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ABSTRACT: The proper indication for laparoendoscopic single-site surgery (LESS) in urology is still under debate, especially for malignant diseases. We compared the perioperative outcomes between LESS and conventional laparoscopy (CL) for upper urinary tract malignancies.
We reviewed the records of 75 patients who underwent radical nephrectomy, nephroureterectomy with bladder cuff excision, or partial nephrectomy with the LESS or CL approach between December 2008 and December 2010. We compared characteristics and perioperative outcomes between patients who underwent LESS or CL. All operations were performed by three surgeons using the transperitoneal approach.
For all three surgery types, no differences in patient characteristics, estimated blood losses, transfusion rates, or durations of hospital stay were found between the two groups. No complications were found between the two groups in those who underwent nephroureterectomy with bladder cuff excision; however, significantly more complications were found in the LESS group than in the CL group in those who underwent radical nephrectomy or partial nephrectomy. Most of the complications with LESS radical nephrectomy occurred in the early introduction period of the technique.
No significant differences in perioperative outcomes were found between the LESS and CL groups in those who underwent radical nephrectomy or nephroureterectomy with bladder cuff excision. Therefore, the use of LESS in these cases is expected to expand as surgeons gain more experience with this technique and as other technical advances in laparoscopic instruments occur. However, partial nephrectomy with LESS should be performed restrictively considering the current level of surgical skill.
Korean journal of urology 04/2013; 54(4):244-8.
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ABSTRACT: OBJECTIVES: To investigate the incidence of lymphocele and determine the risk factors for postoperative lymphocele after extraperitoneal robot-assisted radical prostatectomy by using propensity score-matching.
METHODS: A total of 483 patients underwent extraperitoneal robot-assisted radical prostatectomy for prostate cancer between January 2009 and August 2011. Of these, 200 patients underwent pelvic lymph node dissection during robot-assisted radical prostatectomy. All patients underwent magnetic resonance imaging or computed tomography postoperatively to detect lymphocele after robot-assisted radical prostatectomy. Propensity scores for an established control group were calculated for each patient using multivariate logistic regression based on the following covariates: age, body mass index, preoperative prostate-specific antigen level, prostate volume calculated by transrectal ultrasound, biopsy Gleason sum and clinical tumor stage.
RESULTS: Lymphocele was identified in 41 patients (20.5%). There were no statistical differences in variables used in propensity score-matching. Operation time, estimated blood loss, catheterization and surgical margin positivity did not show differences between the two groups. Seminal vesicle invasion (P = 0.015) and tumor volume (P = 0.042) between the two groups were significantly different. In the multivariate logistic regression model, extracapsular extension (P = 0.017, odds ratio 4.231), seminal vesicle invasion (P = 0.028, odds ratio 2.643) and the number of positive lymph nodes (P = 0.041, odds ratio 3.532) were independent risk factors for lymphocele development after extraperitoneal robot-assisted radical prostatectomy with pelvic lymph node dissection.
CONCLUSIONS: Lymphocele might preferentially develop in cases with seminal vesicle invasion and large tumor volume. Additionally, extracapsular extension, seminal vesicle invasion, and the number of positive lymph nodes are independent risk factors for postoperative lymphocele after extraperitoneal robot-assisted radical prostatectomy.
International Journal of Urology 03/2013; · 1.75 Impact Factor
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ABSTRACT: OBJECTIVES: To investigate the incidence of lymphocele and determine the risk factors for postoperative lymphocele after extraperitoneal robot-assisted radical prostatectomy by using propensity score-matching. METHODS: A total of 483 patients underwent extraperitoneal robot-assisted radical prostatectomy for prostate cancer between January 2009 and August 2011. Of these, 200 patients underwent pelvic lymph node dissection during robot-assisted radical prostatectomy. All patients underwent magnetic resonance imaging or computed tomography postoperatively to detect lymphocele after robot-assisted radical prostatectomy. Propensity scores for an established control group were calculated for each patient using multivariate logistic regression based on the following covariates: age, body mass index, preoperative prostate-specific antigen level, prostate volume calculated by transrectal ultrasound, biopsy Gleason sum and clinical tumor stage. RESULTS: Lymphocele was identified in 41 patients (20.5%). There were no statistical differences in variables used in propensity score-matching. Operation time, estimated blood loss, catheterization and surgical margin positivity did not show differences between the two groups. Seminal vesicle invasion (P = 0.015) and tumor volume (P = 0.042) between the two groups were significantly different. In the multivariate logistic regression model, extracapsular extension (P = 0.017, odds ratio 4.231), seminal vesicle invasion (P = 0.028, odds ratio 2.643) and the number of positive lymph nodes (P = 0.041, odds ratio 3.532) were independent risk factors for lymphocele development after extraperitoneal robot-assisted radical prostatectomy with pelvic lymph node dissection. CONCLUSIONS: Lymphocele might preferentially develop in cases with seminal vesicle invasion and large tumor volume. Additionally, extracapsular extension, seminal vesicle invasion, and the number of positive lymph nodes are independent risk factors for postoperative lymphocele after extraperitoneal robot-assisted radical prostatectomy.
