Minh Do

University of Leipzig, Leipzig, Saxony, Germany

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Publications (74)191.51 Total impact

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    ABSTRACT: Objectives: To describe the progress in training for minimally invasive surgical (MIS) options in urology Methods: A group of experts in the field provided input to define the recommendations for MIS training. A literature search was carried out on MIS training in general and for urological procedures specifically. Results: A literature search showed the rapidly developing options for e-learning, box and virtual training and suggested that box training is a relatively cheap and effective means of improving laparoscopic skills. The development of nontechnical skills is an integral part of surgical skills training and should be included in training curricula. The application of modular training in surgical procedures showed more rapid acquirement of skills. Training curricula for minimally invasive surgery in urology are being developed in both the US and Europe. Conclusion: Training in MIS has shifted from “see-one-do-one-teach-one” to structured learning from e-learning to skills lab and modular training settings.
    MINIMALLY INVASIVE SURGERY IN UROLOGY, 1st edited by W. Artibani, J. Rassweiler, J. Kaouk, M. Menon, 03/2015: chapter Minimally Invasive Surgery In Urology Training: pages 329-49; European Association of Urology., ISBN: 978-9953-493-22-0
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    ABSTRACT: Since its initial description 20 years ago, laparoscopic radical prostatectomy (LRP) is now a standard treatment option for localized prostate cancer. However, in recent years robot-assisted laparoscopic radical prostatectomy (RALP) has been gradually replacing LRP, despite high costs incurred with RALP. The purpose of this work was to determine the oncological outcomes of LRP from selected series with a follow-up of around 10 years and to compare oncological and functional outcomes between LRP and RALP. The outcomes of a case series of LRP with a median follow-up of at least 3 years were reviewed. In addition, the outcomes of comparative studies between LRP and RALP were reviewed. The first case series of LRP with follow-ups of 10 years after LRP are available and show favorable oncologic outcomes. Current data show that RALP offers superior functional results (recovery of erectile function) following bilateral nerve sparing when compared to LRP. The first review a few years ago showed comparable oncologic and functional outcomes between open prostatectomy, LRP, and RALP. Recent data from comparative studies show superiority of RALP over LRP for potency following bilateral nerve sparing. The potency outcomes between LRP and RALP are, however, similar following wide excision of both neurovascular bundles. Therefore, both treatment options can be recommended for the treatment of localized PC.
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    ABSTRACT: We assessed the misdiagnosed prostate cancer in radical prostatectomy (RP) specimens and the associated parameters. A total of 3,821 patients were treated by RP. A meticulous process to identify misdiagnosed PCa in the specimen was followed. This protocol included the review of biopsies, prostatic specimens after TURP and RP surgical specimens. The prostatic specimens were further sectioned. Immunohistochemistry was also performed. The clinical parameters of the cases that were confirmed to be pT0 stage were compared to 1,164 RP patients. The incidence of pT0 was 0.7 % of the cases. Eighteen patients (Group A) were operated after TURP and 10 patients (Groups B) after transrectal ultrasound-guided biopsy of the prostate. Eleven (Group Ac) cases of Group A and seven (Group Bc) cases of Group B were confirmed to be pT0 cases. The re-examination of the slides and specimens revealed the presence of PCa in three cases. The remaining cases were detected by IHC. The comparison of Group Ac to the Group C (representative cohort, 1164 patients) showed that the pre-operative PSA value was significantly higher in the case of the Group C. The pre-operative Gleason, the percentage of biopsy cores for cancer and the length of cores containing cancer were observed to be significantly lower in the case of Group Bc in comparison with Group C. The meticulous search protocol in pT0 cases showed that 35.7 % of the specimens included undiagnosed PCa. This strengthens the need for further careful work-up of any RP specimen of stage pT0.
