Firas Petros

James A. Haley Veterans Hospital, Tampa, Florida, United States

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Publications (32)83.89 Total impact

  • Firas G Petros · Jordan E Angell · Ronney Abaza ·

    Urology 06/2015; 85(6):1359. DOI:10.1016/j.urology.2014.11.065 · 2.19 Impact Factor
  • Firas G Petros · Jordan E Angell · Ronney Abaza ·
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    ABSTRACT: To review the outcomes of robot-assisted laparoscopic nephrectomy (RALN) after 101 consecutive cases, the largest reported series to date. The benefit of adding robotic technology to laparoscopic nephrectomy is unclear and controversial. We used robotics for nephrectomy routinely, including for simpler cases rather than laparoscopy, as well as for the most complex nephrectomies rather than open surgery. We reviewed a prospective database of 101 consecutive nephrectomy procedures by a single surgeon (R.A.). All were initiated as RALN regardless of complexity. Patient characteristics and outcomes were reviewed, including tumor complexity, conversion rate, transfusions, length of stay, and complications. Mean age was 60 years (19-86 years), and mean body mass index was 31 kg/m(2) (16-54 kg/m(2)). Ninety patients had tumors with mean size of 8.2 cm (2.2-25.8 cm). Eighty were malignant, including 31 pT3a tumors (39%), with 9 renal vein thrombi. Eight malignancies had caval tumor thrombi (10%). Local invasion required 1 bowel resection, 1 partial hepatectomy, and 1 distal pancreatectomy, all performed robotically with no conversions to open surgery. Ipsilateral retroperitoneal lymphadenectomy was performed in 40 patients removing 13.7 nodes (4-36). Mean operative time and blood loss were 172 minutes (57-411 minutes) and 67 mL (10-400 mL) with only 1 transfusion (1%). Mean length of stay was 1.1 days (0-7 days), with 94% discharged by postoperative day 1. Clavien grade III-IV complications occurred in 5% without deaths. Robotic nephrectomy allows for consistent outcomes regardless of procedure complexity. Completion of procedures without need for open conversion was possible even in the most complex procedures, including those with vascular and contiguous organ invasion. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 04/2015; 85(6). DOI:10.1016/j.urology.2014.11.063 · 2.19 Impact Factor
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    ABSTRACT: Objectives: Accurate tumor identification during partial nephrectomy is essential for successful tumor control. Intraoperative laparoscopic ultrasonography is useful for tumor localization, but the ultrasound probe is controlled by the assistant rather than the surgeon. We evaluated our initial experience using a robotic ultrasound probe that is controlled by the console surgeon. Methods: Partial nephrectomy was carried out in 22 consecutive patients between November 2010 and March 2011. A robotic ultrasound probe under console surgeon control was used in all the cases. All patients had at least 1 year follow up. Results: Mean patient age was 59 years and mean tumor size was 2.7 cm. There were six hilar tumors (27%) and 21 (95%) endophytic tumors. Mean R.E.N.A.L. nephrometry score was 6.9 (range 6–9). Mean operative time was 205.7 min and mean warm ischemia time was 17.9 min (range 6–28 min). All patients had negative tumor margins and were free of disease recurrence at a mean follow up of 13 months. Conclusion: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure.
    International Journal of Urology 08/2012; 20(2). DOI:10.1111/j.1442-2042.2012.03127.x · 2.41 Impact Factor
  • Wooju Jeong · Firas Petros · Craig Rogers ·
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    ABSTRACT: Robot-assisted surgery has emerged as a viable approach to minimally invasive surgery. A basic knowledge of the da Vinci® Surgical System and instrumentation, as well as troubleshooting techniques, is useful when implementing robot-assisted minimally invasive surgery into a surgical practice. The da Vinci Surgical System includes a surgeon's console, optical system, and surgical component with robotic arms manipulating surgical instruments. The surgeon's console provides control of robotic arms and EndoWrist® instruments with seven degrees of freedom and tremor-free movement. A binocular optic robotic camera system delivers three-dimensional vision to the surgeon on the console. A variety of robotic instruments are available, each with relative advantages for different procedures. Other features of the da Vinci Surgical System include a third instrument arm for self-retraction and TilePro™ multi-image display for overlay of radiographic images or other inputs. The reported incidence of mechanical failure or malfunction, or of instrument failure is low and the need for laparoscopic or open conversion is rare.
    Smith's Textbook of Endourology, 01/2012: pages 843-847; , ISBN: 9781444335545
  • Craig G. Rogers · Firas G. Petros · Surena F. Matin ·
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    ABSTRACT: The advent of robotic partial nephrectomy (RPN) may help overcome some of the limitations encountered during laparoscopic partial nephrectomy (LPN), namely, the longer warm ischemia time and higher rate of urologic complications. RPN is an advanced surgical technique that should be performed by experienced surgeons on select patients, and with an adequately prepared assistant bedside surgeon. A 3- or 4-arm approach may be utilized, although a 3-arm approach is recommended for those early in their experience. Surgeons should be familiar with strategies for avoiding hemorrhage and other complications, and if encountered, strategies for controlling bleeding, including suturing, additional clamping of unidentified arterial inflow, or venous unclamping. Surgeons should also be familiar with strategies that minimize warm ischemia time, namely preemptive selective ligation of involved arterioles and early unclamping. Strategies for achieving renal hypothermia primarily include retrograde injection of ice-cold saline. Surgeons performing RPN need to be comfortable with laparoscopic dissection of the renal hilum. Anticipating and preventing hemorrhage during hilar dissection, during warm ischemia time (WIT), and after hilar unclamping is a fundamental technical skill that should be mastered to safely and consistently perform RPN in a quality fashion. KeywordsChronic kidney failure-Kidney ­cancer-Laparoscopy-Minimally invasive surgical procedures-Nephron-sparing surgery-Renal cell ­carcinoma-Robotics-Urologic surgical procedures