International Journal of Urology 03/2013; · 1.75 Impact Factor
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ABSTRACT: OBJECTIVE: To evaluate the effect of bent distortion of the image of the prostate on the accuracy of 3-dimensional measurements during transrectal ultrasonography (TRUS). METHODS: TRUS images were obtained prospectively from 60 patients with prostate cancer. The degree of rectal compression on the probe was varied in each case to obtain a typical bent distortion image (BDI) and a minimally bent image (MBI). Magnetic resonance imaging (MRI) served as the reference. Axial and midsagittal BDI, MDI, and MRI were selected. Three-dimensional prostate diameters (height, width, and length) and volume were obtained from all images by 2 independent observers. The data were analyzed by using a paired t test, intraclass correlation coefficients (ICCs), and Bland-Altman plots. RESULTS: The MBI and BDI diameters differed significantly (P <.001). All ICCs for the MBI diameters and volume and the ICCs for BDI length and volume exceeded 0.9, which indicates high measurement reliability. However, the ICCs for BDI height and width were below 0.9. When the difference in MBI or BDI relative to MRI was calculated for each variable, the MBI differences were all significantly smaller than the BDI differences (P <.001). CONCLUSION: Bent distortion during TRUS affects the accuracy of measurements. MBI is also morphologically more realistic than BDI. Therefore, to minimize prostatic image distortion, the rectal probe should be placed so that the posterior wall of the prostate is as flat as possible.
Urology 01/2013; · 2.43 Impact Factor
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ABSTRACT: To evaluate the effect of the prostatic urethral angle (PUA) on the peak flow rate (Qmax) and urinary symptoms in the clinical setting.
The records were obtained from a prospectively maintained database for first-visit men with lower urinary tract symptoms. Uroflowmetric measurements, postvoid residual urine volume, and International Prostate Symptom Score were assessed. The prostate-related parameters, including prostate volume, PUA, and intravesical prostatic protrusion, were measured using transrectal ultrasonography. Patients with comorbidities that can affect voiding function or in whom the PUA could not be measured were excluded.
A total of 316 patients were included. On multivariate linear regression analysis, the PUA (P = .002) was independently associated with the International Prostate Symptom Score. However, the International Prostate Symptom Score was not influenced by patient age, prostate volume, or intravesical prostatic protrusion. The mean PUA was significantly different according to symptom severity. The mean PUA was 42.2° ± 7.0°, 45.5° ± 9.1°, and 47.3° ± 8.6° in patients with mild, moderate, and severe symptoms, respectively (P = .004, analysis of variance). Although the PUA (P <.001) and patient age (P <.001) were independent predictors of Qmax, the prostate volume and intravesical prostatic protrusion did not affect the Qmax. The mean PUA was 52.2° ± 7.3° in patients with a Qmax <10 mL/s, 45.0° ± 7.9° in those with a Qmax ≥10 mL/s but <20 mL/s, and 39.8° ± 7.9° in those with a Qmax of ≥20 mL/s (P <.001, analysis of variance).
The results of our study has shown that the PUA is significantly associated with the Qmax and symptom scores in men with lower urinary tract symptoms. Our findings suggest that the PUA should be considered in the treatment of male patients with lower urinary tract symptoms.
Urology 12/2012; 80(6):1333-7. · 2.43 Impact Factor
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ABSTRACT: To assess the clinical reliability of the Bosniak IIF category and to determine the proper radiologic follow-up duration and intervals for category IIF complex renal cysts.
We studied 201 patients with category IIF renal cysts from January 1996 to January 2011. Renal cyst progression to category III was defined as an increase in complexity of the cyst in follow-up radiologic studies. We monitored radiologic changes and progression of renal cysts during the follow-up period and analyzed the pathologic results of those patients who were treated surgically.
