Robot-assisted laparoscopic prostatectomy : How can we get better?

Peer reviewe

The future of robotic surgery

© 2018 Royal College of Surgeons.For 20 years Intuitive Surgical’s da Vinci® system has held the monopoly in minimally invasive robotic surgery. Restrictive patenting, a well-developed marketing strategy and a high-quality product have protected the company’s leading market share.1 However, owing to the nuances of US patenting law, many of Intuitive Surgical’s earliest patents will be expiring in the next couple of years. With such a shift in backdrop, many of Intuitive Surgical’s competitors (from medical and industrial robotic backgrounds) have initiated robotic programmes – some of which are available for clinical use now. The next section of the review will focus on new and developing robotic systems in the field of minimally invasive surgery (Table 1), single-site surgery (Table 2), natural orifice transluminal endoscopic surgery (NOTES) and non-minimally invasive robotic systems (Table 3).Peer reviewedFinal Published versio

Biomarkers in Bladder Cancer Survellance

© 2021 Sugeeta, Sharma, Ng, Nayak and Vasdev. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). https://doi.org/10.3389/fsurg.2021.735868Aim: This is a narrative review with an aim to summarise and describe urinary biomarkers in the surveillance of non-muscle-invasive bladder cancer (NMIBC). It provides a summary of FDA-approved protein biomarkers along with emerging ones which utilise genetic, epigenetic and exosomal markers. We discuss the current limitations of the available assays. Background: Current guidelines advice a combination of cystoscopy, imaging, and urine cytology in diagnosis and surveillance. Although cytology has a high specificity, it is limited by low sensitivity particularly in low grade tumours. There are six FDA-approved urinary assays for diagnosis and surveillance of bladder cancer. They have shown to improve sensitivity and specificity to be used alongside cytology and cystoscopy but have a lower specificity in comparison to cytology and false positives often occur in benign conditions. Recent developments in laboratory techniques has allowed for use of markers which are RNA-, DNA-based as well as extracellular vesicles in the past decade. Methods: Using the PubMed/Medline search engines as well as Google Scholar, we performed an online search using the terms “bladder cancer,” “non-muscle invasive bladder cancer,” and “urine biomarkers” with filter for articles in English published up to May 2021. Systematic reviews and original data of clinical trials or observational studies which contributed to the development of the biomarkers were collated. Results: Biomarkers identified were divided into FDA-approved molecular biomarkers, protein biomarkers and gene-related biomarker with a table summarising the findings of each marker with the most relevant studies. The studies conducted were mainly retrospective. Due to the early stages of development, only a few prospective studies have been done for more recently developed biomarkers and limited meta-analyses are available. Therefore a detailed evaluation of these markers are still required to decide on their clinical use. Conclusion: Advancements of analytical methods in BC has driven the research towards non-invasive liquid-based biomarkers in adjunct to urine cytology. Further large prospective studies are required to determine its feasibility in a clinical setting as they are not effective when used in isolation as they have their limitation. With the ongoing pandemic, other than reduction in costs and increased accuracy, the need for biomarkers to cope with delay in cystoscopies in diagnosis and surveillance is crucial. Thus clinical trials with direct comparison is required to improve patient care.Peer reviewe

A systematic review of the harmful effects of surgical smoke inhalation on operating room personnel

© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Background Surgical smoke refers to the plume produced by usage of energy-generating surgical equipment on tissues. This review aimed to assess the potential of this smoke to be a serious occupational hazard to theatre staff due to its composition, particularly during the COVID-19 pandemic. Method A search of Ovid MEDLINE, EMBASE, and PubMed databases was undertaken for publications reporting plume composition, presence of infectious material, carcinogenic potential and comparisons between production in laparoscopic versus open surgery. All human in-vivo and ex-vivo primary studies were included, provided English language translation was available. A narrative synthesis was conducted due to the methodologic heterogeneity of the studies. Results 25 studies resulted from the primary search, and an additional 3 from cross-referencing, leading to 28 included studies. Studies addressing particle size found that smoke particles were respirable in size. Viral DNA was present in 3 studies, while 1 study demonstrated the ability for surgical smoke to produce clinically important infection. Chemical composition was explored in 8 studies, revealing the presence of carcinogenic compounds in concentrations above occupational safety limits. Open surgery was found to generally produce less smoke than laparoscopic. Conclusion Surgical smoke contains a myriad of hazardous constituents, such as carcinogenic compounds and infectious materials, however, the extent to which inhalation of these plumes may be harmful remains unknown due to the lack of high-level evidence regarding infectivity and carcinogenicity. Safety measures such as extraction of plumes using local exhaust ventilation, and usage of protective equipment such as N95 masks should be instilled.Peer reviewe

