Monish Aron

Keck School of Medicine USC, Los Ángeles, California, United States

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Publications (298)978.49 Total impact

  • Raj Satkunasivam, Monish Aron
    European Urology 03/2015; 67(3):589-590. DOI:10.1016/j.eururo.2014.11.057 · 12.48 Impact Factor
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    ABSTRACT: To assess survival following radical prostatectomy (RP), intensity modulated radiation therapy (IMRT) or conformal radiation therapy (CRT) versus no local therapy (NLT) for metastatic prostate cancer (MPCa), adjusting for patient comorbidity, androgen deprivation therapy (ADT) and other factors. Men ≥66 with MPCa undergoing treatment by RP, IMRT, CRT or NLT identified from SEER-Medicare linked database (2004-2009). Multivariable Cox proportional hazards models, before and after inverse propensity score weighting, were used to assess all cause and PCa specific mortality. Competing risk regression analysis was used to assess PCa specific mortality. Among 4069 men with MPCa, RP (n=47), IMRT (n=88), CRT (n=107) were selected as local therapy versus NLT (n=3827). RP was associated with a 52% (HR: 0.48, 95% CI: 0.27-0.85) reduction in the risk of PCa specific mortality, after adjusting for socio-demographic, primary tumour characteristics, comorbidity, ADT and bone radiation within 6 months of diagnosis. IMRT was associated with a 62% (HR: 0.38, 95% CI: 0.24-0.61) reduction in the risk of PCa specific mortality, respectively. CRT was not associated with improved survival compared to NLT. Propensity score weighting yielded comparable results. Competing risk analysis revealed a 42% (SHR: 0.58, 95% CI: 0.35-0.95) and 57% (SHR: 0.43, 95% CI: 0.27-0.68) reduction in the risk of PCa specific mortality for RP and IMRT. Local therapy with RP and IMRT, but not CRT, was associated with a survival benefit in MPC and warrants prospective evaluation in clinical trials. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of Urology 02/2015; DOI:10.1016/j.juro.2015.02.084 · 3.75 Impact Factor
  • Monish Aron, Inderbir S Gill
    European Urology 01/2015; 67(3). DOI:10.1016/j.eururo.2014.12.054 · 12.48 Impact Factor
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    ABSTRACT: Abstract Background. Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique. Objective. To report a large multi-institutional series of minimally invasive simple prostatectomy (MISP). Design, Setting, and Participants. Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in USA and Europe were included in this retrospective analysis. Intervention. Laparoscopic or robotic SP. Outcome Measurements and Statistical Analysis. Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable “trifecta” outcome, arbitrarily defined as a combination of the following postoperative events: IPSS<8, Qmax> 15 ml/sec, no perioperative complications. Results and Limitation. Overall, 1330 consecutive cases were analyzed, including 487 (36.6%) robotic and 843 (63.4%) laparoscopic SP cases. Median overall prostate volume was 100 cc (89, 126). Median estimated blood loss was 200 ml (150, 300). An intra-operative transfusion was required in 3.5% of cases, an intra-operative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 (3, 5) days. On pathology, a prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 months, a significant improvement was observed for subjective and objective indicators of BOO. “Trifecta” outcome was not significantly influenced by the type of procedure (robotic versus laparoscopic) (p=0.136; OR: 1.6; 95% CI: 0.8-2.9), whereas operative time (p=0.01; OR: 0.9; 95% CI: 0.9-1.0) and estimated blood loss (p=0.03; OR: 0.9; 95% CI 0.9-1.0) were the only two significant factors. Retrospective study design, lack of control arm and limited follow-up represent major limitations of the present analysis. Conclusions. This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings, where specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in case of large prostatic adenomas. The use of robotic technology for this indication can be considered in Centers where a robotic program is in place for other urological indications. Patient Summary. Analysis of a large dataset from multiple institutions show that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using standard of robot-assisted laparoscopy.
    European Urology 11/2014; DOI:10.1016/j.eururo.2014.11.044 · 10.48 Impact Factor
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    ABSTRACT: To prospectively evaluate the feasibility and safety of a novel, second-generation telementoring interface (Connect(TM) ) for the da Vinci robot.
    BJU International 11/2014; DOI:10.1111/bju.12985 · 3.13 Impact Factor
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    ABSTRACT: Purpose: We present a 2-institution experience with completely intracorporeal robotic orthotopic ileal neobladder after radical cystectomy in 132 patients. Materials and Methods: Established open surgical techniques were duplicated robotically with all neobladders suture constructed intracorporeally in a globular configuration. Nerve sparing was performed in 56% of males. Lymphadenectomy was extended (up to aortic bifurcation in 51, 44%) and superextended (up to the inferior mesenteric artery in 20, 17%). Ureteroileal anastomoses were Wallacetype (86, 65%) or Bricker-type (46, 35%). The learning curve at each institution was assessed using chronological subgroups and by trends across the entire cohort. Data were prospectively collected and retrospectively queried. Results: Mean operating time was 7.6 hours (range 4.4 to 13), blood loss was 430 cc (range 50 to 2,200) and hospital stay was 11 days (median 8, range 3 to 78). Clavien grade I, II, III, IV and V complications within 30 days were 7%, 25%, 13%, 2% and 0%, respectively, and between 30 and 90 days were 5%, 9%, 11%, 1% and 2%, respectively. Mean nodal yield was 29 (range 7 to 164) and the node positivity rate was 17%. Operative time, blood loss, hospital stay and prevalence of late complications improved with experience. During a mean followup of 2.1 years (range 0.1 to 9.8) cancer recurred in 20 patients (15%). Five-year overall, cancer specific and recurrence-free survival was 72%, 72% and 71%, respectively. Conclusions: We developed a refined technique of robotic intracorporeal orthotopic neobladder diversion, duplicating open principles. Operative efficiency and outcomes improved with experience. Going forward, we propose a prospective randomized comparison between open and robotic intracorporeal neobladder surgery.