At a mean follow-up of 20 months, only 14 cases (7%) showed evidence of progression to stage III, with a mean time to progression of 11 months (range, 3 to 65 months). There were no significant differences in age, gender, cyst size, or change in cyst size between the progressive and non-progressive groups. Of 12 cases treated surgically, 10 cases (83.3%) showed renal cell carcinoma with pT1 stage, and there was no recurrence during postoperative follow-up of 23 months. Of the 187 patients without radiologic progression, 23 cases were treated surgically, and all of them showed benign cysts.
The IIF category showed significant clinical reliability by a low rate of radiologic progression and a high rate of malignancy in the radiologic progressive group but a low rate of malignancy in the non-progressive group. Although it is hard to decide on a proper follow-up duration because of the variable time to progression, too frequent follow-up study seems to be unnecessary considering that most malignant cases were of a low stage.
Korean journal of urology 06/2012; 53(6):386-90.
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ABSTRACT: Robot-assisted laparoscopic radical prostatectomy has become a frequently used alternative treatment option in the management
of prostate cancer. As more operations are performed, more challenging patient conditions are encountered, for example those
with previous abdominal cancer surgery. We present our experience of robot-assisted laparoscopic radical prostatectomy (RALP)
in patients with previous cancer surgery. Seven patients with a history of previous surgery for malignancy underwent RALP.
All the prostatectomies were performed using the da Vinci™ S surgical system by a single surgeon. All operations were approached
transperitoneally. We reviewed perioperative data and surgical outcomes retrospectively. The mean age at surgery was 68.43years
(range 63–82). The mean operative time was 214±47.32min, and the median estimated blood loss was 500ml (range 200–1,300).
The mean hospital stay was 6.57±2.15days, and the mean duration of catheterization was 8.29±3.09days. Nerve-sparing
procedure and pelvic lymph node dissection were performed in six patients. Rectal injury occurred in one patient who had undergone
hemi-colectomy 15years previously and was resolved by primary closure. Positive surgical margin was found in three patients.
Although one patient had an intraoperative rectal injury, RALP in a patient with previous cancer surgery seems to be feasible
and safe in experienced hands.
Journal of Robotic Surgery 04/2012; 3(4):223-227.
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Urology 03/2012; 79(3):748. · 2.43 Impact Factor
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ABSTRACT: A 21-year-old woman with a 4 cm enhancing cystic renal mass in the left moiety of a horseshoe kidney was treated through a retroperitoneal laparoscopic approach. The tumor was excised completely with cold scissors, and renal parenchyma suturing with a surgical bolster was done with Vicryl 2-0 sutures. Choosing the proper approach according to the location of the lesion and the surgeon's experience with both approaches are of importance in laparoscopic surgery in horseshoe kidney cases. A preoperative kidney computed tomography angiography was helpful for understanding the complex renal vasculature.
Korean journal of urology 11/2011; 52(11):795-7.
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ABSTRACT: To introduce a novel method to successfully remove organized hematoma. Endoscopic evacuation can be troublesome in some patients with a large amount of blood clots or organized hematoma.
We retrospectively reviewed medical records of 15 patients who were treated with a so-called "suction and fishing method" for severe clot retention. A large-bore catheter connected with a wall suction unit was inserted into the bladder through the resectoscope sheath, and subsequently a large volume of urine retention and quite a substantial amount of soft clots were removed (suction step). After awhile, negative pressure could not work when the catheter met large and organized fragments of blood clots. In this situation, large blood clots hanging on the catheter tip were removed by gently removing the catheter (fishing step).
In all patients, clot retention was successfully managed with this method. Clot evacuation was performed without anesthesia in 9 patients when electrocauterization was not planned, and opioid analgesics were sufficient for pain control. In the other 6 patients, clot evacuation and fulguration were performed under anesthesia. Median time for clot evacuation was 20 minutes (range 5-55) and median estimated volume of clot evacuated was 200 mL (range 50-600). There was no procedure-related complication such as bladder rupture.
The suction and fishing method is a simple, safe, and successful way to evacuate severe organized clot retention. It can resolve intractable clot retention and rapidly relieve related symptoms without anesthesia.
Urology 09/2011; 78(5):1199-202. · 2.43 Impact Factor
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ABSTRACT: To describe our experience with robot-assisted laparoendoscopic single-site (R-LESS) surgeries and evaluate a homemade port system as an effective access technique.
