[Show abstract][Hide abstract] ABSTRACT: To assess the impact of 3D printed models of renal tumor on patient's understanding of their conditions. Patient understanding of their medical condition and treatment satisfaction has gained increasing attention in medicine. Novel technologies such as additive manufacturing [also termed three-dimensional (3D) printing] may play a role in patient education.
A prospective pilot study was conducted, and seven patients with a primary diagnosis of kidney tumor who were being considered for partial nephrectomy were included after informed consent. All patients underwent four-phase multi-detector computerized tomography (MDCT) scanning from which renal volume data were extracted to create life-size patient-specific 3D printed models. Patient knowledge and understanding were evaluated before and after 3D model presentation. Patients' satisfaction with their specific 3D printed model was also assessed through a visual scale.
After viewing their personal 3D kidney model, patients demonstrated an improvement in understanding of basic kidney physiology by 16.7 % (p = 0.018), kidney anatomy by 50 % (p = 0.026), tumor characteristics by 39.3 % (p = 0.068) and the planned surgical procedure by 44.6 % (p = 0.026).
Presented herein is the initial clinical experience with 3D printing to facilitate patient's pre-surgical understanding of their kidney tumor and surgery.
World Journal of Urology 07/2015; DOI:10.1007/s00345-015-1632-2 · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe our approach for port placement and robot docking for pelvic and kidney surgery (KS).
We utilize a four-arm robotic approach and a 5-6 port placement consisting of: 1- 12 mm camera port, 3- 8 mm robotic ports, and 1 to 2 assistant ports. For radical prostatectomy, the working robotic ports run parallel below the level of the umbilicus. Radical cystectomy ports are more cephalad and above the level of the umbilicus. For transperitoneal KS, two bariatric robotic ports are used, aiming for an equilateral triangle configuration. With retroperitoneal (RN) KS, a balloon dilator and balloon port create the RN space; bariatric ports comprise the most anterior and posterior ports.
This technique has been utilized since 2010 on over 2,370 robotic urologic cases. To date, no procedure has required patient or robot positioning while maintaining 4th arm functionality with minimal robotic arm clashing.
Our approach of port placement and robot docking is reproducible and feasible for pelvic and kidney surgery.
Journal of endourology / Endourological Society 04/2015; DOI:10.1089/end.2015.0077 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: We present an updated version of our previously validated robotic partial nephrectomy (RPN) training model,1,2 which includes the reconstructive part of the procedure in addition to the tumor excision component. Material and Methods: For this pilot series, participants were recruited as novice (zero console cases), intermediate (1, but <100 cases), and expert (≥100 console cases). After parenchymal resection with opening of the collecting system, a 5-cm Styrofoam ball mimicking a lower pole tumor was glued on an ex vivo porcine kidney. Each participant performed an RPN using the da Vinci SI Surgical System to excise the Styrofoam tumor. For reconstruction and hemostasis, two horizontal mattress sutures were applied. Renal artery and collecting system were perfused respecting physiologic conditions to test hemostasis and watertightness. Participants completed a poststudy questionnaire assessing training model realism and utility and were anonymously judged by expert reviewers using a validated laparoscopic assessment tool.3 Focusing on expenses per kidney: the preparation time is around 10 min and the costs for disposables (tissue, Styrofoam ball, glue, and fixation) is ∼5 to 10 USD (without training instruments). Results: The 13 participants included 7 novices, 2 intermediates, and 4 experts. Overall, surgeons rated the training model as “very realistic” (median visual analogue score [VAS] 8/10) (face validity). Expert surgeons rated it as an “extremely useful” training tool for residents and attendings (median VAS 9/10) (content validity).4 Experts outscored all others on overall performance (p<0.05) (construct validity). Additionally, the video displays in a head-to-head manner the way an expert surgeon outscores a novice on individual metrics. Thereby, model validation and training potential are demonstrated. Conclusions: Our perfused RPN training model has demonstrated face, content, and construct validity. Herewith tumors of any complexity and reconstruction can be simulated without patients at risk. In addition, the easy to build up, reproducible, and cheap model can be used, for example, within a residency training program. It allows to evaluate individual learning curves and to differentiate distinct surgical skills. No competing financial interests exist. Runtime of video: 7 mins 52 secs
[Show abstract][Hide abstract] 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; 68(1). DOI:10.1016/j.eururo.2014.11.044 · 12.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To prospectively evaluate the feasibility and safety of a novel, second-generation telementoring interface (Connect™; Intuitive Surgical Inc., Sunnyvale, CA, USA) for the da Vinci robot.Materials and Methods
Robotic surgery trainees were mentored during portions of robot-assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in-room mentoring or remote mentoring using Connect. While viewing two-dimensional, real-time video of the surgical field, remote mentors delivered verbal and visual counsel, using two-way audio and telestration (drawing) capabilities. Perioperative and technical data were recorded. Trainee robotic performance was rated using a validated assessment tool by both mentors and trainees. The mentoring interface was rated using a multi-factorial Likert-based survey. The Mann-Whitney and t-tests were used to determine statistical differences.ResultsWe enrolled 55 mentored surgical cases (29 in-room, 26 remote). Perioperative variables of operative time and blood loss were similar between in-room and remote mentored cases. Robotic skills assessment showed no significant difference (P > 0.05). Mentors preferred remote over in-room telestration (P = 0.05); otherwise no significant difference existed in evaluation of the interfaces. Remote cases using wired (vs wireless) connections had lower latency and better data transfer (P = 0.005). Three of 18 (17%) wireless sessions were disrupted; one was converted to wired, one continued after restarting Connect, and the third was aborted. A bipolar injury to the colon occurred during one (3%) in-room mentored case; no intraoperative injuries were reported during remote sessions.Conclusion
In a tightly controlled environment, the Connect interface allows trainee robotic surgeons to be telementored in a safe and effective manner while performing basic surgical techniques. Significant steps remain prior to widespread use of this technology.
BJU International 11/2014; 116(2). DOI:10.1111/bju.12985 · 3.53 Impact Factor