    Robotic Urologic Surgery, 12/2011: pages 287-294;
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    ABSTRACT: Discovery of macroscopically positive lymph nodes (LN) during radical prostatectomy for clinically localized prostate cancer (PCa) is a rare event. We describe our experience of intraoperative finding of grossly positive LN during radical prostatectomy and evaluate outcomes and predictors. A total of 4,480 patients underwent robot-assisted radical prostatectomy (RARP) for clinically localized PCa from 2001 to 2010, and pelvic LN dissection was performed in 4,090 of these patients (91.3%). Patients with macroscopically positive LN discovered and confirmed intraoperatively were assessed, as was surgical decision (abort versus continue RARP). Patients with macroscopic LN-positive disease were also evaluated and oncologic outcomes were compared with patients with microscopic LN-positive disease on final pathology. LN-positive disease was found at final pathology in 87 patients (2.1%), of whom 13 (14.9%) had grossly abnormal LN confirmed intraoperatively by frozen section. RARP was aborted in nine cases and completed in four patients. All patients received adjuvant therapy with hormonal deprivation and/or radiation. Two patients in the aborted RARP subset died of PCa. All patients who underwent completion RARP are still alive at a mean follow-up of 57.2 months with one patient still alive at 95 months. Patients with macroscopically positive LN had a higher median preoperative prostate serum antigen (PSA) (17.2 vs. 6.7 μg/L, P = 0.002) and were more likely have biopsy perineural invasion (77.8 vs. 32.4%, P = 0.012). Intraoperative findings of macroscopically positive LN during RARP is a rare event that may occur in high-risk patients, particularly in those with a high PSA and biopsy perineural invasion. Long-term survival is possible after completion RARP.
    Journal of Robotic Surgery 12/2011; 6(4). DOI:10.1007/s11701-011-0316-1
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    ABSTRACT: Robot-assisted partial nephrectomy (RPN) has emerged as a viable approach to minimally invasive surgery for small renal tumors. There are few reports of RPN for tumors >4 cm. Our objective was to evaluate outcomes of RPN for tumors >4 cm compared with RPN for tumors ≤ 4 cm in a large multi-institutional study. We reviewed data for 445 consecutive patients who underwent RPN by experienced surgeons at four academic institutions from 2006 to 2010. Patients were stratified into two groups according to radiographic tumor size. Patient demographics, perioperative outcomes, and oncologic outcomes were recorded. A total of 83 of 445 (18.7%) patients had tumors >4 cm with a median radiographic tumor size of 5.0 cm (4.1-11 cm). Patients with tumors >4 cm had a higher proportion of hilar tumors (9.8% vs 4.7%, P<0.001), a higher mean R.E.N.A.L. nephrometry score (8.0 vs 6.3, P<0.01), longer warm ischemia time (WIT) (24 vs 17 min, P<0.001), and an increased rate of collecting system repair (72.2% vs 51.6%, P=0.006) compared with patients with tumors ≤ 4 cm. Functional outcomes and complications were similar between groups. There were no positive margins in patients with tumors >4 cm and only one recurrence. In the largest multi-institutional series of RPN for tumors >4 cm, we demonstrate safety, feasibility, and efficacy of RPN for tumors >4 cm. Patients with tumors >4 cm had a higher nephrometry score, longer WIT, and slightly higher estimated blood loss compared with patients who had tumors ≤ 4 cm, but there was no increased risk of adverse outcomes in the hands of experienced surgeons.
    Journal of endourology / Endourological Society 11/2011; 26(6):642-6. DOI:10.1089/end.2011.0340 · 1.71 Impact Factor
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    ABSTRACT: The need for a skilled assistant to perform hilar clamping during robotic partial nephrectomy is a potential limitation of the technique. We describe our experience using robotic bulldog clamps applied by the console surgeon for hilar clamping. A total of 60 consecutive patients underwent robotic partial nephrectomy, 30 using laparoscopic bulldog clamps applied by the assistant and 30 using robotic bulldog clamps applied with the robotic Prograsp instrument. Perioperative outcomes were compared between groups. All 30 patients underwent successful hilar clamping during robotic partial nephrectomy using robotic bulldog clamps with no intraoperative complications and without the need for readjustment/reclamping. Robotic bulldog clamps provided adequate ischemia even for tumors >4 cm, hilar, endophytic, multiple tumors, and multiple renal arteries. Both groups had similar baseline characteristics. Perioperative outcomes with robotic bulldog clamps were at least comparable to the laparoscopic bulldog group, with a trend to lower console time, warm ischemia time, and estimated blood loss. Use of robotically applied bulldog clamps is a safe and feasible method of hilar occlusion during robotic partial nephrectomy; they perform at least as well as laparoscopic bulldog clamps while allowing the console surgeon greater autonomy and precision for hilar clamping.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 10/2011; 15(4):520-6. DOI:10.4293/108680811X13176785204274 · 0.91 Impact Factor