    The Journal of Urology 07/2014; 192(6). DOI:10.1016/j.juro.2014.06.087 · 3.75 Impact Factor
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    ABSTRACT: There have been a number of advances in robotic partial nephrectomy (RPN) for renal masses. We reviewed these advances with emphasis on the evolution of technique and outcomes as well as the expanding indications for RPN. Literature in the English language was reviewed using the National Library of Medicine database. Relevant articles were extracted, and their citations were utilized to broaden our search. The identified articles were reviewed and summarized with a focus on novel developments. RPN is an evolving procedure and is an emerging viable alternative to laparoscopic partial nephrectomy and open partial nephrectomy with favorable outcomes. The contemporary techniques used for RPN demonstrate excellent perioperative outcomes. The short-term oncologic outcomes are comparable to those of laparoscopic and open surgical approaches. Further studies are needed to assess long-term oncologic control.
    Indian Journal of Urology 07/2014; 30(3):275-82. DOI:10.4103/0970-1591.135667
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    ABSTRACT: Radical cystectomy is the gold-standard treatment for muscle-invasive and refractory nonmuscle-invasive bladder cancer. We describe our technique for robotic radical cystectomy (RRC) and intracorporeal urinary diversion (ICUD), that replicates open surgical principles, and present our preliminary results.
    Indian Journal of Urology 07/2014; 30(3):300-6. DOI:10.4103/0970-1591.135673
  • Andrew J Sun, Monish Aron, Andrew J Hung
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    ABSTRACT: The objectives of this review are to summarize the current training modalities and assessment tools used in urological robotic surgery and to propose principles to guide the formation of a comprehensive robotics curriculum.
    Indian Journal of Urology 07/2014; 30(3):333-8. DOI:10.4103/0970-1591.128506
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    ABSTRACT: Pelvic organ prolapse (POP) is a prevalent condition with 1 in 9 women seeking surgical treatment by the age of 80 years. Goals of treatment are relief and prevention of symptoms, and restoration of pelvic floor support. The gold standard for surgical treatment of POP has been abdominal sacrocolpopexy (ASC). However, emerging technologies have allowed for more minimally invasive approach including the use of laparoscopic assisted sacrocolpopexy and robotic assisted sacrocolpopexy (RASC). We performed a PubMed literature search for sacrocolpopexy, "robotic sacrocolpopexy" and "RASC" and reviewed all retrospective, prospective and randomized controlled trials. The techniques, objective and subjective outcomes and complications are discussed. The most frequent technique involves a polypropylene Y mesh attached to the anterior and posterior walls of the vagina with the single arm attached to the sacrum. Multiple concomitant procedures have been described including hysterectomy, anti-incontinence procedures and concomitant vaginal prolapse repairs. There are few studies comparing RASC to ASC, with the longest follow-up data showing no difference in subjective and objective outcomes. Anatomic success rates have been reported at 79-100% with up to 9% of patients requiring successive surgery for recurrence. Subjective success is poorly defined, but has been reported at 88-97%. Most common complications are urinary retention, urinary tract infection, bladder injury and vaginal mucosal injury. Mesh exposure is reported in up to 10% of patients. RASC allows for a minimally invasive approach to treatment of POP with comparable outcomes and low complication rates.
    Indian Journal of Urology 07/2014; 30(3):318-25. DOI:10.4103/0970-1591.128502
  • Monish Aron
    Indian Journal of Urology 07/2014; 30(3):273-4. DOI:10.4103/0970-1591.135664
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    ABSTRACT: Objectives: To present time-efficiency data during our initial experience with intracorporeal urinary diversion and technical tips that may shorten operative time early in the learning curve. Patients and methods: Data were analyzed in the initial 37 consecutive patients undergoing robotic radical cystectomy and intracorporeal urinary diversion in whom detailed step-wise operative time data were available. Median age was 65 years and median BMI was 27. Neoadjuvant chemotherapy was administered in 6 patients and 11 patients had clinical evidence of T3 or lymph node-positive disease. Each component of the operation was subdivided into specific steps and operative time for each step was prospectively recorded. Peri-operative and follow-up data upto 90 days and final pathological data were recorded. Results: All procedures were completed intracorporeally and robotically without need for conversion to open surgery or extracorporeal diversion. Median total operative time was 387 vs 386 minutes (p=0.2) and median total console time was 361 vs 295 minutes (p<0.007) for orthotopic neobladder and ileal conduit, respectively. Median time for radical cystectomy was 77 min, extended PLND was 63 min and diversion was 111 min (Ileal conduit 92 min, orthotopic neobladder 124 min). Median estimated blood loss was 250 cc, and median hospital stay was 9 days. High grade (Clavien grade 3-5) complications at 30 and 90 days follow up were recorded in 6 (16%) and 9 (24%) patients, respectively. Over a median follow up of 16 months, 12 (32%) patients experienced disease recurrence and 9 (24%) died from bladder cancer. These correspond to 1-year recurrence-free and overall survival of 64% and 70%, respectively. Conclusions: Intracorporeal urinary diversion following robotic radical cystectomy can be performed safely and reproducibly in a time efficient manner even during the early learning curve.
