Robot Assisted Radical Prostatectomy in A Patient with Previous Abdominoperineal Resection and Pelvic External Beam Radiation Therapy

WOS: 000437812800012PubMed ID: 29277880Though previous major abdominal surgery and pelvic irradiation may be a significant drawback of subsequent laparoscopic procedure, technological advances such as better visualization and more controlled finer movements of robotic arms allowing better dissection in robotic-assisted laparoscopic surgery may reduce some of these challenges. However, limited data are available on the effect and safety of robotic surgery in these patients. The aim of this case report is to present efficacy and safety of robot assisted radical prostatectomy in a patient who has rectal and concurrent prostate cancer with the history of abdominoperineal resection, pelvic irradiation and adjuvant chemotherapy

Robot-assisted Partial Nephrectomy with Segmental Renal Artery Clamping: A Single Center Experience

WOS: 000497596300010PubMed: 30852838Purpose: the aim of our study is to evaluate the feasibility and effectiveness of robotic partial nephrectomy performed with segmental clamping of tumor-feeding arteries. Materials and Methods: Thirty-six patients with renal tumor who underwent robotic partial nephrectomy with segmental renal artery clamping were included in this study. Prospectively recorded patient demographics, mean operation time, estimated blood loss, warm ischemia time, length of hospital stay, pre- and postoperative renal functions and oncological outcomes were analyzed retrospectively. All complications were graded based on the modified Clavien-Dindo classification system. Surgical success was defined as no conversion from segmental artery clamping to the main renal artery clamping. Results: Mean tumor size was 40 mm and, R.E.N.A.L nephrometry score was 6.74. Mean operation time, estimated blood loss and warm ischemia time were 162 min, 236 ml, and 16 min, respectively. Five postoperative complications were observed. There were no significant differences in terms of renal functional outcomes before and after surgery (P =.18). of 36 patients, 34 were completed successfully; however, main renal artery clamping was required in two patients due to excessive bleeding from the tumor bed. the success rate of the segmental renal artery clamping technique was determined as % 94.4 (34/36) in our study. Conclusion: Segmental renal artery clamping may be considered as a reliable and effective surgical method for vascular control during robotic partial nephrectomy. For this technique, tumor characteristics and intrarenal vascular anatomy should be precisely evaluated by the preoperative contrast-enhanced computerized tomography with 3-D reconstruction

'Trifecta' outcomes of robot-assisted partial nephrectomy: Results of the 'low volume' surgeon

Reis, AlessanRSS/0000-0001-8486-7469WOS: 000560788000006PubMed: 32822123Objective: There is limited data regarding surgeon volume and partial nephrectomy outcomes. the aim of this study is to report trifecta outcomes of robot-assisted partial nephrectomy (RAPN) performed by the low volume surgeon. Materials and Methods: Thirty-nine patients with clinical T1-2 renal tumors who underwent RAPN between 2012 and 2018 were included in this study. Trifecta was defined as negative surgical margins, warm ischemia time <= 20 minutes, and no operative complications. Patient demographics, R.E.N.A.L. nephrometry score, operation time, estimated blood loss, warm ischemia time, length of hospital stay, renal functions, and oncological outcomes were analyzed retrospectively. Complications were graded based on the modified Clavien-Dindo classification system. Results: the median R.E.N.A.L. nephrometry score was 6 (4-10). RAPN was successfully performed in all but one patient. the median operation time was 180 (90-240) minutes. Warm ischemia was performed only by segmental renal artery control in 35 and, by main renal artery control in three patients. the off-clamp technique was used in two patients. the median warm ischemia time was 16 (0-31) minutes. Seven patients had a warm ischemia time of longer than 20 minutes. Three patients had postoperative complications. the surgical margin was positive in one patient. As a result, the trifecta was achieved in 30 of the 39 patients (77 %). Conclusion: RAPN is a safe and effective minimally invasive alternative in the treatment of renal masses. the present study suggests that reasonable trifecta rates can be achieved even by low volume surgeons

Synchronous presentation of muscle-invasive urothelial carcinoma of bladder and peritoneal malign mesothelioma

WOS: 000482126100026PubMed: 30912893Introduction: Cancer is one of the most important leading cause of death in man and woman in the world. the occurrence of new cancer has become more frequent in recent years due to strict screening protocols and occupational and environmental exposure to carcinogens. the incidence of secondary malignancies has also increased due to close medical follow-up and advanced age. Herein, we report a case and its management diagnosed as synchronous peritoneal malignant mesothelioma and muscle-invasive urothelial carcinoma. Case Description: A 71-year-old male presented with macroscopic hematuria and abdominal distension increasing gradually. A contrast enhanced computerized tomography demonstrated bladder mass and diffuse ascites with nodular peritoneal thickening and umbilical mass. He was treated with the multidisciplinary team working including urologist, medical oncologist and general surgeon. Conclusions: To our knowledge, this is the first case of peritoneal malign mesothelioma with synchronous muscle-invasive urothelial carcinoma. Because of the rarity of this condition, there is still no consensus on the definitive treatment protocols, yet. Individualized treatment with multidisciplinary close follow-up might improve the survival outcomes

Robot-Assisted Laparoscopic Bladder Diverticulectomy Combined with Photoselective Vaporization of Prostate: A Case Report and Review of Literature

WOS: 000268700000009PubMed ID: 19591613Purpose: Open surgery, endoscopic technique, and standard laparoscopic technique are surgical options for the management of bladder diverticuli. In this article, we report robot-assisted bladder diverticulectomy ( RABD) and photoselective vaporization of prostate ( PVP) in the same patient sequentially. To the best of our knowledge, this is the first case report of RABD combined with PVP. Materials and Methods: A 63-year-old patient with benign prostatic hyperplasia and a secondary large bladder diverticulum underwent sequential PVP and RABD. Cystoscopic examination revealed obstructing prostate lobes and a large diverticulum at posterior wall of bladder. After completion of PVP procedure, a 16F urethral catheter was inserted into the diverticulum via outer sheath of optic urethrotome and another 16F urethral catheter was left in bladder for urinary drainage. A transperitoneal approach was preferred. The diverticulum was distended with saline infusion via the Foley catheter inside the diverticulum. The distended diverticulum was seen easily and dissected from the surrounding tissue. The bladder was closed in two separate layers. Results: Total operative time, including diverticulectomy with PVP procedure, was 230 minutes, and console time was 90 minutes. The length of stay was 7 days. Conclusions: There has been always concern about the high intravesical pressures secondary to irrigant instillation that may disrupt the bladder repair. To avoid this problem we combined robotic diverticulectomy with PVP. Because of hemostatic properties of potassium-titanyl-phosphate laser, we did not encounter with bleeding after prostatectomy procedure. Moreover, we did not use irrigation, and the suture line of the bladder was kept safe. Therefore, we recommend to use greenlight laser in combined prostate and RABD operations. RABD is a feasible and safe procedure. RABD and PVP can be performed safely in the same patient sequentially

Automazione e sistemi di controllo

Il volume consiste in un'introduzione ai controlli automatici e descrizione dei sistemi di controllo più utilizzati. In particolare vengono descritti i metodi fondamentali di analisi e sintesi dei sistemi dinamici, lineari e stazionari. Successivamente vengono presentati i fondamentali componenti fisici presenti in un sistema di controllo

A NOVEL LOOP KNOT FOR FIXATION OF RUNNING SUTURES DURING ROBOTIC SURGERY

WOS: 000296792201354

Extended laparoscopic iliac lymphadenectomy before radical cystectomy

WOS: 000250759101604