  • European Urology Supplements 10/2011; 10(8):544-544. DOI:10.1016/S1569-9056(11)61365-1 · 3.37 Impact Factor
  • S. Sukumar · Q. D. Trinh · F. Petros · C. Rogers ·

    European Urology Supplements 10/2011; 10(8):560-561. DOI:10.1016/S1569-9056(11)61407-3 · 3.37 Impact Factor

  • European Urology Supplements 10/2011; 10(8):544-544. DOI:10.1016/S1569-9056(11)61366-3 · 3.37 Impact Factor
  • S. Sukumar · F. Petros · N. Mander · R. Chen · M. Menon · C. Rogers ·

    Urology 09/2011; 78(3). DOI:10.1016/j.urology.2011.07.335 · 2.19 Impact Factor
  • C. Rogers · S. Sukumar · W. Jeong · F. Petros · J. Sammon · Q. Trinh · M. Menon ·

    Urology 09/2011; 78(3):S137. DOI:10.1016/j.urology.2011.07.334 · 2.19 Impact Factor
  • S. Sukumar · F. Petros · A. Bhandari · M. Menon · C. Rogers ·

    Urology 09/2011; 78(3). DOI:10.1016/j.urology.2011.07.333 · 2.19 Impact Factor
  • S. Sukumar · F. Petros · M. Menon · C. Rogers ·