Between May 2009 and April 2010, 68 consecutive R- LESS urologic operations were performed in our institution. A 4 to 5 cm long incision was made over the umbilicus. After the inner ring of the Alexis wound retractor was placed into the peritoneum, a common size 7 surgical glove was then applied over the external side of the wound retractor. A homemade single port was established by inserting two 12-mm trocars and two 8-mm trocars through fingers of a surgical glove and securing it to the port.
Sixty-eight patients underwent R-LESS, including partial nephrectomy in 51, nephroureterectomy in 12, radical nephrectomy and adrenalectomy in 2 each, and simple nephrectomy in 1. Mean patient age was 56 years (range 16-81 y). Mean body mass index was 23.9 kg/m(2) (range 17.2-32.9 kg/m(2)). The mean operative time was 219 minutes (range 109-382 min). Mean estimated blood loss 319 mL (range 50-1550 mL), and change in hematocrit was 5.2 % (range 0.0-14.8%). At a mean follow-up of 8 months, there were no port-related complications, and cosmesis was excellent.
R-LESS is feasible and can be safely applied to a variety of urologic operations, considering the low intraoperative complication rate. Our homemade single-port device provides adequate range of motion and is more flexible in port placement for R-LESS than the current multichannel port.
Journal of endourology / Endourological Society 09/2011; 25(9):1481-5. · 1.75 Impact Factor
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ABSTRACT: To assess the clinical utility of laparoendoscopic single-site surgery (LESS) nephrectomy using a modified umbilical incision and home-made transumbilical port in cases requiring extirpative surgery.
Initial consecutive 18 patients underwent LESS nephrectomies that were performed by a single surgeon. A home-made port was placed through a modified umbilical incision, the length of which had preoperatively been determined. The laparoscopic transperitoneal nephrectomy procedures were performed with various combinations of standard and articulating laparoscopic instruments. Patient characteristics and perioperative outcomes, including pathologic results, were recorded prospectively.
All 18 extirpative surgeries, including simple nephrectomy (eight cases), radical nephrectomy (nine cases), and nephroureterectomy (one case), were completed successfully. The median operation time was 167 min (range 82-220), and the median blood loss was 250 mL (range 0-1050). All specimens were extracted intact through a modified umbilical incision (median length 2.5 cm, range 1.5-6.0). Final pathological analysis revealed a nonfunctioning kidney in five cases, a dysplastic kidney in three cases, a mixed epithelial and stromal tumor in one case, renal cell carcinoma in eight cases (T1: five cases, T3: three cases), and Ta ureter transitional cell carcinoma in one case.
LESS nephrectomy using a home-made port and modified umbilical incision is feasible with both minimal incision and cost-effective. Our technique may be more useful for extirpative procedures in which a specimen needs to be removed intact, because incision length can be freely adjusted. Prospective comparisons are warranted to more clearly elucidate the utility of this surgical technique.
Yonsei medical journal 03/2011; 52(2):307-13. · 0.77 Impact Factor
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Jae Seung Chung,
Han Yong Choi,
Hae-Ryoung Song,
Seok-Soo Byun,
Seong Il Seo,
Cheryn Song,
Jin Seon Cho,
Sang Eun Lee,
Hanjong Ahn,
Eun Sik Lee,
Tae-Kon Hwang,
Wun-Jae Kim,
Moon Kee Chung,
Tae Young Jung, Ho Song Yu,
Young Deuk Choi
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ABSTRACT: Due to the availability of serum prostate specific antigen (PSA) testing, the detection rate of insignificant prostate cancer (IPC) is increasing. To ensure better treatment decisions, we developed a nomogram to predict the probability of IPC.
The study population consisted of 1,471 patients who were treated at multiple institutions by radical prostatectomy without neoadjuvant therapy from 1995 to 2008. We obtained nonrandom samples of n = 1,031 for nomogram development, leaving n = 440 for nomogram validation. IPC was defined as pathologic organ-confined disease and a tumor volume of 0.5 cc or less without Gleason grade 4 or 5. Multivariate logistic regression model (MLRM) coefficients were used to construct a nomogram to predict IPC from five variables, including serum prostate specific antigen, clinical stage, biopsy Gleason score, positive cores ratio and maximum % of tumor in any core. The performance characteristics were internally validated from 200 bootstrap resamples to reduce overfit bias. External validation was also performed in another cohort.
