Hitendra R H Patel

Publications (39)117.59 Total impact

• Article: Surgical case order does not affect outcomes during robot-assisted radical prostatectomy

  Seth A. Capello, Hitendra R. H. Patel, Jean V. Joseph
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  ABSTRACT: Fatigue has been implicated in medical errors. There has not been any report in the surgical literature addressing the impact of case order on patient outcomes. The purpose of this study was to determine whether the order of robot-assisted radical prostatectomy (RARP) has an influence on surgical outcomes. All patients undergoing RARP by a single surgeon (J.V.J.) on days during which there were three consecutive RARP cases were divided into three groups based on case order. They were compared with respect to pre-operative, intra-operative, and post-operative parameters. Complications were classified as surgical (bladder neck contracture, urinary tract infection, post-operative bleeding) or medical (deep venous thrombosis, myocardial infarction, C. difficile colitis) and compared between the groups. A total of 381 patients were evaluated, 127 in each group. The median start time for group 1 was 0732hours (range 0722–0900hours), group 2 was 1108hours (range 1008–1344hours), and group 3 was 1458hours (range 1258–1742hours). Patient age, body mass index, pre-operative PSA, pre-operative Gleason score, and clinical stage were all similar amongst the groups. The total operative time was equivalent, as was the estimated blood loss. Prostate volume and pathologic Gleason score showed no significant changes between groups. Pathologic stage showed a slight trend toward increasing percentages of T3 disease with increasing group number (group 1=17%, group 2=19%, and group 3=24%). Positive margin rates were lowest in group 3 (11.8% for group 1, 12.6% for group 2, and 3.9% for group 3). Complication rates were equivalent at 5–7% overall (2–6% surgical complications, 2–4% medical). Three patients from each group had PSA recurrence. With an experienced surgical team, three RARP procedures may be performed in 1day without significant variation in surgical outcomes among the cases.
  Journal of Robotic Surgery 04/2012; 2(1):25-29.
• Article: The cost of radical prostatectomy: retrospective comparison of open, laparoscopic, and robot-assisted approaches

  Jean V. Joseph, Ann Leonhardt, Hitendra R. H. Patel
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  ABSTRACT: New technologies are regularly being used for surgical treatment of prostate cancer, however the cost associated is often a secondary issue. We assessed the operative costs incurred by using the daVinci robot assisted prostatectomy (RAP) method compared to pure laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP). We retrospectively analyzed three techniques of radical prostatectomies: ORP, LRP, and RAP (n=70, 57, 106, respectively). The mean patient age was 53.6, 57.6, and 60 with a mean preoperative prostate specific antigen (PSA) of 7.2, 8.4, and 6.6, respectively. The mean Gleason score was 6. Operative cost was measured for each patient. Charts were reviewed to assess individual patients postoperative requirements, and hospital length of stay (LOS). Intraoperative data show costs to be higher with the RAP and LRP compared to open surgery. Average total operating room (OR) costs per case were 5410,5410, 3876, and $1870 for RAP, LRP, and open prostatectomy, respectively. However when comparisons are made in the postoperative period with regard to LOS, there is a significant advantage of the RAP and LRP groups over open surgery (P<0.05). Intraoperative costs are highest for RAP. Both LRP and RAP are associated with a shorter hospital stay.
  Journal of Robotic Surgery 04/2012; 2(1):21-24.
• Article: Microrobot assisted laparoscopic urological surgery in a canine model.