    Urology 09/2011; 78(3). DOI:10.1016/j.urology.2011.07.332 · 2.19 Impact Factor
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    ABSTRACT: We evaluated the incidence of perioperative complications after robotic partial nephrectomy. We retrospectively reviewed the records of patients treated with robotic assisted partial nephrectomy across the 4 participating institutions. Demographic, blood loss, warm ischemia time, and intraoperative and postoperative complication data were collected. All complications were graded according to the Clavien classification system. A total of 450 consecutive robotic assisted partial nephrectomies were done between June 2006 and May 2009. Overall 71 patients (15.8%) had a complication, including intraoperative and postoperative complications in 8 (1.8%) and 65 (14.4%), respectively. Hemorrhage developed in 2 patients (0.2%) intraoperatively and in 22 (4.9%) postoperatively. Seven patients (1.6%) had urine leakage. As classified by the Clavien system, complications were grade I-II in 76.1% of cases and grade III-IV in 23.9%. Robotic assisted partial nephrectomy was converted to open or conventional laparoscopic surgery in 3 patients (0.7%) and to radical nephrectomy in 7 (1.6%). There were no deaths. Current data indicate that robotic assisted partial nephrectomy is safe. Most postoperative complications are Clavien grade I or II, or can be managed conservatively.
    The Journal of urology 06/2011; 186(2):417-21. DOI:10.1016/j.juro.2011.03.127 · 4.47 Impact Factor

  • The Journal of Urology 04/2011; 185(4). DOI:10.1016/j.juro.2011.02.1905 · 4.47 Impact Factor
  • Q. D. Trinh · S. Sukumar · J. Sammon · F. Petros · M. Menon · C. Rogers ·

    European Urology Supplements 03/2011; 10(2):355-355. DOI:10.1016/S1569-9056(11)61137-8 · 3.37 Impact Factor
  • S. Sukumar · Q. D. Trinh · F. Petros · M. Menon · C. Rogers ·

    European Urology Supplements 03/2011; 10(2):347-347. DOI:10.1016/S1569-9056(11)61100-7 · 3.37 Impact Factor
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    ABSTRACT: Robot-assisted partial nephrectomy (RAPN) is an emerging technique for minimally invasive nephron-sparing surgery that may facilitate the technical challenges of sutured renorrhaphy. Barbed suture allows for knotless wound closure and improves suturing efficiency. We present the first clinical study of barbed suture for renorrhaphy during RAPN in human patients and compare perioperative outcomes to RAPN with polyglactin suture. Thirty consecutive patients underwent RAPN by a single surgeon; 15 using polyglactin suture for renorrhaphy followed by 15 using the V-Loc 180 wound closure device. Renorrhaphy was performed in two layers, with a continuous running closure of deep vessels and the collecting system, followed by a running closure of the renal capsule, using the sliding Hem-o-lok clip technique. Operative characteristics and complications were compared between groups. Renorrhaphy was successfully completed in all 30 consecutive RAPN procedures. V-Loc and conventional groups were equivalent in demographic and tumor characteristics. Mean operative and console time were equivalent; warm ischemia time was significantly shorter in the V-Loc group (18.5 vs 24.7 min, P = 0.008). There were no instances of suture slippage or tearing in the barbed suture group. The barbs held the sliding clip renorrhaphy intact without the need for redundant clips to prevent backsliding. Conclusion: Use of barbed suture simplifies the renorrhaphy technique during RAPN and improves efficiency, allowing for reduced warm ischemia times. We demonstrate feasibility and safety of this suture technique in human patients undergoing minimally invasive partial nephrectomy.
    Journal of endourology / Endourological Society 02/2011; 25(3):529-33. DOI:10.1089/end.2010.0455 · 1.71 Impact Factor

Publication Stats

287 Citations
83.89 Total Impact Points


  • 2015
    • James A. Haley Veterans Hospital
      Tampa, Florida, United States
  • 2010-2012
    • Henry Ford Hospital
      • Surgery
      Detroit, Michigan, United States
  • 2011
    • Henry Ford Health System
      Detroit, Michigan, United States
  • 2010-2011
    • Michigan Institute of Urology
      Detroit, Michigan, United States