About
477
Publications
61,129
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
11,474
Citations
Introduction
All that is gold does not glitter,
Not all those who wander are lost;
The old that is strong does not wither,
Deep roots are not reached by the frost.
John Ronald Reuel Tolkien
Current institution
Additional affiliations
January 1999 - August 2005
July 1999 - August 2005
July 2006 - present
Publications
Publications (477)
Introduction
Open ureteroenteric reimplantation (OUER) of ureteroenteric strictures (UESs) is related to important morbidity. Robot-assisted ureteroenteric reimplantation (RUER) has been proposed to provide similar outcomes with lower morbidity. We aimed to compare perioperative and functional outcomes between RUER and OUER.
Methods
A retrospectiv...
Robot-assisted radical cystectomy (RARC) has evolved as a viable alternative option to the standard open radical cystectomy as a treatment option for muscle-invasive bladder cancer, and refractory non-muscle invasive disease. The objective of this chapter is to summarize the preoperative preparation, key technical steps for RARC performed in female...
Introduction:
We aimed to investigate the differences in perioperative outcomes, especially ureteroenteric strictures, between patients who underwent a stented ureteroenteric anastomosis at the time of robot-assisted radical cystectomy (RARC) and ileal conduit vs those who did not.
Methods:
A retrospective review of our RARC database was perform...
Bladder cancer, the sixth most common cancer in the United States, is most commonly of the urothelial carcinoma histologic subtype. The clinical spectrum of bladder cancer is divided into 3 categories that differ in prognosis, management, and therapeutic aims: (1) non–muscle-invasive bladder cancer (NMIBC); (2) muscle invasive, nonmetastatic diseas...
Objective
We described the technique and outcomes of robot-assisted repair of uretero-enteric strictures (UES) following robot-assisted radical cystectomy (RARC) and urinary diversion.
Methods
Retrospective review of our RARC database from November 2005 to August 2023 at Roswell Park Comprehensive Cancer center was performed. Patients who develope...
We sought to investigate the change in the urinary microbiome profile after transurethral resection of bladder tumor (TURBT).
Urine specimens were collected from consecutive patients with bladder cancer. Patients were divided into those with bladder tumors (“Tumor group”: de novo tumors or recurrent/progressed after TURBT ± intravesical therapy) ve...
Purpose:
We aimed to evaluate the impact of testosterone replacement therapy (TRT) in patients with localized prostate cancer (CaP) who elected active surveillance (AS).
Methods:
A retrospective review of our CaP database was performed. Patients who received TRT while on AS were identified and were matched to a cohort of patient on AS while not...
Context:
Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear.
Objective:
This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was...
Background:
We sought to investigate the impact of an NCCN-compliant multidisciplinary conference on treatment decisions of patients with localized prostate cancer.
Methods:
A retrospective review of our quality assurance localized prostate cancer database was performed. All patients with localized prostate cancer who sought a second opinion at...
530
Background: Sarcomatoid bladder cancer is an extremely rare and aggressive histological variant with poor prognosis and limited consensus regarding its management given rarity and lack of high-quality data. Radical cystectomy (RC) is the mainstay of treatment in muscle-invasive disease and adjuvant therapy is often offered to eligible patients...
TPS406
Background: Most patients with high or very high risk localized prostate cancer (PCa) experience disease recurrence after radical prostatectomy (RP). Neoadjuvant androgen ablation has not improved high-risk pathological features or recurrence rates after RP. ¹ We reported the association between high intratumoral CD8 ⁺ T lymphocyte (CTL) den...
Many studies are currently investigating the association between the urinary microbiome and bladder cancer, focusing on differences between stages and with risk of recurrence and progression. However, many of these studies are limited by the small number of patients, presence of confounders and issues with sampling, DNA extraction, and analyses. Re...
Objectives:
To identify trends in complications following robot-assisted radical cystectomy (RARC) using a multi-institutional database, the International Robotic Cystectomy Consortium (IRCC).
Methods:
A retrospective review of the IRCC database was performed (2976 patients, 26 institutions from 11 countries). Postoperative complications were ca...
In the initial era of robot-assisted radical cystectomy (RARC), urologic surgeons mainly focused on developing surgical techniques that optimize oncological outcomes. RARC has been shown to provide equivalent oncologic outcomes to its open counterpart and may be superior in terms of perioperative outcomes. A complete intracorporeal approach utilizi...