    World Journal of Urology 11/2014; DOI:10.1007/s00345-014-1441-z · 3.42 Impact Factor
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    ABSTRACT: To present the experience with the extraperitoneal approach for robotic-assisted simple prostatectomy (RASP) in a technique replicating the vesicocapsular incision technique of open surgery. RASP was performed on patients with a prostate volume of >80 cm(3) with an indication for open enucleation of the prostate. Preoperatively, all patients were evaluated by uroflowmetry, prostate-specific antigen level, and postvoid residual measurement, as well as by the International Prostate Symptom Score questionnaire. All perioperative data were recorded in a prospective database. Follow-up appointments included the aforementioned measurements and were scheduled at 1 and 6 months postoperatively. Ten RASP procedures were successfully performed by the extraperitoneal approach. Mean patient age and prostate volume were 63.1 years (range, 55-74 years) and 129.4 cm(3) (range, 90-170 cm(3)), respectively. Mean operative time was 122.5 minutes (range, 85-140 minutes) and represented the time from the first incision to the closure of the all incisions. The estimated blood loss was minimal (mean value, 230 mL). Transfusions were not necessary. Mean catheterization period was 7.4 days (range, 6-8 days). The symptomatology, as reported by the International Prostate Symptom Score, was improved at the follow-up appointments in comparison with the baseline values. One case of prolonged fever was noted postoperatively and managed by antibiotics. The extraperitoneal approach for RASP proved to be efficient in the management of large prostates. The results are directly comparable with the current available experience with transperitoneal RASP. The extraperitoneal RASP seems to favorably compare with the open simple prostatectomy, while the results are at least comparable with those of conventional laparoscopic approach. Copyright © 2014 Elsevier Inc. All rights reserved.
    Urology 11/2014; 84(5):1099-105. DOI:10.1016/j.urology.2014.06.045 · 2.13 Impact Factor
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    ABSTRACT: Clinical management of prostate cancer increasingly aims to distinguish aggressive types that require immediate and radical treatment from indolent tumors that are candidates for watchful waiting. This requires reliable and reproducible parameters to effectively control potential cancer progression. Magnetic resonance imaging (MRI) may provide a non-invasive means for this purpose. To assess the value of diffusion-weighted imaging and proton MR spectroscopy for the prediction of prostate cancer (PCa) aggressiveness. In 39 of 64 consecutive patients who underwent endorectal 3-T MRI prior to radical prostatectomy, prostate specimens were analyzed as whole-mount step sections. Apparent diffusion coefficient (ADC), normalized ADC (nADC: tumor/healthy tissue), choline/citrate (CC), and (choline + creatine)/citrate (CCC) ratios were correlated with Gleason scores (GS) from histopathological results. The power to discriminate low (GS ≤ 6) from higher-risk (GS ≥ 7) tumors was assessed with receiver operating characteristics (area under the curve [AUC]). Resulting threshold values were used by a blinded reader to distinguish between aggressive and indolent tumors. Ninety lesions (1 × GS = 5, 41 × GS = 6, 36 × GS = 7, 12 × GS = 8) were considered. nADC (AUC = 0.90) showed a higher discriminatory power than ADC (AUC = 0.79). AUC for CC and CCC were 0.73 and 0.82, respectively. Using either nADC < 0.46 or CCC > 1.3, as well as both criteria for aggressive PCa, the reader correctly identified aggressive and indolent tumors in 31 (79%), 28 (72%), and 33 of 39 patients (85%), respectively. Predictions of tumor aggressiveness from TRUS-guided biopsies were correct in 27 of 36 patients (75%). The combination of a highly sensitive normalized ADC with a highly specific CCC was found to be well suited to prospectively estimate PCa aggressiveness with a similar diagnostic accuracy as biopsy results.
    Acta Radiologica 02/2014; DOI:10.1177/0284185113520311 · 1.35 Impact Factor
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    ABSTRACT: Introduction: Ureteral reconstructive surgery requires adequate exposure of the ureteral lesion and results in large abdominal incisions. Robotic-assistance allows the performance of complex ureteral reconstructive surgery through small incisions. The current series includes only cases of Boari flaps performed by robotic-assistance and attempts to describe in detail the technique, review the literature as well as to expand the experience in current literature. Patients and methods: Eight patients underwent ureteral reimplantation by Boari flap technique. The indications for the performance of the procedure included ureteral stricture due to iatrogenic injury in 3 patients, recurrent ureteral stricture after multiple endoscopic stone management procedures in 1 patient, ureteral stricture due to previous malignant disease in the pelvis or abdomen in 3 patients and ureteral stricture due to trauma in 1 patient. Five cases were located in the left side and 3 cases in the right side. A variety of parameters were recorded in a prospective database including the time for robot docking and total operative time as well as catheterization and drainage time. The follow-up of the patients included the performance of renal ultrasound 4 weeks, 3, 6 and 12 months after the procedure. Results: Mean age of the patients was 50.8 (range 39-62) years and mean Body Mass Index of 26.2 (range 23.22-29.29) kg/m2. Operative time ranged 115 and 240 (mean 171.9) min. Mean blood loss was 161.3 (50-250) ml. Conversion to open surgery did not take place in the current series. No intra-operative complications were observed. Post-operative complications included one case of prolonged anastomotic leakage Conclusion: The Robotic-assisted approach is efficient in the performance of ureteral reimplantation with Boari flap. Low blood loss, short catheterization time, low complication rate and excellent reconstructive outcome are associated with the approach. Robotic-assistance seems to be beneficial for ureteral reconstructive surgery.
