Robot-Assisted Laparoscopic Dismembered Pyeloplasty

OBJECTIVE: Advanced laparoscopic skills limit the implementation of laparoscopic pyeloplasty to centers with extensive experience. The introduction of robotic technology into the field of minimally invasive surgery has facilitated complex surgical dissection and genitourinary reconstruction. We report our experience with robot-assisted laparoscopic pyeloplasty using the da Vinci Robotic Surgical System at 3 New York City medical centers. METHODS: A review of all robot-assisted laparoscopic Anderson-Hynes dismembered pyeloplasty cases in 38 patients (21 females, 17 males) between April 2001 and January 2004 was performed. All patients had symptoms or radiographic evidence of ureteropelvic junction obstruction. Robotic assistance with the da Vinci Robotic Surgical System was used after preparation of the ureteropelvic junction with a standard laparoscopic approach. RESULTS: The average patient age was 39.3 years (range, 15 to 69). The mean operative time and suturing time were 225.6+/-59.3 minutes and 64.2+/-14.6 minutes. The average estimated blood loss was minimal at 77.3+/-55.3 mL. The mean length of hospitalization was 69.6 hours (range, 28 to 310). The average use of intravenous morphine was 26.5 mg (range, 0 to 162). No intraoperative complications occurred, and open conversions were not necessary. A mean follow-up of 12.2 months revealed a success rate of 94.7% with 2/38 patients requiring further treatments. CONCLUSIONS: This combined multi-institutional series reveals that robot-assisted pyeloplasty with the da Vinci Surgical System is safe and reproducible. These intermediate results appear comparable to results with open and laparoscopic pyeloplasty repairs

Monthly Variations in Urolithiasis Presentations and Their Association with Meteorologic Factors in New York City

Introduction: Nephrolithiasis in the United States has been on the rise during the past several decades. Temperature has been shown to directly correlate with increased stone disease. We examine the association between climactic factors and monthly urolithiasis presentation rates for 6 years at a single institution in New York City. Methods: Emergency department (ED) data on patient visitations were collected along with patient demographics. Meteorological data were collected using the website Weather Underground (www.wunderground.com). Average monthly temperature, dew point, precipitation, and sea level pressure were obtained and relative humidity was calculated using the dew point. Monthly urolithiasis visitations and the correlation of atmospheric factors were analyzed using an autoregressive integrated moving average (ARIMA) model. Results: The total number of renal colic visits to the hospital\u27s ED from January 2007 through December 2012 tallied 3647 visits. The lowest average monthly rate per 1000 ED visits occurred in the month of February (28.8) and the highest in the month of August (43.8). There was a strong correlation between monthly presentation rate and temperature (

Utilization of a Pre-operative Checklist Reduces Risk of Penile Prosthesis Infection

PURPOSE:: Infection of a penile prosthesis (PP) is a devastating complication that necessitates removal of all device components. Many aspects of pre- and intra-operative infection prophylaxis practices have been examined but the specific relevant factors remain unknown. We determined whether use of a mandatory checklist of peri-operative practices believed to reduce prosthesis infection risk would impact patient safety. MATERIALS AND METHODS:: We retrospectively reviewed men with erectile dysfunction (ED) who underwent PP insertion. Only patients who had not previously undergone PP surgery were included. Following an outbreak of infections, a mandatory checklist comprised of best infection prophylaxis practices was developed and required for all subsequent implant surgeries. Patient cohorts were divided into 3 groups: baseline period, outbreak period, and intervention period. Statistical analysis was performed using Chi-Square, Fisher\u27s exact test, and ANOVA. RESULTS:: During the baseline period 2/68 (2.9%) inflatable penile prosthesis (IPP) devices became infected. During the outbreak break 6/11 (54.5%) of devices became infected, representing an incidence risk ratio 18.55 times that of the baseline period. Following the implementation of the pre-operative checklist, the incidence risk ratio fell to 0.0 in the intervention period with 0/52 (0%) becoming infected. CONCLUSIONS:: Following an outbreak of an unusually high number of PP infections, implementation of a required checklist brought the rate down to zero. Although the specific factors that led to the infection outbreak and subsequent cessation of infections are unknown, we have shown that utilization of a checklist was associated with a dramatic impact on patient safety

Use of a Preoperative Checklist Reduces Risk of Penile Prosthesis Infection

Purpose: Infection of a penile prosthesis is a devastating complication that necessitates the removal of all device components. Many aspects of preoperative and intraoperative infection prophylaxis practices have been examined but the specific relevant factors remain unknown. We determined whether use of a mandatory checklist of perioperative practices believed to reduce the risk of prosthesis infection would impact patient safety. Materials and Methods: We retrospectively reviewed men with erectile dysfunction who underwent penile prosthesis insertion. Only patients who had not previously undergone penile prosthesis surgery were included in the study. After an outbreak of infections, a mandatory checklist comprised of best infection prophylaxis practices was developed and was required for all subsequent implant surgeries. Patient cohorts were divided into 3 groups of baseline period, outbreak period and intervention period. Statistical analysis was performed using the chi-square test, Fisher\u27s exact test and ANOVA. Results: During the baseline period 2 of 68 (2.9%) inflatable penile prosthesis devices became infected. During the outbreak period 6 of 11 (54.5%) devices became infected, representing an incidence risk ratio 18.55 times that of the baseline period. After the implementation of the preoperative checklist the incidence risk ratio decreased to 0.0 in the intervention period with 0 of 52 devices (0%) becoming infected. Conclusions: After an outbreak of an unusually high number of penile prosthesis infections, implementation of a required checklist brought the rate down to zero. Although the specific factors that led to the infection outbreak and subsequent cessation of infections are unknown, we have shown that use of a checklist was associated with a dramatic impact on patient safety