Introduction
To evaluate the prevalence, predictors, management, and trends for ureteroenteric strictures (UES) after robot-assisted radical cystectomy (RARC).
Methods
Retrospective review of our RARC database was performed (2005-2022). UES was described in terms of timing, laterality, and management. Kaplan-Meier curves were used to depict time t...
The NCCN Guidelines for Bladder Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with bladder cancer and other urinary tract cancers (upper tract tumors, urothelial carcinoma of the prostate, primary carcinoma of the urethra). These NCCN Guidelines Insights summarize the panel discussion behind rece...
Introduction and Objective
The surgical management of radiation-induced distal ureteral stricture and contracted bladder is challenging. The purpose of this video is to show the feasibility, safety, and functional outcomes of an intracorporeal robot-assisted ileal ureter and bladder augmentation in a modified Studer fashion for a long right uretera...
We sought to describe the development of the robotic urology program at Sindh Institute of Urology and Transplantation (SIUT) and the feasibility of transitioning from the da Vinci to Versius robotic systems. The SIUT robotics program began in 2017 utilizing the da Vinci Si robotic system, transitioning to the Versius system in 2021. Retrospective...
OBJECTIVES
To investigate the oncologic outcomes of pT0 after robot-assisted radical cystectomy (RARC).
METHODS
A retrospective review of the International Robotic Cystectomy Consortium database was performed. Patients with pT0 after RARC were identified and analyzed. Data were reviewed for demographics and pathologic outcomes. Kaplan Meier(KM) cu...
Neoadjuvant chemotherapy (NAC) followed by radical cystectomy is the standard of care for patients with muscle-invasive bladder cancer (MIBC). Defects in nucleotide excision repair (NER) are associated with improved responses to NAC. Excision Repair Cross-Complementation group 3 (ERCC3) is a key component of NER process. No NER inhibitors are avail...
Introduction
: We sought to report the oncologic and functional outcomes of endopelvic fascia (EPF), puboprostatic ligaments (PPL), and dorsal venous complex (DVC) preservation with hydrodissection of the neurovascular bundles (NVB) during robot-assisted radical prostatectomy (RARP).
Materials and Methods
: A retrospective review of our prospectiv...
Background
Open revision of ureteroenteric strictures (UESs) is associated with considerable morbidity. There is a lack of data evaluating the feasibility of robotic revisions.
Objective
To analyze the perioperative and functional outcomes of robot-assisted ureteroenteric reimplantation (RUER) for the management of UESs after radical cystectomy (R...
Objectives
To analyze the impact of neoadjuvant chemotherapy on survival and recurrence patterns in muscle-invasive bladder cancer after robot-assisted radical cystectomy.
Materials and methods
The International Robotic Cystectomy Consortium database was reviewed to identify patients who underwent robot-assisted radical cystectomy for muscle-invas...
Objectives
To analyze the long-term effects of continent (neobladder) compared with incontinent (ileal conduit) urinary diversion.
Methods
We carried out a retrospective review of our departmental database. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Neobladder and ileal...
Objective:
To develop a structured and objective scoring tool for assessment of robot assisted partial nephrectomy (RAPN): Scoring for Partial Nephrectomy (SPaN).
Materials and methods:
Content development: RAPN was deconstructed into 6 domains by a multi-institutional panel of 10 expert robotic surgeons. Performance on each domain was represent...
Purpose of review:
Radical cystectomy is a complex procedure that encompasses surgery involving the urinary, gastrointestinal tracts and the retroperitoneum, with significant morbidity. Robot-assisted radical cystectomy (RARC) has been introduced to improve perioperative outcomes.
Recent findings:
It has been shown to provide equivalent oncologi...
Surgical complications result in patient morbidity and mortality. Clearly, avoidance is better than cure, but when complications occur, prompt detection and management are needed.You are a true surgeon from the moment you are able to deal with your complications. (Owen H Wangensteen 1898–1981) You are a true surgeon from the moment you are able to...
Objectives
To compare perioperative and oncologic outcomes of intracorporeal (ICNB) and extracorporeal neobladder (ECNB) following robot assisted radical cystectomy (RARC) from a multi-institutional, prospectively maintained database, the International Robotic Cystectomy Consortium (IRCC).