    Journal of endourology / Endourological Society 01/2014; 28(6). DOI:10.1089/end.2013.0775 · 2.10 Impact Factor
  • The Journal of Urology 04/2013; 189(4):e373. DOI:10.1016/j.juro.2013.02.480 · 3.75 Impact Factor
  • European Urology Supplements 03/2013; 12(1):eV17. DOI:10.1016/S1569-9056(13)61600-0 · 3.37 Impact Factor
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    ABSTRACT: The frequent application of ultrasound and radiological imaging for non-urological indications in recent years has resulted in an increase in the diagnosis of small renal masses. The treatment options for patients with a small renal mass include active surveillance, surgery (both open and minimally invasive) as well as ablative techniques. As there is a risk for metastatic spread even in small renal masses surgical extirpation remains the treatment of choice in most patients. Ablative procedures, such as cryoablation and radiofrequency ablation are appropriate for old and multi-morbid patients who require active treatment of a small renal mass. Active surveillance is an alternative for high-risk patients. Meticulous patient selection by the urologist and patient preference will determine the choice of treatment option in the future.
    Der Urologe 10/2012; 51(10):1459-68. · 0.44 Impact Factor
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    ABSTRACT: Die zunehmende Anzahl von Ultraschall- und Schnittbilduntersuchungen bei nichturologischen Fragestellungen führt in der letzten Zeit zu einer gestiegenen Anzahl diagnostizierter kleiner, inzidenteller, asymptomatischer Nierentumoren. Zu den Optionen bei Patienten mit einem kleinen Nierentumor gehören die aktive Überwachung, die chirurgische Exstirpation sowie ablative Techniken. Auch bei kleinen Nierentumoren besteht ein Metastasierungsrisiko, sodass die chirurgische Tumorentfernung bei allgemeiner Operabilität die Therapie der Wahl bleibt. Die Nierenteilresektion (offen-chirurgisch oder minimal-invasiv) ist aufgrund der hervorragenden onkologischen Langzeitergebnisse und der Protektion der Nierenfunktion der Goldstandard in der Therapie des kleinen Nierentumors. Ablative Verfahren wie Kryoablation und Radiofrequenzablation sind angemessen bei multimorbiden Patienten, die eine aktive Behandlung des kleinen Nierentumors wünschen. „Active surveillance“ ist bei Hochrisikopatienten eine mögliche Alternative. Eine sorgfältige Patientenselektion durch den Urologen und die Patientenpräferenz werden die Wahl der Therapie in Zukunft bestimmen.
    Der Urologe 10/2012; 51(10). DOI:10.1007/s00120-012-2960-0 · 0.44 Impact Factor
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    ABSTRACT: Abstract Background and Purpose: Radical prostatectomy is the gold standard surgical treatment for organ-confined prostate cancer. There is no consensus on the impact of previous laparoscopic experience on the learning curve of robot-assisted laparoscopic prostatectomy (RALP). We compared the perioperative complications and early patient outcomes from our initial 100 cases of RALP with laparoscopic prostatectomy (LRP) cases performed well beyond the learning curve. Patients and Methods: Between July 2011 and January 2012, 110 RALP were performed by one of two surgeons, each with previous experience of more than 1000 LRP. The cases were pair matched from among the last 208 patients who had undergone LRP by the same surgeons at the same time. The clinical parameters, operative details, postoperative complications, and short-term outcomes from these patients, collected prospectively, were compared between the two groups. Results: The prostate-specific antigen (PSA) level and age of the two groups was similar. The operative time (128.4 vs 153.9 min; P=0.01) and blood loss (200 vs 254 mL; P=0.01) was significantly less for the LRP group, but the duration of catheterization was similar (5.89 vs 6.2 days). The complication rate was low. No procedures needed conversions, and no patient had a visceral injury or blood transfusion. Twenty-three patients in the LRP group and 33 patients in the RALP group had extraprostatic disease, and the positive margin rate was 14% and 19% for these respective groups. At 3 months, PSA level was undetectable in 94% of LRP and 92% RALP patients, while 56% and 65% (P=0.062) patients in these groups were using 0 to 2 pads per day. Conclusions: The initial results of the outcome of RALP are at least at par with those of LRP and with those of previously published RALP series. This suggests the lack of a steep learning curve for experienced laparoscopic surgeons in performing RALP.