    Journal of endourology / Endourological Society 06/2014; DOI:10.1089/end.2014.0284 · 1.75 Impact Factor
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    ABSTRACT: Purpose: To determine the occurrence of flank symptoms, flank muscle atrophy, bulge, and hernia formation after open and laparoscopic partial nephrectomy (LPN). Patients and Methods: Our prospective Institutional Review Board-approved database was queried to identify 50 consecutive patients who were treated with open partial nephrectomy (OPN) and 50 consecutive patients who were treated with LPN between September 2006 and May 2008. Study patients had: Solitary clinical T1 renal tumor, preoperative and =6 month postoperative CT scan performed at our institution, and a confirmed renal-cell carcinoma on the final pathology report. Patients with previous abdominal surgery and neuromuscular disorders were excluded. Oncocare software was used to measure abdominal wall musculature on preoperative and postoperative CT scan. Bilateral flanks were compared for muscle volume, bulge, and hernia. Patients were administered a phone questionnaire to assess postoperative flank symptoms. Results: No statistical significant difference was found in the demographics between the two groups. Median age (range) was 59.9 years (20.6-80.7) in the OPN group and 57.5 years (25-78) in the LPN group (P=0.89). Median (range) body mass index and American Society of Anesthesiologists scores were similar between the two groups. On CT scans, median percent variation (range) in abdominal wall muscle volume was significantly greater in the OPN group: -1.03% (-31.4-1.5) vs-0.39% (-5.2-1.8) (P=0.006). The median extent of flank bulge on CT scans (range) was also greater in the OPN group: 0.75cm (-1.9-7.6) vs 0cm (-2.7-2.8) (P=0.0004). The OPN group was also more symptomatic, including paresthesia 48% vs 8% (P=0.0053); numbness 44% vs 0% (P=0.002); and flank bulge 57% vs 12% (P=0.007). Conclusions: Minimally invasive partial nephrectomy has lesser deleterious impact on flank muscle volume compared with OPN with fewer symptoms of flank bulge, paresthesia, and numbness.
    Journal of endourology / Endourological Society 06/2014; 28(10). DOI:10.1089/end.2013.0782 · 1.75 Impact Factor
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    ABSTRACT: Objective: To determine the feasibility and develop a robotic technique for intracorporeal implantation of a biodegradable tubular scaffold seeded with adipose-sourced smooth muscle cells (Neo-Urinary-Conduit® (NUC), Tengion®) which, when implanted as a conduit for urinary diversion, facilitates regeneration of native-like neo-urinary tissue. Material and Methods: Robotic NUC implantation was performed in two fresh male cadavers. The greater omentum was widely detached from the greater curvature of the stomach, in preparation for final wrapping of the conduit. Bilateral ureters were mobilized for implantation. The NUC, with two pre-created ureteral openings, was inserted into the abdomen. Bilateral, stented uretero-NUC anastomoses were created. The NUC was circumferentially wrapped with the pre-dissected omentum, exteriorized through the abdominal wall, and maturated. Results: Both procedures were successfully completed intracorporeally. Operative time for NUC implantation was 90 and 100 min, respectively. Examination of gross anatomy showed no injury to other organs. There was no omental kinking, rotation, eversion, or stripping from the NUC. Bilateral stents were confirmed to be in situ with the proximal coil in the kidney. Uretero-NUC anastomoses and omentum were tension-free. The entire NUC, including its distal edge and posterior aspect, was circumferentially wrapped 360 degrees. Conclusion: We demonstrated the feasibility and developed a robotic technique for intracorporeal implantation of a biodegradable regenerative urinary conduit. This study serves as the foundation for the robotic surgical technique prior to the clinical application.
    Journal of endourology / Endourological Society 05/2014; 29(1). DOI:10.1089/end.2014.0271 · 1.75 Impact Factor
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    ABSTRACT: Purpose: To describe our technique for robotic bladder diverticulectomy (RBD). Patients and Methods: Ten patients underwent RBD using an extra- or transvesical approach. Three (30%) patients underwent concomitant procedures: robot-assisted radical prostatectomy, robotic simple prostatectomy, and transurethral resection of the prostate. Results: All RBDs were performed successfully. Median estimated blood loss, operative time and diverticulectomy time were 75ml, 210 min and 80 min, respectively. Median follow up time was 18 months. Median International Prostate Symptom Score decreased by 57%, p = 0.001. Conclusions: RBD is feasible and safe. It can be performed via a trans- or extra-vesical approach, as a standalone, or concomitant procedure.
    Journal of endourology / Endourological Society 04/2014; 28(10). DOI:10.1089/end.2014.0149 · 1.75 Impact Factor
  • European Urology Supplements 04/2014; 13(1):e831. DOI:10.1016/S1569-9056(14)60819-8 · 3.37 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e735. DOI:10.1016/j.juro.2014.02.2032 · 3.75 Impact Factor
  • European Urology Supplements 04/2014; 13(1):e950-e950a. DOI:10.1016/S1569-9056(14)60934-9 · 3.37 Impact Factor

