Robotic partial nephrectomy for posterior tumors through a retroperitoneal approach offers decreased length of stay compared with the transperitoneal approach: A propensity-matched analysis

INTRODUCTION: We sought to compare surgical outcomes between transperitoneal and retroperitoneal robotic partial nephrectomy (RPN) for posterior tumors. PATIENTS AND METHODS: Using our multi-institutional RPN database, we reviewed 610 consecutive cases for posterior renal masses treated between 2007 and 2015. Primary outcomes were complications, operative time, length of stay (LOS), surgical margin status, and estimated glomerular filtration rate (eGFR) preservation. Secondary outcomes were estimated blood loss, warm ischemia time (WIT), disease recurrence, and disease-specific mortality. Due to significant differences in treatment year and tumor size between approaches, retroperitoneal cases were matched 1:4 to transperitoneal cases based on propensity scores using the greedy algorithm. Outcomes were compared between approaches using the chi-square and Mann-Whitney U tests. RESULTS: After matching, 296 transperitoneal and 74 retroperitoneal cases were available for analysis, and matched groups were well balanced in terms of treatment year, age, gender, race, American Society of Anesthesiologists physical status classification (ASA) score, body mass index, tumor laterality, tumor size, R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus, anterior/posterior, location relative to polar lines) score, and hilar location. Compared with transperitoneal, the retroperitoneal approach was associated with significantly shorter mean LOS (2.2 vs 2.6 days, p = 0.01), but longer mean WIT (21 vs 19 minutes, p = 0.01). Intraoperative (p = 0.35) and postoperative complications (p = 0.65), operative time (p = 0.93), positive margins (p = 1.0), and latest eGFR preservation (p = 0.25) were not significantly different between approaches. No differences were detected in the other outcomes. CONCLUSIONS: Among high-volume surgeons, transperitoneal and retroperitoneal RPN achieved similar outcomes for posterior renal masses, although with slight differences in LOS and WIT. Retroperitoneal RPN may be an effective option for the treatment of certain small posterior renal masses

The audio notebook : paper and pen interaction with structured speech

Thesis (Ph. D.)--Massachusetts Institute of Technology, Program in Media Arts & Sciences, 1997.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Includes bibliographical references (leaves 143-150).Lisa Joy Stifelman.Ph.D

VoiceNotes--an application for a voice-controlled hand-held computer

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Architecture, 1992.Includes bibliographical references (leaves 123-126).by Lisa Joy Stifelman.M.S

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

Desafios da Participação Popular: O Plano Diretor de Desenvolvimento Urbano de Entre Rios

O presente artigo apresenta os desafios propostos para a adequação do Plano Diretor de Desenvolvimento Urbano de Entre Rio, no Litoral Norte da Bahia, às exigências do Estatuto da Cidade, Lei 10.257-2001, que torna obrigatório o diálogo com a sociedade no processo de construção e gestão do PDDU. O artigo foi estruturado em cindo partes: o Estatuto da Cidade e o PDDU; a realidade sócio-econômica, urbanística, ambiental e cultural do Município; o processo de participação para a proposta de adequação, e a conclusão sobre os novos paradigmas que dizem respeito à democratização do processo de planejamento e gestão urbanos

U-Note: Capture the Class and Access it Everywhere

We present U-Note, an augmented teaching and learning system leveraging the advantages of paper while letting teachers and pupils benefit from the richness that digital media can bring to a lecture. U-Note provides automatic linking between the notes of the pupils' notebooks and various events that occurred during the class (such as opening digital documents, changing slides, writing text on an interactive whiteboard...). Pupils can thus explore their notes in conjunction with the digital documents that were presented by the teacher during the lesson. Additionally, they can also listen to what the teacher was saying when a given note was written. Finally, they can add their own comments and documents to their notebooks to extend their lecture notes. We interviewed teachers and deployed questionnaires to identify both teachers and pupils' habits: most of the teachers use (or would like to use) digital documents in their lectures but have problems in sharing these resources with their pupils. The results of this study also show that paper remains the primary medium used for knowledge keeping, sharing and editing by the pupils. Based on these observations, we designed U-Note, which is built on three modules. U-Teach captures the context of the class: audio recordings, the whiteboard contents, together with the web pages, videos and slideshows displayed during the lesson. U-Study binds pupils' paper notes (taken with an Anoto digital pen) with the data coming from U-Teach and lets pupils access the class materials at home, through their notebooks. U-Move lets pupils browse lecture materials on their smartphone when they are not in front of a computer