    Journal of endourology / Endourological Society 07/2012; 27(1). DOI:10.1089/end.2012.0262 · 2.10 Impact Factor
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    ABSTRACT: Objectives:  Urologists are cautious to offer minimally invasive radical prostatectomy in prostate cancer patients with high prostate-specific antigen (and therefore anticipated to have locally advanced or metastatic disease) because of concerns regarding lack of complete cure after minimally invasive radical prostatectomy and of worsening of continence if adjuvant radiotherapy is used. Methods:  A retrospective review of our institutional database was carried out to identify patients with PSA ≥20 ng/mL who underwent minimally invasive radical prostatectomy between January 2002 and October 2010. Intraoperative, pathological, functional and short-term oncological outcomes were assessed. Results:  Overall, 233 patients met study criteria and were included in the analysis. The median prostate-specific antigen and prostate size were 28.5 ng/mL and 47 mL, respectively. Intraoperative complications were the following: rectal injury (0.86%) and blood transfusion (1.7%). Early postoperative complications included prolonged (>6 days) catheterization (9.4%), hematoma (4.7%), deep venous thrombosis (0.86%) and lymphocele (5.1%). Late postoperative complications included cerebrovascular accident (0.4%) and anastomotic stricture (0.8%). Pathology revealed poorly differentiated cancer in 48.9%, pT3/pT4 disease in 55.8%, positive margins in 28.3% and lymph node disease in 20.2% of the cases. Adverse pathological findings were more frequent in patients with prostate-specific antigen >40 ng/mL and (or) in those with locally advanced disease (pT3/pT4). In 62.2% of the cases, adjuvant radiotherapy was used. At 1-year follow up, 80% of patients did not show evidence of biochemical recurrence and 98.8% of them had good recovery of continence. Conclusion:  Minimally invasive radical prostatectomy might represent a reasonable option in prostate cancer patients with high prostate-specific antigen as a part of a multimodality treatment approach.
    International Journal of Urology 07/2012; 19(10):923-7. DOI:10.1111/j.1442-2042.2012.03068.x · 1.80 Impact Factor
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    ABSTRACT: Organ-confined prostate cancer can be treated with curative intent by different types of radiotherapy or by radical surgery. Regardless of improvements in radiotherapy about 60% of patients with prostate cancer develop biochemical recurrence (BCR) which is defined by the progressive increase in serum prostate-specific antigen (PSA) and necessitates further diagnostic procedures. If non-organ-confined cancer and metastasis are categorically excluded by cross-sectional imaging using computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography CT (PET-CT) and bone scintigraphy, a prostate biopsy should be performed. Biopsy proven detection of recurrent or persisting prostate cancer after irradiation is essential prior to a salvage prostatectomy. The function of the lower urinary tract should be evaluated prior to surgery. Preoperative PSA measurement is the best prognostic indicator prior to surgery. Salvage prostatectomy in irradiated patients is more challenging and requires extensive skill. The most common complications are incontinence, rectal injury and anastomotic strictures. Both functional and oncologic outcome have improved due to better irradiation techniques and surgical skills. Provided post-radiotherapy recurrence of prostate cancer is diagnosed early enough, curing is possible by salvage prostatectomy.
    Der Urologe 06/2012; 51(6):869-78; quiz 879-80. DOI:10.1007/s00120-012-2894-6 · 0.44 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 05/2012; 184(S 01). DOI:10.1055/s-0032-1311251 · 1.96 Impact Factor
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    ABSTRACT: To evaluate the influence of the choice of b values on the diagnostic value of the apparent diffusion coefficient (ADC) for detection and grading of prostate cancer (PCa). Forty-one patients with biopsy-proven PCa underwent endorectal 3-T MRI before prostatectomy. Different combinations of b values (0-800 s/mm(2)) were used to calculate four representative ADC maps. Mean ADCs of tumours and non-malignant tissue were determined. Tumour appearance on different ADC maps was rated by three radiologists as good, fair or poor by assigning a visual score (VS) of 2, 1 or 0, respectively. Differences in the ADC values with the choice of b values were analysed using one-way ANOVA. Choice of b values had a highly (P < 0.001) significant influence on the absolute ADC in each tissue. Maps using b = [50, 800] and [0, 800] were rated best (VS= 1.6 ± 0.3) and second best (1.1 ± 0.3, P < 0.001), respectively. For low-grade carcinomas (Gleason score ≤ 6, 13/41 patients), only the former choice received scores better than fair (VS = 1.4 ± 0.3). Mean tumour ADCs showed significant negative correlation (Spearman's ρ -0.38 to -0.46, P < 0.05) with Gleason score. Absolute ADC values strongly depend on the choice of b values and therefore should be used with caution for diagnostic purposes. A minimum b value greater than zero is recommended for ADC calculation to improve the visual assessment of PCa in ADC maps. • Absolute ADC values are highly dependent on the choice of b values. • Absolute ADC thresholds should be used carefully to predict tumour aggressiveness. • Subjective ratings of ADC maps involving b = 0 s/mm ( 2 ) are poor to fair. • Minimum b value greater than 0 s/mm ( 2 ) is recommended for ADC calculation.