  Jean V Joseph, Dimitry Oleynikov, Mark Rentschler, Jason Dumpert, Hitendra R H Patel
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  ABSTRACT: Robotic technologies have had a significant impact on surgery. We report what is to our knowledge the first use of microrobots to perform laparoscopic urological surgery in a canine model. Nonsurvival laparoscopic radical prostatectomy and radical nephrectomy were performed using microrobotic camera assistance. Following the administration of general anesthesia miniature camera robots were inserted in the insufflated abdomen via a 15 mm laparoscopic port. These microrobots were mobile, controlled remotely to desired locations and provided views of the abdominal cavity, assisting the laparoscopic procedures. Additional ports and laparoscopic instruments were placed in the abdomen using the views provided by these microrobots. One dog underwent laparoscopic prostatectomy and another underwent laparoscopic nephrectomy. The 2 procedures were completed successfully. Microrobots provided additional views from several angles, aiding in the performance of the procedures. Miniature camera robots (microrobots) provide a mobile viewing platform. With added functionality these new robots have the potential to further evolve the robotic armamentarium for surgeons.
  The Journal of urology 10/2008; 180(5):2202-5. · 4.02 Impact Factor
• Article: Page kidney phenomenon presenting as acute renal failure after partial nephrectomy: a case report and review of the literature.

  Jason John, Siân Allen, Matthew Perry, Hitendra R H Patel, Tim O'Brien
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  ABSTRACT: The Page kidney phenomenon, whilst a known condition, is in itself a rare entity. This report illustrates a case following partial nephrectomy which presented as post-operative renal failure. The authors present a case of renal cell carcinoma in a solitary kidney that after partial nephrectomy resulted in a subcapsular haematoma formation and acute renal failure. The condition of Page kidneys are typically described in young patients after trauma. However, with the increasing usage of surgical interventions, post-operative bleeding can result in a compression-induced necrosis.
  Urologia Internationalis 02/2008; 80(4):440-3. · 0.99 Impact Factor
• Article: Randomized comparison of extraperitoneal and transperitoneal access for robot-assisted radical prostatectomy.

  Seth A Capello, Judd Boczko, Hitendra R H Patel, Jean V Joseph
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  ABSTRACT: Although extraperitoneal robot-assisted radical prostatectomy (RARP) is gaining popularity, the majority of these procedures are performed transperitoneally. The purpose of this study was to compare the transperitoneal and extraperitoneal approaches for RARP. We randomized 62 consecutive patients undergoing RARP into two equal groups according to the route of access. The groups were evaluated for age, body mass index (BMI), preoperative serum prostate specific antigen (PSA) concentration, total operating time, estimated blood loss, specimen weight, pathologic Gleason score and stage, intraoperative and postoperative complications, and surgical-margin status. No significant differences were noted the extraperitoneal and transperitoneal groups with respect total operative time (181 v 191 minutes), blood loss (199 v 163 mL), pathologic Gleason score (6.6 v 6.7), specimen weight (53 v 48 g), or positive-margin status (0 v 1 patient). There were no significant differences in age (56 v 59 years) or PSA (7.8 v 6.1 ng/dL). However, the BMI was significantly higher in the extraperitoneal group (29.8 v 26.5 kg/m(2); P < 0.01). The only complication in the study was a urine leak, which occurred in the transperitoneal group and was managed conservatively. There were no significant differences in operative parameters in the two groups. Choice of access should be based on patient characteristics as well as surgeon preference. Patients who have had abdominal operations are best suited for the extraperitoneal route. Surgeons should be familiar with both approaches in order to provide patients with the best care.
  Journal of Endourology 11/2007; 21(10):1199-202. · 1.85 Impact Factor
• Article: Nanotechnology and its relevance to the urologist.

  Lyndon Gommersall, Iqbal S Shergill, Hashim U Ahmed, Dickon Hayne, Manit Arya, Hitendra R H Patel, Makoto Hashizume, Inderbir S Gill
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  ABSTRACT: We review important aspects of nanotechnology, and discuss the wide range of research and clinical applications of nanomedicine in the field of urology. There is particular emphasis on key clinical and pre-clinical studies to provide an update on recent and potential applications in the care of urological patients. A directed Medline literature review of nanotechnology was performed. Important publications that have shaped our understanding of nanotechnology were selected for review and were augmented by manual searches of reference lists. Nanotechnology is the study, design, creation, synthesis, manipulation, and application of functional materials, devices, and systems through control of matter at the nanometer scale. Studies demonstrate a number of important concepts. These include nanovectors, nanotubes, and nanosensors for targeted drug delivery; nanowires and nanocantilever arrays for early detection of precancerous and malignant lesions; and nanopores for DNA sequencing. These advances will lead to significant applications relevant to the diagnosis, management, and treatment of all urological conditions. This review is designed for the urologist to provide an overview and update on nanotechnology and its applications in the field of urology. In the future, it is widely expected that nanotechnology and nanomedicine will have a significant impact on urological research and clinical practice, allowing urologists to intervene at the cellular and molecular level. With structured, safe implementation, nanotechnologies have the potential to revolutionise urological practice in our lifetime.
  European Urology 09/2007; 52(2):368-75. · 8.49 Impact Factor
• Article: Is it worth revisiting laparoscopic three-dimensional visualization? A validated assessment.

