeding, erectile dysfunction was reported in a single patient (1.6%), urinary incontinence in one patient (1.6%), and urinary tract infection was the most frequent post-operative complication being reported in 11.3%.Conclusion: Diode laser for the treatment of prostate is easily applicable, cheap and provides good ablation with low morbidity.

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Comparison of the Effects of a Bioceramic and Conventional Resin-Based Sealers on Postoperative Pain after Nonsurgical Root Canal Treatment: A Randomized Controlled Clinical Study

Materials ◽

10.3390/ma14102661 ◽

2021 ◽

Vol 14 (10) ◽

pp. 2661

Author(s):

Kiche Shim ◽

Young-Eun Jang ◽

Yemi Kim

Keyword(s):

Postoperative Pain ◽

Postoperative Period ◽

Root Canal ◽

Continuous Wave ◽

Root Canal Treatment ◽

Root Canals ◽

Anterior Teeth ◽

Significant Difference ◽

Ah Plus ◽

Group 2

Background: This clinical trial aimed to compare the effects of bioceramic sealer and resin-based sealer on the incidence and intensity of postoperative pain. Methods: Patients with anterior teeth or premolars requiring root canal treatment were assigned to group 1 (n = 51). Those with molars requiring treatment were assigned to group 2 (n = 57). In groups 1En and 2En, root canals were obturated with Endoseal MTA using the single-cone technique. In groups 1AH and 2AH, the sealer used was AH Plus with the continuous wave technique. On the day of canal filling, each patient was instructed to indicate their pain intensity over the 7 day postoperative period, at rest and, while biting, using a visual analog scale. Results: There was no significant difference in the incidence or intensity of postoperative pain between the Endoseal MTA and AH Plus groups during the 7 day postoperative period (p > 0.05). Less time was needed to seal the root canals with Endoseal MTA, especially in group 2 (p < 0.05). Conclusions: Endoseal MTA and AH Plus had similar effects on the incidence and intensity of postoperative pain. The obturation time was shorter when using Endoseal MTA compared to AH Plus.

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Clinicopathological correlation of pre-biopsy quantitative PSMA uptake in patients with persistently raised serum PSA: initial experience in 74 patients with simultaneous 68-Ga PSMA PET/MRI

Journal of Clinical Urology ◽

10.1177/2051415820956406 ◽

2020 ◽

pp. 205141582095640

Author(s):

Malik A Rouf ◽

Rajesh Taneja ◽

Venkatesh Kumar

Keyword(s):

Specific Antigen ◽

Digital Rectal Examination ◽

Whole Body ◽

Characteristic Analysis ◽

Positron Emission ◽

Psma Pet ◽

Significant Difference ◽

Magnetic Resonance Imaging Mri ◽

Normal Urine ◽

Delayed Phase

Objective: To analyze 68-Ga prostate-specific membrane antigen (PSMA) uptake pattern of the prostate and its correlation with prostate-specific antigen (PSA), digital rectal examination (DRE), and Gleason’s score in the diagnosis of carcinoma of the prostate (CaP). Methods: This was a retrospective study conducted between June 2015 and August 2017. Patients who had undergone whole body 68-Ga PSMA HBED-CC simultaneous positron emission tomography (PET) or magnetic resonance imaging (MRI) for the diagnosis or staging of CaP were eligible. Patients who presented with persistently raised serum PSA (>4 ng/mL) and normal urine routine and negative culture were included in the study. Results: A total of 74 patients were included in the study. Significant positive correlation was observed between PSMA delayed uptake with the Prostate Imaging Reporting and Data System (PI-RADS) score ( p<0.001, ρ=0.750), PSA level ( p<0.001, ρ=0.414), DRE ( p<0.002, ρ=0.400), and Gleason’s score ( p<0.300, ρ=0.02). There was a significant difference between early and delayed phase of PSMA uptake in malignant prostatic lesions ( p<0.001). Delayed phase of PSMA uptake was able to characterize prostate lesions with an area under curve (AUC) of 0.91. Combined receiver operating characteristic analysis of PI-RADS score derived from multiparametric MRI and differential PSMA uptake to characterize prostatic lesions improved AUC to 0.94. Conclusion: Results demonstrated that the correlation with clinicopathological features (PSA, DRE, and Gleason’s score) could be used in prognostication of prostatic lesion along with PSMA PET/MRI.

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Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a multi-institutional comparative study

African Journal of Urology ◽

10.1186/s12301-020-00083-0 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Amr A. Faddan ◽

Mahmoud M. Shalaby ◽

Mohamed Gadelmoula ◽

Younis Alshamsi ◽

Daniar K. Osmonov ◽

...

