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Investigative and Clinical Urology Mar 2016The first urologic robotic program in the world was built at the Vattikuti Urology Institute, Henry Ford Hospital Detroit, Michigan, in 2000 under the vision of surgical... (Review)
Review
The first urologic robotic program in the world was built at the Vattikuti Urology Institute, Henry Ford Hospital Detroit, Michigan, in 2000 under the vision of surgical innovator, Dr. Mani Menon for the radical prostatectomy. The robot-assisted radical prostatectomy continues being modified with techniques to improve perioperative and surgical outcomes. The application of robotic surgical technique has since been expanded to the bladder and upper urinary tract surgery. The evolution of surgical technique and its expansion of application will continue to improve quality, outcome parameters and experience for the patients.
Topics: Cystectomy; Humans; Prostatectomy; Robotic Surgical Procedures; Urinary Tract; Urologic Surgical Procedures
PubMed: 26981588
DOI: 10.4111/icu.2016.57.2.75 -
Korean Journal of Urology Feb 2015Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of... (Review)
Review
Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each.
Topics: Alprostadil; Erectile Dysfunction; Humans; Male; Penile Implantation; Phosphodiesterase 5 Inhibitors; Prostatectomy; Prostatic Neoplasms; Risk Factors; Vacuum; Vasodilator Agents
PubMed: 25685296
DOI: 10.4111/kju.2015.56.2.99 -
International Braz J Urol : Official... 2022Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency... (Review)
Review
Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.
Topics: Erectile Dysfunction; Humans; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Treatment Outcome
PubMed: 34786925
DOI: 10.1590/S1677-5538.IBJU.2022.99.04 -
BMC Medicine Apr 2016Localized prostate cancer (PCa) is a clinically heterogeneous disease, which presents with variability in patient outcomes within the same risk stratification (low,... (Review)
Review
Localized prostate cancer (PCa) is a clinically heterogeneous disease, which presents with variability in patient outcomes within the same risk stratification (low, intermediate or high) and even within the same Gleason scores. Genomic tools have been developed with the purpose of stratifying patients affected by this disease to help physicians personalize therapies and follow-up schemes. This review focuses on these tissue-based tools. At present, four genomic tools are commercially available: Decipher™, Oncotype DX®, Prolaris® and ProMark®. Decipher™ is a tool based on 22 genes and evaluates the risk of adverse outcomes (metastasis) after radical prostatectomy (RP). Oncotype DX® is based on 17 genes and focuses on the ability to predict outcomes (adverse pathology) in very low-low and low-intermediate PCa patients, while Prolaris® is built on a panel of 46 genes and is validated to evaluate outcomes for patients at low risk as well as patients who are affected by high risk PCa and post-RP. Finally, ProMark® is based on a multiplexed proteomics assay and predicts PCa aggressiveness in patients found with similar features to Oncotype DX®. These biomarkers can be helpful for post-biopsy decision-making in low risk patients and post-radical prostatectomy in selected risk groups. Further studies are needed to investigate the clinical benefit of these new technologies, the financial ramifications and how they should be utilized in clinics.
Topics: Genetic Markers; Genetic Techniques; Humans; Male; Neoplasm Metastasis; Neoplasm Staging; Predictive Value of Tests; Prognosis; Prostatectomy; Prostatic Neoplasms; Risk Assessment
PubMed: 27044421
DOI: 10.1186/s12916-016-0613-7 -
Cancer Control : Journal of the Moffitt... Jul 2007Until recently, open radical prostatectomy was the only approach for the surgical management of prostate cancer. Laparoscopy is now increasingly used as an alternative... (Review)
Review
BACKGROUND
Until recently, open radical prostatectomy was the only approach for the surgical management of prostate cancer. Laparoscopy is now increasingly used as an alternative approach. The procedure can be performed directly or with robot assistance.
METHODS
We review the relevant literature regarding oncologic and functional outcomes with laparoscopic surgery in the management of localized prostate cancer.
