robotic assisted radical prostatectomy
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The Prostate ◽  
2022 ◽  
Author(s):  
David Eugenio Hinojosa‐Gonzalez ◽  
Andres Roblesgil‐Medrano ◽  
Mauricio Torres‐Martinez ◽  
Cordelia Alanis‐Garza ◽  
Ricardo J. Estrada‐Mendizabal ◽  
...  

2022 ◽  
Author(s):  
Eoin Dinneen ◽  
Jack Grierson ◽  
Ricardo Almeida Magana ◽  
Rosie Clow ◽  
Aiman Haider ◽  
...  

Abstract BackgroundRobotic radical prostatectomy (RARP) is a first-line curative treatment option for localized prostate cancer. Postoperative erectile dysfunction and urinary incontinence are common associated adverse side effects that can negatively impact patients’ quality of life. Preserving the lateral neurovascular bundles (NS) during RARP improves functional outcomes. However, selecting men for NS may be difficult when there is concern about incurring in positive surgical margin (PSM) which in turn risks adverse oncological outcomes. The NeuroSAFE technique (intra-operative frozen section examination of the neurovascular structure adjacent prostate margin) can provide real-time pathological consult to promote optimal NS while avoiding PSM.MethodsNeuroSAFE PROOF is a single-blinded, multi-centre, randomised controlled trial (RCT) in which men are randomly allocated 1:1 to either NeuroSAFE RARP or standard RARP. Men electing for RARP as primary treatment, who are continent and have good baseline erectile function (EF), defined by International Index of Erectile Function (IIEF-5) score>21, are eligible. NS in the intervention arm is guided by the NeuroSAFE technique. NS in the standard arm is based on standard of care, i.e., a pre-operative image-based planning meeting, patient-specific clinical information, and digital rectal examination. The primary outcome is assessment of EF at 12-months. The primary endpoint is the proportion of men who achieve IIEF-5 score ≥ 21. A sample size of 404 was calculated to give a power of 90% to detect a difference of 14% between groups based on a feasibility study. Oncological outcomes are continuously monitored by an independent Data Monitoring Committee. Key secondary outcomes include urinary continence at 3 months assessed by the international consultation on incontinence questionnaire, rate of biochemical recurrence, EF recovery at 24-months, and difference in quality of life.DiscussionThe NeuroSAFE PROOF is the first RCT of intra-operative frozen section in radical prostatectomy in the world. It is properly powered to evaluate a difference in the recovery of EF for men undergoing RARP assessed by patient reported outcome measures. It will provide evidence to guide the use of the NeuroSAFE technique around the world.Trial registration: NCT03317990 (23 October 2017). Regional Ethics Committee; reference 17/LO/1978.


2022 ◽  
pp. 1-4
Author(s):  
Bo-Han Chen ◽  
Jen-Shu Tseng ◽  
Allen W. Chiu

Hem-o-lok clips are widely used in robotic-assisted radical prostatectomy (RARP). However, clips-related complications have been reported, including intravesical migration. Here, we share a 60-year-old male case with newly diagnosed prostatic adenocarcinoma. With an unfavorable intermediate risk, he was admitted for RARP. He was discharged from hospital without any immediate complications. However, he reported progressive dysuria and slow urine stream 6 months after surgery. Cystoscopy showed severe bladder neck contracture (BNC), and 2 Hem-o-lok clips were found intravesically and removed during bladder neck incision. Subsequently, fiberocystoscopy revealed another 2 clips near the bladder neck with mild BNC after another 6 months. These 2 clips were also removed during bladder neck dilatation. His urination status then improved without further obstruction. Clip migration after RARP is uncommon; however, clinicians must keep this in mind when patients present with new complaints such as lower urinary tract symptoms, hematuria, and recurrent urinary tract infections.


2022 ◽  
Vol 48 (1) ◽  
pp. 122-130
Author(s):  
Thiago Camelo Mourão ◽  
Renato Almeida Rosa de Oliveira ◽  
Ricardo de Lima Favaretto ◽  
Thiago Borges Marques Santana ◽  
Carlos Alberto Ricetto Sacomani ◽  
...  

Uro ◽  
2021 ◽  
Vol 1 (4) ◽  
pp. 254-265
Author(s):  
Lorenzo Giuseppe Luciani ◽  
Daniele Mattevi ◽  
Tommaso Cai ◽  
Gianni Malossini

Robotic surgery saw unprecedented success throughout the world, with urology as a key discipline. Robotic-assisted radical prostatectomy (RARP) and partial nephrectomy (RAPN) were the frontline procedures. Many other urologic procedures have since been standardized over time. However, there is no universal consensus in current research on the recognition of robotics as the standard of care. Although better operative outcomes have been reported for most robotic procedures compared to open and laparoscopic surgery, no superiority has been proven as far as oncologic outcomes are concerned. This review aims to describe current research on robotic surgery concerning each urologic procedure, showing its applications and limits. The non-classic parameters in part responsible for the planetary success of robotics, such as the shorter learning curve, improved ergonomics, and surgeon’s comfort, as well immersive three-dimensional vision, are further areas of focus.


2021 ◽  
Vol 47 (6) ◽  
pp. 1279-1280
Author(s):  
Igor Nunes-Silva ◽  
Alexandre Kyoshi Hidaka ◽  
Carlos Roberto Monti ◽  
Marcos Tobias-Machado ◽  
Hamilton de Campos Zampolli

Author(s):  
K. R. Seetharam Bhat ◽  
Fikret Fatih Onol ◽  
Marcio Covas Moschovas ◽  
Sunil Reddy ◽  
Jonathan Noel ◽  
...  

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