Keyword(s):

Radical Prostatectomy ◽

Complication Rate ◽

Perioperative Complications ◽

Statistical Significance ◽

Operating Time ◽

Perioperative Outcomes ◽

Academic Institutions ◽

Robot Assisted ◽

Surgical Specimen ◽

Significant Difference

Abstract Background The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions. Methods A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at (P < 0.05). All reported P values are two-sided. Results A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time (P < .0001), catheterization period (P < .001), hospital stay (P < .0001), and overall complications rate (P = .023). Conclusions The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.

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An eye-tracking based robotic scrub nurse: proof of concept

Surgical Endoscopy ◽

10.1007/s00464-021-08569-w ◽

2021 ◽

Author(s):

Ahmed Ezzat ◽

Alexandros Kogkas ◽

Josephine Holt ◽

Rudrik Thakkar ◽

Ara Darzi ◽

...

Keyword(s):

Eye Tracking ◽

Technology Acceptance ◽

Operating Time ◽

Human Robot Interaction ◽

Motion Sensors ◽

Scrub Nurse ◽

Task Load ◽

Significant Difference ◽

Nasa Tlx ◽

Robotic Devices

Abstract Background Within surgery, assistive robotic devices (ARD) have reported improved patient outcomes. ARD can offer the surgical team a “third hand” to perform wider tasks and more degrees of motion in comparison with conventional laparoscopy. We test an eye-tracking based robotic scrub nurse (RSN) in a simulated operating room based on a novel real-time framework for theatre-wide 3D gaze localization in a mobile fashion. Methods Surgeons performed segmental resection of pig colon and handsewn end-to-end anastomosis while wearing eye-tracking glasses (ETG) assisted by distributed RGB-D motion sensors. To select instruments, surgeons (ST) fixed their gaze on a screen, initiating the RSN to pick up and transfer the item. Comparison was made between the task with the assistance of a human scrub nurse (HSNt) versus the task with the assistance of robotic and human scrub nurse (R&HSNt). Task load (NASA-TLX), technology acceptance (Van der Laan’s), metric data on performance and team communication were measured. Results Overall, 10 ST participated. NASA-TLX feedback for ST on HSNt vs R&HSNt usage revealed no significant difference in mental, physical or temporal demands and no change in task performance. ST reported significantly higher frustration score with R&HSNt. Van der Laan’s scores showed positive usefulness and satisfaction scores in using the RSN. No significant difference in operating time was observed. Conclusions We report initial findings of our eye-tracking based RSN. This enables mobile, unrestricted hands-free human–robot interaction intra-operatively. Importantly, this platform is deemed non-inferior to HSNt and accepted by ST and HSN test users.

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Pancreaticogastrostomy after Pancreaticoduodenectomy Using Twin Square Wrapping with Duct-to-Mucosa Anastomosis

European Surgical Research ◽

10.1159/000433425 ◽

2015 ◽

Vol 55 (1-2) ◽

pp. 109-118 ◽

Cited By ~ 6

Author(s):

Kosei Maemura ◽

Yuko Mataki ◽

Hiroshi Kurahara ◽

Shinichiro Mori ◽

Naotomo Higo ◽

...

Keyword(s):

Operating Time ◽

Conventional Group ◽

C Reactive Protein ◽

Pancreatic Anastomosis ◽

Pancreatic Stump ◽

Reactive Protein ◽

Significant Difference ◽

Pancreatic Fistulas ◽

Hospital Stays ◽

Blood Loss Volume

Background/Purpose: This study aimed to evaluate the feasibility and safety of a novel pancreaticogastrostomy technique for diminishing pancreatic fistulas after pancreaticoduodenectomy using gastric wrapping of the pancreatic stump with a twin square-shaped horizontal mattress and a suture fixing the main pancreatic duct to the gastric mucosa anastomosis [twin square wrapping (TSW) method]. Methods: Fifty-three patients undergoing pancreaticogastrostomy after pancreaticoduodenectomy were included in the study and chronologically divided into a conventional group (n = 32) and a TSW group (n = 21). The perioperative factors and the postoperative outcomes were retrospectively analyzed. Results: The operating time for the pancreatic anastomosis, the total operating time, and the blood loss volume in the TSW group were lower than in the conventional group, but without a statistically significant difference. The TSW group had a significantly lower postoperative white blood cell count and C-reactive protein level, with a reduced intra-abdominal fluid accumulation as assessed by computed tomography on postoperative day 7, had a lower incidence of postoperative complications and pancreatic fistulas, and achieved a shorter duration of drain placement and shorter postoperative hospital stays as compared to the conventional group. Conclusions: The TSW technique should be considered for reducing pancreatic fistulas by diminishing the postoperative inflammatory response and improving patient outcomes without increasing the operating time.

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