Technical caveats in salvage robot assisted radical prostatectomy

Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Peer reviewe

Has robotic prostatectomy determined the fall of the laparoscopic approach?

© The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).Robotic Assisted Laparoscopic Prostatectomy (RALP) has revolutionised the surgical management of localised Prostate Cancer in the modern era. The surgeon is provided with greater precision, more versatile dexterity and an immersive three-dimensional visual field. The impressive hardware facilitates, for example, the dissection of the peri-prostatic fascia, whilst preserving the neurovascular bundle, or the suturing of the vesico-urethral anastomosis. Prior to RALP, Laparoscopic Radical Prostatectomy (LRP) represented the first venture into the minimally invasive world. Associated with more cumbersome ergonomics, LRP has a significant learning curve when compared with the robotic approach. There has been a paucity, until recently, of high-quality literature comparing outcomes between the two operations, including the attainment of the Pentafecta of survivorship: biochemical recurrence-free, continence, potency, no postoperative complications and negative surgical margins.Peer reviewedFinal Published versio

Preclinical evaluation of the Versius surgical system: A next‐generation surgical robot for use in minimal access prostate surgery

© 2023 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company. This is an open access article under the terms of the Creative Commons Attribution License, https://creativecommons.org/licenses/by/4.0/Objectives: To evaluate the Versius surgical system for robot‐assisted prostatectomy in a preclinical cadaveric model using varying system setups and collect surgeon feedback on the performance of the system and instruments, in line with IDEAL‐D recommendations. Materials and methods: Procedures were performed in cadaveric specimens by consultant urological surgeons to evaluate system performance in completing the surgical steps required for a prostatectomy. Procedures were conducted using either a 3‐arm or 4‐arm bedside unit (BSU) setup. Optimal port placements and BSU layouts were determined and surgeon feedback collected. Procedure success was defined as the satisfactory completion of all steps of the procedure, according to the operating surgeon. Results: All four prostatectomies were successfully completed; two were completed with a 3‐arm BSU setup and two using a 4‐arm BSU setup. Small adjustments were made to the port and BSU positioning, according to surgeon preference, in order to complete the surgical steps. The surgeons noted some instrument difficulties with the Monopolar Curved Scissor tip and the Needle Holders, which were subsequently refined between the first and second sessions of the study, in line with surgeon feedback. Three cystectomies were also successfully completed, demonstrating the capability of the system to perform additional urological procedures. Conclusions: This study provides a preclinical assessment of a next‐generation surgical robot for prostatectomies. All procedures were completed successfully, and port and BSU positions were validated, thus supporting the progression of the system to further clinical development according to the IDEAL‐D framework.Peer reviewe

Guideline of Guidelines: Muscle Invasive Bladder Cancer

© 2020 Turkish Society of Urology. Final publication available at https://dx.doi.org/10.5152/tud.2020.20337.Muscle-invasive bladder cancer accounts for 25% of bladder cancer cases and represents a spectrum of disease, which can result in significant morbidity and mortality for anyone affected. Current management has evolved through years of research and clinical practice. It is based on a risk-benefit approach, which is often tailored to the individual requirements of patients and involves cystectomy, neoadjuvant and adjuvant therapies, and multimodal surveillance paradigms to achieve high survival rates. Multiple guidelines exist to assist the clinicians in this decision-making process, but their adherence is often variable. In this article, we aimed to review the 4 most commonly used guidelines from the European Association of Urology, the National Institute for Health and Care Excellence, the National Comprehensive Cancer Network, and the American Urological Association.Peer reviewe