Overall, 67 (6.5%) patients had a so-called "insignificant" tumor in nomogram development cohort. PSA, clinical stage, biopsy Gleason score, positive core ratio and maximum % of biopsy tumor represented significant predictors of the presence of IPC. The resulting nomogram had excellent discrimination accuracy, with a bootstrapped concordance index of 0.827.
Our current nomogram provides sufficiently accurate information in clinical practice that may be useful to patients and clinicians when various treatment options for screen-detected prostate cancer are considered.
Yonsei medical journal 01/2011; 52(1):74-80. · 0.77 Impact Factor
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ABSTRACT: We report herein 119 patients with pheochromocytoma at our institute over the last 23 years.
Between 1986 and 2009, 119 patients were diagnosed with pheochromocytoma at our institute. We reviewed the medical records of these patients.
Of 119 patients, 45 were male and 74 were female, and mean age was 43.83 ± 13.49 years. Forty-three patients (36.1%) were diagnosed incidentally, and 8 patients (6.7%) were found to have familial pheochromocytoma. The mean dimension of the tumors was 5.89 ± 3.18 cm. 4 patients had bilateral tumors; three of these patients were found to have familial pheochromocytoma and 1 patient was diagnosed with malignant pheochromocytoma. A total of eight patients (6.7%) were found to have malignant pheochromocytoma. In 1 patient, metastasis to a lymph node was found at the time of diagnosis. Metastases were found at a mean of 49 ± 25.83 (6-75) months after surgery in the other seven patients. 6 patients died of malignant pheochromocytoma at a mean of 31 ± 28.71 months (1-81) after diagnosis, and the other 2 patients survived for 15 and 24 months, respectively.
Approximately 35% of patients with pheochromocytoma are diagnosed incidentally, and the number of detected cases is increasing. Although familial pheochromocytoma was found only in 6.7% of the patients, genetic testing should be considered in all patients, especially in patients with a family history, young age, or multifocal, bilateral, extra-adrenal, or malignant tumors. Given that malignant pheochromocytomas are frequently diagnosed during the follow-up period, long-term follow-up is necessary to confirm the absence of recurrence or metastasis.
Yonsei medical journal 01/2011; 52(1):45-50. · 0.77 Impact Factor
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ABSTRACT: To compare the oncologic results, functional outcomes, and complications of transperitoneal (TP) and extraperitoneal (EP) robotic radical prostatectomy.
From June 2007 to April 2009, 105 patients underwent TP robotic radical prostatectomy, and 155 patients underwent EP robotic radical prostatectomy. Clinicopathological and perioperative data were compared between the two groups. Postoperative complications and functional outcomes including potency and incontinence were assessed.
Patient demographics were similar in the TP and EP groups. No significant differences in positive surgical margins were noted between the groups. The total operative time, number of lymph nodes removed, and estimated blood loss were also not significantly different. However, the robot console time was shorter for the EP group than for the TP group (89.1 vs. 107.8 minutes, p = 0.03). Postoperative pain scale scores were lower in the EP group than in the TP group (2.7 vs. 6.3, p < 0.001). The incidence of ileus and hernia were lower in the EP group; however, the incidence of lymphocele was higher in the EP group. Postoperative potency and continence rates were similar between the groups; however, the EP group had a faster recovery of continence compared with the TP group.
The EP approach has similar oncological and perioperative results, less postoperative pain, less bowel-associated complication, and better functional outcomes than those of the TP approach. The EP approach may be an important alternative in robotic radical prostatectomy.
Journal of endourology / Endourological Society 11/2010; 25(5):787-92. · 1.75 Impact Factor
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Jae Seung Chung,
Han Yong Choi,
Hae-Ryoung Song,
Seok-Soo Byun,
Seong il Seo,
Cheryn Song,
Jin Seon Cho,
Sang Eun Lee,
Hanjong Ahn,
Eun Sik Lee,
Won-Jae Kim,
Moon Kee Chung,
Tae Young Jung, Ho Song Yu,
Young Deuk Choi
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ABSTRACT: We developed a nomogram to predict the probability of extracapsular extension (ECE) in localized prostate cancer and to determine when the neurovascular bundle (NVB) may be spared. Total 1,471 Korean men who underwent radical prostatectomy for prostate cancer between 1995 and 2008 were included. We drew nonrandom samples of 1,031 for nomogram development, leaving 440 samples for nomogram validation. With multivariate logistic regression analyses, we made a nomogram to predicts the ECE probability at radical prostatectomy. Receiver operating characteristic (ROC) analyses were also performed to assess the predictive value of each variable alone and in combination. The internal validation was performed from 200 bootstrap re-samples and the external validation was also performed from the another cohort. Overall, 314 patients (30.5%) had ECE. Age, Prostate specific antigen (PSA), biopsy Gleason score, positive core ratio, and maximum percentage of biopsy tumor were independent predictors of the presence of ECE (all P values <0.05). The nomogram predicted ECE with good discrimination (an area under the ROC curve of 0.777). Our nomogram allows for the preoperative identification of patients with an ECE and may prove useful in selecting patients to receive nerve sparing radical prostatectomy.