Publication Stats

5k Citations
978.49 Total Impact Points

Institutions

  • 2015
    • Keck School of Medicine USC
      Los Ángeles, California, United States
  • 2009–2015
    • University of Southern California
      • • Keck School of Medicine
      • • Department of Anesthesiology
      Los Ángeles, California, United States
  • 2014
    • Michigan Institute of Urology
      Detroit, Michigan, United States
  • 2010–2014
    • University of California, Los Angeles
      Los Ángeles, California, United States
    • Children's Hospital Los Angeles
      Los Angeles, California, United States
  • 2008–2009
    • Port Macquarie Base Hospital
      Порт Маккуори, New South Wales, Australia
    • Centro Médico de Caracas
      Caracas, Capital, Venezuela
    • Muljibhai Patel Urological Hospital
      Aimand, Gujarāt, India
  • 2007–2009
    • Cleveland Clinic
      • Department of Urology
      Cleveland, OH, United States
  • 1998–2008
    • All India Institute of Medical Sciences
      • • Department of Anatomy
      • • Department of Urology
      • • Department of Radiology
      New Delhi, NCT, India
  • 2003
    • University of Aberdeen
      Aberdeen, Scotland, United Kingdom
  • 1999
    • S.N. Medical College, Agra
      Agra, Uttar Pradesh, India