Methods
A retrospective review of IRCC database between 20...
IntroductionA hierarchical structure is where all individuals are organized according to importance and are subordinate to a single person. In the operating room (OR), this structure may negatively impact the quality of communication and jeopardize patient safety. We examined how the surgical team’s hierarchical relationships affect the frequency a...
Objective
To develop an algorithm for objective evaluation of distraction of surgeons during robot-assisted surgery (RAS).
Materials and Methods
Electroencephalogram (EEG) of 22 medical students was recorded while performing five key tasks on the robotic surgical simulator: Instrument Control, Ball Placement, Spatial Control II, Fourth Arm Tissue...
Enhanced Recovery After Surgery Protocols
This chapter reviews the construction of orthotopic bladder substitution with tricks and tips as performed by the authors. Along with intraoperative photographs and surgical technique, we have outlined our routine postoperative management, workup, and treatment of commonly seen complications.
Urinary diversion (UD) is a technically demanding surgery even after decades of its implementation. Although multiple UD techniques have been described, ileal conduit remains the most frequent, probably due to its easy and quick construction. The individual selection of UD should be based on the balance between the oncological control and quality o...
Introduction
During robot-assisted surgery (RAS), changes to the operating room configuration pose challenges to communication by limiting team members’ ability to see one another or use gesture. Referencing (the act of pointing out an object or area in order to coordinate action around it), may be susceptible to miscommunication due to these const...
Introduction: We sought to describe the incidence, risk factors, and survival outcomes associated with pathologic upstaging from non-muscle invasive bladder cancer (NMIBC) to muscle invasive bladder cancer (MIBC) after robot-assisted radical cystectomy (RARC). Methods: We reviewed the International Robotic Cystectomy Consortium database between 200...
Objective: The aim of this work was to examine (electroencephalogram) EEG features that represent dynamic changes in the functional brain network of a surgical trainee and whether these features can be used to evaluate a robot assisted surgeon’s (RAS) performance and distraction level in the operating room. Materials and Methods: Electroencephalogr...
Robot‐assisted radical cystectomy has steadily gained wider acceptance among urologists compared with open and laparoscopic approaches. Robot‐assisted radical cystectomy has shown comparable perioperative and oncologic outcomes compared with open radical cystectomy. Nevertheless, data about the functional outcomes and quality of life after robot‐as...
Bacillus Calmette-Guérin (BCG) is commonly used in the immunotherapy of bladder cancer (BlCa) but its effectiveness is limited to only a fraction of patients. To identify the factors that regulate the response of human BlCa tumor microenvironment (TME) to BCG, we used the ex vivo whole-tissue explant model. The levels of COX2 in the BCG-activated e...
Surgical gestures detection can provide targeted, automated surgical skill assessment and feedback during surgical training for robot-assisted surgery (RAS). Several sources including surgical videos, robot tool kinematics, and an electromyogram (EMG) have been proposed to reach this goal. We aimed to extract features from electroencephalogram (EEG...
Introduction
We sought to investigate the association between the urinary microbiome and bladder cancer, including the difference between nonmuscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer, and Bacillus Calmette Guerin (BCG) responsive vs. BCG-refractory NMIBC.
Methods
Urine specimens were collected from consecutive patients with...
Erlotinib was covalently linked to 3-(1'-hexyloxy)ethyl-3-devinylpyropheophorbide-a (HPPH) and structurally related chlorins and bacteriochlorins at different positions of the tetrapyrrole ring. The functional consequence of each modification was determined by quantifying the uptake and subcellular deposition of the erlotinib conjugates, cellular r...
Introduction:
We sought to investigate the effect of exposure to a dedicated art gallery during the perioperative period on the recovery of patients undergoing major oncologic procedures.
Methods:
80 patients were randomized into 2 arms; standard of care versus exposure to art. All patients completed a survey assessing their baseline art knowled...
Mental health is an integral part of the quality of life of cancer patients. It has been found that mental health issues, such as depression and anxiety, are more common in cancer patients. They may result in catastrophic consequences, including suicide. Therefore, monitoring mental health metrics (such as hope, anxiety, and mental well-being) is r...
Background
Although pathological factors remain the main determinate of survival for patients with bladder cancer, quality of surgical care is crucial for satisfactory outcomes. Using a validated quality score, we investigated the impact of surgical factors on the overall survival (OS), recurrence-free survival (RFS) and disease-specific survival (...