RESULTS
Oncologic and functional outcomes are similar between open and laparoscopic radical prostatectomy. Pure laparoscopic prostatectomy and robotic assisted laparoscopic prostatectomy result in less blood loss and shorter convalescence. Costs associated with the initial investment, disposables, and maintenance of the robot system are higher than for pure laparoscopic prostatectomy.
CONCLUSIONS
Laparoscopic radical prostatectomy, either pure or robotic, is becoming the preferred approach for the surgical management of localized prostate cancer. Oncologic and functional outcomes are similar to the open approach.
Topics: Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Robotics; Treatment Outcome
PubMed: 17615531
DOI: 10.1177/107327480701400308 -
Journal of Robotic Surgery Apr 2023Video labelling is the assigning of meaningful information to raw videos. With the evolution of artificial intelligence and its intended incorporation into the operating...
Video labelling is the assigning of meaningful information to raw videos. With the evolution of artificial intelligence and its intended incorporation into the operating room, video datasets can be invaluable tools for education and the training of intelligent surgical workflow systems through computer vision. However, the process of manual labelling of video datasets can prove costly and time-consuming for already busy practising surgeons. Twenty-five robot-assisted radical prostatectomy (RARP) procedures were recorded on Proximie, an augmented reality platform, anonymised and access given to a novice, who was trained to develop the knowledge and skills needed to accurately segment a full-length RARP procedure on a video labelling platform. A labelled video was subsequently randomly selected for assessment of accuracy by four practising urologists. Of the 25 videos allocated, 17 were deemed suitable for labelling, and 8 were excluded on the basis of procedure length and video quality. The labelled video selected for assessment was graded for accuracy of temporal labelling, with an average score of 93.1%, and a range of 85.6-100%. The self-training of a novice in the accurate segmentation of a surgical video to the standard of a practising urologist is feasible and practical for the RARP procedure. The assigning of temporal labels on a video labelling platform was also studied and proved feasible throughout the study period.
Topics: Male; Humans; Robotic Surgical Procedures; Robotics; Artificial Intelligence; Prostate; Prostatectomy
PubMed: 36309954
DOI: 10.1007/s11701-022-01465-y -
International Braz J Urol : Official... 2022Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been...
INTRODUCTION
Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been proposed by several authors (1). However, even with the robotic surgery advantages, functional outcomes following RARP, especially erection recovery, still challenge surgeons and patients (2, 3). In this scenario, we have described different ways and grades of neurovascular bundle preservation (NVB) using the prostatic artery as a landmark until our most recent technique with lateral prostatic fascia preservation and modified apical dissection (4-6). In this video compilation, we have illustrated the anatomical and technical details of different grades of NVB preservation.
SURGICAL TECHNIQUE
After the anterior and posterior bladder neck dissection, we lift the prostate by the seminal vesicles to access the posterior aspect of the prostate. Then, we incise the Denonvilliers layers and work between an avascular plane to release the posterior NVB from 5 to 1 and 7 to 11 o'clock positions on the right and left sides, respectively6. In sequence, we access the prostate anteriorly by incising the endopelvic fascia bilaterally (close to the prostate) until communicating the anterior and posterior planes. Finally, we control the prostatic pedicles with Hem-o-lok clips and then proceed for the apical dissection preserving the maximum amount of urethra length and periurethral tissues. Considerations: Potency recovery following radical prostatectomy remains a challenge due to its multifactorial etiology. However, basic concepts for nerve-sparing are crucial to achieving optimal outcomes, such as minimizing the amount of traction used on dissection, avoiding excessive cautery, and neural preservation based on anatomical landmarks (arteries and planes of dissection).
Topics: Humans; Male; Penile Erection; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 34786924
DOI: 10.1590/S1677-5538.IBJU.2022.99.03 -
Journal of Endourology May 2018Radical prostatectomy remains an important means to treat prostate cancer. A major limiting factor to radical prostatectomy is short- and long-term complications,...