Journal of Korean medical science 10/2010; 25(10):1443-8. · 0.84 Impact Factor
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ABSTRACT: We compared the efficacy and safety of multiple session 99% ethanol sclerotherapy to single session OK-432 sclerotherapy for the treatment of simple renal cysts.
Between September 2004 and November 2006, 41 patients (50 cysts, group 1) underwent sclerotherapy with 99% ethanol at least twice and 48 (61 cysts, group 2) underwent a single session of OK-432 sclerotherapy. Followup was performed with ultrasound or computerized tomography every 3 months for 1 year. Complete regression of the renal cyst or more than 70% reduction with no symptoms was considered successful treatment.
There was no significant difference in the mean size of renal cysts between the 2 treatment groups. The overall success rate was 84.0% in group 1 and 98.4% in group 2. For cysts smaller than 500 ml there was a similar complete regression rate between the 2 groups whereas in cysts 500 ml or larger the complete regression ratio of group 2 was higher than group 1. The symptom relief rate of group 2 was higher than group 1. In group 1 there were 2 patients with a recurrent cyst but in group 2 there was no enlargement of the aspirated cysts. For cysts smaller than 200 ml neither treatment group had complications whereas in cysts 200 ml or larger the frequency of complications was higher in group 1.
Single session OK-432 sclerotherapy is simpler, safer and more effective than multiple session 99% ethanol sclerotherapy for the treatment of simple renal cysts, especially large cysts.
The Journal of urology 11/2008; 180(6):2552-6. · 4.02 Impact Factor
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ABSTRACT: An analysis of differentially expressed genes (DEGs) between bladder transitional cell carcinoma (TCC) and the surrounding urothelium to help identify what lies behind the mechanism of multifocal tumor development has not yet been performed. We sought to find a new DEG related to the development of bladder TCC.
Thirty-nine bladder TCC tissues paired with normal-appearing urothelium tissues obtained from the same patient were used as subjects. Initially, we compared the messenger RNA (mRNA) profiles between normal-appearing urothelium and TCC tissue of 1 patient by using annealing control primer (ACP)-based GeneFishing polymerase chain reaction (PCR) and selective amplification of family members (SAFM) PCR to identify potential DEGs. To validate the results of the ACP data, reverse transcriptase-polymerase chain reaction (RT-PCR) was performed on those of all 39 patients.
Among the several DEGs discovered in the ACP data, 1 DEG was chosen as the candidate for the RT-PCR, that is present or markedly upregulated in normal-appearing urothelial tissue compared with TCC tissue. Gene sequence searching revealed that this DEG is chicken ovalbumin upstream promoter-transcription factor I (COUP-TFI). Downregulation of COUP-TFI mRNA expression in TCC tissue compared to normal-appearing urothelium tissue of the same patient, irrespective of tumor stage and grade, was confirmed by RT-PCR in 39 patients.
Our results suggest that the loss of COUP-TFI may play a role in the transition from normal epithelium to TCC. Further characterization of the COUP-TFI gene is expected to give us informations about bladder TCC tumorigenesis.
Urology 05/2008; 72(4):921-6. · 2.43 Impact Factor
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ABSTRACT: Recently, increasing numbers of robotic-assisted laparoscopic radical prostatectomy have been performed at many centers. Although uncommon, malfunction of the da Vinci Surgical system represents a new and unique problem in urologic surgery. In this study, we report a rare case of a disassembled surgeon's console hand piece because of a loose screw during robotic-assisted laparoscopic radical prostatectomy.
Urology 05/2008; 73(1):209.e7-8. · 2.43 Impact Factor