  Hitendra R H Patel, Maria-Jose Ribal, Manit Arya, Rohan Nauth-Misir, Jean V Joseph
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  ABSTRACT: Pure laparoscopic urologic surgery is becoming the standard of care for many urologic procedures. Training surgeons without any experience in the field is still a challenge. It is well recognized that two-dimensional optics causes difficulty for the novice. Thus, we assessed a new-generation, three-dimensional (3D) visualization system. Fifteen laparoscopically novice surgeons were asked to perform five validated laparoscopic training exercises using the two-dimensional and 3D systems in random order: (a) linear cutting and suturing; (b) curved cutting and suturing; (c) tubular suturing; (d) dorsal vein complex suturing simulation; and (e) urethrovesical anastomosis. The objective (time taken to complete the task versus the time needed by an expert) and subjective (accuracy on completion versus an expert's) scoring were performed independently by advanced laparoscopists. Statistical analysis was performed using the t test. All tasks were completed by the participants. The statistical analysis revealed a trend toward improved task performance using 3D visualization. Our preliminary testing has suggested that the new-generation, 3D system used will be helpful for developing skills in laparoscopy for the novice surgeon.
  Urology 08/2007; 70(1):47-9. · 2.43 Impact Factor
• Article: Robot-assisted radical prostatectomy in obese patients.

  Judd Boczko, Ralph Madeb, Dragan Golijanin, Erdal Erturk, Mary Mathe, Hitendra R H Patel, Jean V Joseph
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  ABSTRACT: Few centers perform extraperitoneal robot assisted radical prostatectomy. The average patient weight is increasing to the mildly obese. Little is known as to the difficulty-impact, obesity may have on robot-assisted extraperitoneal prostatectomy (RAP). We assess our own experience with obese patients undergoing RAP. Information on 375 consecutive patients undergoing robot-assisted extraperitoneal prostatectomy by a single surgeon was gathered. Obesity is defined as having a body mass index (BMI) greater than 30 kg/m2. Patients with BMI >/= 30 were compared to those with BMI < 30. Specific comparators between the groups were: age, total operating time, estimated blood loss, total prostate specific antigen (PSA), specimen weight, pathological stage, grade and margin, complications, and functional outcomes. Sixty-seven men were identified as obese. When comparing the two groups, no statistically significant difference (p > .05) was noted in operative time (229 versus 217 min), blood loss (205 versus 175 ml), PSA, clinical and pathologic stages, specimen weight, and complications. 15% of non-obese patients had a positive margin compared to 12% of obese patients (p > .05). The 6-month continence rate in patients with a BMI >/= 30 was 92% versus 97% in patients with a BMI < 30. The extraperitoneal approach to performing a robot-assisted prostatectomy is not associated with increased morbidity in the obese patient. There were no statistically significant differences noted in oncological or functional outcomes between the two groups.
  The Canadian Journal of Urology 08/2006; 13(4):3169-73. · 0.64 Impact Factor
• Article: The overactive bladder: review of current pharmacotherapy in adults. Part 1: pathophysiology and anticholinergic therapy.