Objective
To understand the structures around the vesicourethral junction and to improve functional outcomes after nerve-sparing radical cystectomy with orthotopic urinary diversion for female patients, we histologically elucidated the fibromuscular construction and nerve distribution around the vesicourethral junction.
Methods
Pelvic specimens co...
Introduction:
The Khorana score (KS) is used to predict the risk of VTE for cancer patients. We sought to assess the association between KS and VTE for patients who underwent robot-assisted radical cystectomy (RARC).
Materials and methods:
We reviewed our prospectively maintained quality assurance RARC database between 2005 and 2020. KS was calc...
Objective
To describe incidence and variables associated with venous thromboembolism (VTE) after robot-assisted radical cystectomy (RARC).
Methods
A retrospective review of the prospectively maintained departmental database was performed. Extended thromboprophylaxis (for 4 weeks postoperatively) was implemented November 2017. Patients were divided...
Background
A high density of CD8⁺ tumor infiltrating lymphocytes (TILs) is associated with improved survival in multiple cancers, but its prognostic role in prostate cancer remains controversial. The aim of our study was to evaluate the prognostic value of CD8⁺ TILs in prostate cancer patients undergoing radical prostatectomy (RP). We hypothesized...
Introduction and objectives:
There have been concerns about higher incidence of local and retroperitoneal recurrences after robot-assisted radical cystectomy (RARC) compared to open radical cystectomy. We sought to report and detail relapses following RARC utilizing a multinational database.
Methods:
A retrospective review of the International R...
Objective:
To investigate the effect of incorporating physical rehabilitation, nutrition and psychosocial care as part of the "NEEW" (Nutrition, Exercise, patient Education and Wellness) on perioperative outcomes after Robot-Assisted Radical Cystectomy (RARC).
Methods:
Patients were divided into 2 groups: pathway group (NEEW in addition to ERAS)...
Background: Patients with advanced bladder cancer have limited therapeutic options, apart from cisplatin-based chemotherapy and use of immune checkpoint inhibitors (ICI). Median survival for patients with metastatic disease is 15 to 18 months. Hence there is a need for more effective therapies. Adoptive cell therapy using tumor-infiltrating lymphoc...
Video understanding of robot-assisted surgery (RAS) videos is an active research area. Modeling the gestures and skill level of surgeons presents an interesting problem. The insights drawn may be applied in effective skill acquisition, objective skill assessment, real-time feedback, and human-robot collaborative surgeries. We propose a solution to...
Objective:
To describe urinary tract infections (UTIs) after robot-assisted radical cystectomy (RARC) and investigate the variables associated with it.
Methods and material:
A retrospective review of 616 patients who underwent RARC 2005-2019 was performed. Patients were divided into those who developed UTI and those who did not. Patients who dev...
Introduction:
We sought to identify the factors associated with deterioration of renal functions after robot-assisted radical cystectomy (RARC), and to develop a nomogram to detect the probability of progression to chronic kidney disease (CKD).
Methods:
A retrospective review of our prospectively maintained database. eGFR was calculated using th...
The EAU guidelines panel on muscle-invasive and metastatic bladder cancer (MIBC) recently recommended open radical cystectomy (ORC) as the best surgical approach for MIBC patients. We critically re-examine the indications for considering ORC as the first choice over robot-assisted radical cystectomy. To the best of our knowledge, this is not suppor...
Background
It has been suggested that, in comparison with open radical cystectomy (ORC), robot‐assisted radical cystectomy (RARC) results in less blood loss, shorter convalescence and fewer complications, with equivalent short‐term oncological and functional outcomes; however, uncertainty remains as to the magnitude of these benefits.
Objectives
T...
Objective
To compare the perioperative outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot‐assisted radical cystectomy (RARC).
Patients and Methods
We retrospectively reviewed the prospectively maintained International Robotic Cystectomy Consortium (IRCC) database. A total of 972 patients from 28 institutions w...
Objective
To report the outcomes of patients who underwent robot-assisted radical cystectomy (RARC) and have a history of previous pelvic surgery and/or radiation.
Methods
Retrospective review of our prospectively maintained database between 2005 and 2018. Patients were divided into three groups based on surgical complexity; Complexity grade 1 inc...