Radical prostatectomy remains an important means to treat prostate cancer. A major limiting factor to radical prostatectomy is short- and long-term complications, especially incontinence and sexual dysfunction. With the advent of robotic radical prostatectomy, the ability to easily evaluate technical issues with video has been realized. In this article, we present a step-by-step examination of our procedure and our results over the past 5 years.
Topics: Humans; Male; Patient Positioning; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Urinary Incontinence
PubMed: 29421921
DOI: 10.1089/end.2017.0723 -
BMC Urology Dec 2021Radical prostatectomy (RP) is the primary treatment of localized prostate cancer. Immediate urinary incontinence post-RP was still common and depressing without specific...
BACKGROUND
Radical prostatectomy (RP) is the primary treatment of localized prostate cancer. Immediate urinary incontinence post-RP was still common and depressing without specific reason.
METHODS
A multicenter cohort of 154 consecutive patients from 2018 to 2020, who was diagnosed with localized prostate cancer underwent either modified mini-incision retropubic radical prostatectomy (Mmi-RRP) or laparoscopic radical prostatectomy (LRP) or robotic-assisted radical prostatectomy (RARP). Seventy-two patients with Denonvilliers' fascia (DF) spared were included in DFS (Denonvilliers' fascia sparing) group. Whereas eighty-two patients with DF completely or partially dissected were set as Group Control. The primary outcome was immediate continence (ImC). Continuous data and categorical data were analyzed with t-test and Chi-square test, respectively. Odds ratios (ORs) were calculated with logistic regression.
RESULTS
Urinary continence of Group DFS was significantly better than that of Group Control at each time point within one year after operation. Incidence rate of continence in Group DFS and Group Control were 83.3% vs 13.4% (P < 0.01) for ImC, 90.3% vs 30.5% (P < 0.01) at 3 months, 91.7% vs 64.6% (P < 0.01) at 6 months, and 93.1% vs 80.5% (P = 0.02) at 1 year after operation, respectively. Positive surgical margin (PSM) showed no significant difference (20.8% vs 20.7%, P = 1.0). In multivariate analysis, DFS showed importance for ImC post RP (OR = 26.4, P < 0.01).
CONCLUSIONS
Denonvilliers' fascia acted as the fulcrum and hammock for continence post RP. Preservation of DF contributed to better continence after RP without increase of PSM. Trail registration Our research was conducted retrospectively and approved by the ethical committees of Minhang Hospital, but not registered.
Topics: Aged; Aged, 80 and over; Fascia; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prostate; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Transurethral Resection of Prostate; Urinary Incontinence
PubMed: 34920713
DOI: 10.1186/s12894-021-00943-z -
Minerva Urologica E Nefrologica = the... Oct 2017Gleason Score discordance can confound optimal treatment allocation of patients diagnosed with prostate cancer and place these patients at risk of worse oncological... (Review)
Review
INTRODUCTION
Gleason Score discordance can confound optimal treatment allocation of patients diagnosed with prostate cancer and place these patients at risk of worse oncological outcomes. Its prevalence remains endemic; its exact causation remains unknown. The objective of this review was to examine the observational studies of patient cohorts who have undergone radical prostatectomy with the aim of identifying any preoperative variables that may be associated with an upgrade in final prostatectomy Gleason Score.
EVIDENCE ACQUISITION
A non-systematic review of English articles from 2010 to present was performed through a MEDLINE search. Search terms included "Gleason Score," "pathological," "upgrade," and "radical prostatectomy."
EVIDENCE SYNTHESIS
All studies included for review were retrospective analyses of radical prostatectomy series that examined factors associated with Gleason Score discordance.
CONCLUSIONS
The various studies found that Gleason Score upgrading remains highly prevalent, and that some association can be seen with greater percent positive cores, longer biopsy core lengths, smaller prostate glands, higher percent tumor volume per gland, prostate-specific antigen density and visible lesions on multiparametric magnetic resonance imaging.
Topics: Humans; Male; Neoplasm Grading; Prognosis; Prostatectomy; Prostatic Neoplasms; Risk Factors
PubMed: 28008754
DOI: 10.23736/S0393-2249.16.02684-9