  Arun Sahai, Mohammed Shamim Khan, Manit Arya, Jason John, Rajinder Singh, Hitendra R H Patel
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  ABSTRACT: Overactive bladder is a syndrome characterised by urinary urgency, with or without urge incontinence, and usually with frequency and nocturia. It affects millions of people of all ages worldwide and causes significant morbidity, especially in terms of health-related quality of life. It poses a huge economic burden on health resources. Managing such patients involves a thorough history, physical examination and the use of pertinent investigations before the initiation of treatment. Therapy consists of lifestyle changes, bladder training, anticholinergics, second-line agents such as resiniferatoxin instillation or botulinum toxin injections into the bladder in refractory cases and, finally, in intractable cases, surgery. In the first part of this review of pharmacotherapy for the treatment of this condition, the focus is on the pathophysiological factors potentially involved in overactive bladder and covers the wide range of currently available first-line anticholinergic agents. Treatment algorithms are suggested on the basis of current literature.
  Expert Opinion on Pharmacotherapy 05/2006; 7(5):509-27. · 3.20 Impact Factor
• Article: The overactive bladder: review of current pharmacotherapy in adults. Part 2: treatment options in cases refractory to anticholinergics.

  Arun Sahai, Mohammed Shamim Khan, Manit Arya, Jason John, Rajinder Singh, Hitendra R H Patel
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  ABSTRACT: In the first part of this review the potential pathophysiological factors involved in the overactive bladder were outlined, and the wide range of first-line anticholinergic pharmacotherapies available for such patients were reviewed. The second part will focus on the intravesical instillation of resiniferatoxin and injections of botulinum toxin into the bladder to treat overactive bladder and detrusor overactivity. Resiniferatoxin has been shown to increase bladder capacity and improve incontinence in patients with neurogenic and non-neurogenic detrusor overactivity. Botulinum toxin has successfully been used to treat neurogenic and idiopathic detrusor overactivity, with improvements observed in bladder capacity, decreases in detrusor pressures on filling and voiding, and increased volumes at first contraction. Further validation is required for both treatments, in the form of large randomised controlled trials, before their use can be considered routine, with particular focus on dosing required.
  Expert Opinion on Pharmacotherapy 05/2006; 7(5):529-38. · 3.20 Impact Factor
• Article: Anti-emetic therapy: updating urological cancer-care providers.

  Peter Pietrzak, Manit Arya, Hitendra R H Patel
  BJU International 05/2006; 97(4):673-5. · 2.84 Impact Factor
• Article: Anti‐emetic therapy: updating urological cancer‐care providers

  PETER PIETRZAK, MANIT ARYA, HITENDRA R.H. PATEL
  BJU International 03/2006; 97(4):673 - 675. · 2.84 Impact Factor
• Article: Tissue microarrays and their relevance to the urologist.

  Iqbal S Shergill, Amrith R Rao, Faqar H Anjum, Manit Arya, Hitendra R H Patel, Anthony R Mundy
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  ABSTRACT: We review important aspects of TMA methodology and discuss its wide range of clinical applications with particular emphasis on key clinical studies. We also provide an update on recent and projected uses of this technology to help the urologist improve care in oncology patients. A directed MEDLINE literature review of TMAs was performed. Important publications that have shaped our understanding of TMAs were selected for review. They were augmented by manual searches and our personal bibliographic collections. The TMA is a high throughput molecular biology technique that can significantly accelerate the processing of a large number of tissue specimens with excellent quality, good reliability and the preservation of original tissue. TMA studies demonstrate their accuracy and reliability compared to those of standard histological techniques and correlate with clinicopathological information to determine disease progression and prediction of the clinical outcome. This review represents an overview and update for the urologist on TMAs and their clinical applications in urological oncology. In the future it is anticipated that the outcomes of this method will be used to assist in the diagnosis, prognosis and development of novel therapies in individual patients.
  The Journal of Urology 02/2006; 175(1):19-26. · 3.75 Impact Factor
• Article: Bladder carcinoma: understanding advanced and metastatic disease with potential molecular therapeutic targets.