    European Radiology 04/2012; 22(8):1820-8. DOI:10.1007/s00330-012-2432-3 · 4.34 Impact Factor
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    ABSTRACT: Laparoendoscopic single-site surgery (LESS) represents the next step of laparoscopic surgery and a major advancement towards scarless surgery. LESS radical nephrectomy is an evolving technique based on technological advancement of laparoscopic instruments as well as the refinement of existing techniques.The current report describes LESS nephrectomy technique, presents the experience with the technique in a series of 42 patients and reviews current literature in the field of LESS nephrectomy.
    Archivos españoles de urología 04/2012; 65(3):294-302.
  • European Urology Supplements 02/2012; 11(1):e71, e71a. DOI:10.1016/S1569-9056(12)60070-0 · 3.37 Impact Factor
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    ABSTRACT: Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure's established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.
    Asian Journal of Andrology 12/2011; 14(2):278-84. DOI:10.1038/aja.2011.53 · 2.53 Impact Factor
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    ABSTRACT: The laparoscopic approach has been established as a treatment modality for the performance of radical nephrectomy during the recent years, while laparoscopic partial nephrectomy represents an alternative under investigation in several centers of laparoscopic excellence around the world. Significant advantages of laparoscopic surgery when compared to the classical open approach have extensively documented for over 2 decades. Nevertheless, laparoscopy is an evolving surgical field, which is characterized by the rapid adaptation of technical innovations. Laparoscopic renal surgery includes approaches for radical and partial nephrectomy with oncological outcome similar to open surgery and decreased postoperative morbidity and therefore can be considered for the same indications as open surgery. Several issues regarding the technical feasibility and refinement as well as the oncological efficacy of these procedures are presented.
    World Journal of Urology 11/2011; 31(4). DOI:10.1007/s00345-011-0754-4 · 3.42 Impact Factor
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    ABSTRACT: PURPOSE: Laparoendoscopic single-site surgery (LESS) has emerged in the recent years as an alternative approach to conventional laparoscopic surgery which is accompanied by additional advantages over laparoscopy. In this work we attempt to review the current literature and to investigate the possible combination of LESS to other currently available approaches such as natural orifice transluminal endoscopic surgery (NOTES), needlescopic and robotic laparoscopic surgery. METHODS: Extensive literature search on the topics of LESS, hybrid and pure NOTES, Needlescopic-assisted LESS and "Robot-assisted LESS" took place. Additionally, the accumulated experience from 118 LESSs performed in our departments is presented in an attempt to provide evidence regarding the mix of technique in LESS in urology. RESULTS: The challenging nature of LESS limits the broader application and acceptance. Expanding experience in single-site surgery has currently provided tools such as transvaginal access, needlescopic instruments and robot assistance that can aid LESS and enhance its efficiency without compromising any of its advantages. A mix of these techniques with LESS could ease the stiff learning curve of the second and benefit not only its performance but also the adaptation of LESS as a standard practice. CONCLUSION: Pure LESS although feasible, remains a technical challenge for the surgeon, preventing the widespread application of the technique. The goal of urologists on LESS surgery should not be the purity of LESS approach, but the superiority against already established techniques. A mix of techniques could be a key for the documentation of the advantages of LESS over conventional laparoscopy.
    World Journal of Urology 10/2011; 30(5). DOI:10.1007/s00345-011-0766-0 · 3.42 Impact Factor

Publication Stats

1k Citations
191.51 Total Impact Points

Institutions

  • 2003–2014
    • University of Leipzig
      • • Institute of Pathology
      • • Klinik und Poliklinik für Urologie
      Leipzig, Saxony, Germany
  • 2012
    • Klinikum Dortmund gGmbH
      • Urologische Klinik
      Dortmund, North Rhine-Westphalia, Germany
  • 2007–2012
    • University of Patras
      • Department of Urology
      Patrís, Kentriki Makedonia, Greece