  Hashim Uddin Ahmed, Manit Arya, Hitendra R H Patel
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  ABSTRACT: This article is an expert review of bladder cancer genetics focusing on genetic changes and their significance in the pathogenesis and progression of bladder transitional cell carcinoma, in particular, muscle-invasive disease. Alongside the relevant genetic markers and their products, new therapeutic targets and agents that are being developed are presented.
  Expert Review of Anti-infective Therapy 01/2006; 5(6):1011-22. · 2.65 Impact Factor
• Article: Non-myeloablative allogeneic stem cell transplantation: a promising new therapy in the management of metastatic renal cell cancer.

  Manit Arya, Lyndon M Gommersall, Iqbal S Shergill, Hitendra R H Patel, David Chao
  BJU International 10/2005; 96(4):474-5. · 2.84 Impact Factor
• Article: Re: Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle?

  Jean V Joseph, Hitendra R H Patel
  The Journal of Urology 09/2005; 174(2):789-90. · 3.75 Impact Factor
• Article: Robot-assisted vs pure laparoscopic radical prostatectomy: are there any differences?

  Jean V Joseph, Ivelisse Vicente, Ralph Madeb, Erdal Erturk, Hitendra R H Patel
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  ABSTRACT: To compare our experience of pure laparoscopic radical prostatectomy (LRP) with robot-assisted radical prostatectomy (RAP). The two techniques were compared retrospectively in 100 patients with localized prostate cancer who had LRP or RAP (50 each). Both groups were similar in age, serum prostate-specific antigen level, Gleason score and clinical stage. Their charts were reviewed, collating intraoperative data and early functional outcome. The mean surgical time for LRP and RAP was 235 and 202 min (P > 0.05) and mean (95% confidence interval) blood loss 299 (40) and 206 (63) mL (P = 0.014), with no transfusions in either group. The positive margin rate did not differ significantly (14% LRP and 12% RAP) and there was no biochemical recurrence in either group. Early functional outcomes were similar. Both LRP and RAP are technically demanding, but feasible, with the patient clearly benefiting. There were no major surgical differences between the techniques, but RAP is more costly.
  BJU International 08/2005; 96(1):39-42. · 2.84 Impact Factor
• Article: Autonomic dysreflexia: the forgotten medical emergency.

  Cherian Jacob, Ali Thwaini, Amrith Rao, Neehar Arya, Iqbal S Shergill, Hitendra R H Patel
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  ABSTRACT: Autonomic dysreflexia (AD) is a potentially dangerous complication of spinal cord injury (SCI). In AD, an individual's blood pressure may rise to dangerous levels and, if not treated, can lead to stroke and possibly death. All medical personnel, especially those interacting with SCI patients, must have a good understanding of its aetiology, complications and emergency management.
  Hospital medicine (London, England: 1998) 06/2005; 66(5):294-6. · 0.33 Impact Factor
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  Available from: unictbiolmol-lab.it

  Article: Basic principles of real-time quantitative PCR.

  Manit Arya, Iqbal S Shergill, Magali Williamson, Lyndon Gommersall, Neehar Arya, Hitendra R H Patel
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  ABSTRACT: Real-time quantitative PCR allows the sensitive, specific and reproducible quantitation of nucleic acids. Since its introduction, real-time quantitative PCR has revolutionized the field of molecular diagnostics and the technique is being used in a rapidly expanding number of applications. This exciting technology has enabled the shift of molecular diagnostics toward a high-throughput, automated technology with lower turnaround times. This article reviews the basic principles of real-time PCR and describes the various chemistries available: the double-stranded DNA-intercalating agent SYBR Green 1, hydrolysis probes, dual hybridization probes, molecular beacons and scorpion probes. Quantitation methods are discussed in addition to the competing instruments available on the market. Examples of applications of this important and versatile technique are provided throughout the review.
  Expert Review of Molecular Diagnostics 04/2005; 5(2):209-19. · 4.86 Impact Factor
• Article: Robotic surgery: the coming of a new era in surgical innovation.

  Jean V Joseph, Manit Arya, Hitendra R H Patel
  Expert Review of Anti-infective Therapy 03/2005; 5(1):7-9. · 2.65 Impact Factor