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Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy:A propensity score matched analysis

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Asian Journal of Urology 2024年第1期11卷 19-25页

作者： Jonathan Noël Daniel Stirt Marcio Covas Moschovas Sunil Reddy Abdel Rahman Jaber Marco Sandri Seetharam Bhat Travis Rogers Subuhee Ahmed Anya Mascarenhas Ela patel vipul patel Advent Health Global Robotics Institute CelebrationFLUSA University of Central Florida College of Medicine OrlandoFLUSA Big and Open Data Innovation Laboratory University of BresciaItaly SUNY Upstate Medical University SyracuseNYUSA Kansas City University College of Medicine Kansas CityMOUSA Harvard University CambridgeMAUSA

Objective:Placement of human placenta derived grafts during robotic-assisted radical prostatectomy(RARP)hastens the return of continence and *** long-term impact on the oncologic outcomes remains to be *** objective was to determine the oncologic outcomes of patients with dehydrated human amnion chorion membrane(dHACM)at RARP compared to a matched ***:In a referral centre,from August 2013 to October 2019,599 patients used dHACM in bilateral nerve-sparing *** excluded patients with less than 12 months follow-up,simple prostatectomy,and unilateral *** with dHACM(amnio group)were 529,and were propensity score matched 1:1 to 2465 patients without dHACM(non-amnio group)and a minimum follow-up of 36 *** the time of RARP,dHACM was placed around the neurovascular bundle in the amnio *** and categorical variables in matched groups was tested by two-sample Kolmogorov-Smirnov test and Fisher's exact test *** measured were biochemical recurrence(BCR),adjuvant and salvage therapy ***:Propensity score matching resulted in two groups of 444 *** incidence functions for BCR did not show a difference between the groups(p=0.3).Patients in the non-amnio group required salvage therapy more frequently than the amnio group,particularly after partial nerve-sparing RARP(6.3%vs.2.3%,p=0.001).Limitations are the absence of prospective ***:The data suggest that using dHACM does not have a negative impact on BCR in *** of cancer specific and overall survival will require follow-up study to increase our understanding of these grafts’impact on prostate cancer biology.

关键词： Prostatectomy Prostatecancer Robotic Oncology Outcome Allograft Biomaterial Dehydrated human amnionchorion membrane

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Totally intracorporeal robot-assisted urinary diversion for bladder cancer(Part 1).Review and detailed characterization of ileal conduit and modified Indiana pouch

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Asian Journal of Urology 2021年第1期8卷 50-62页

作者： Hugo Otaola-Arca Rafael Coelho vipul R.patel Marcelo Orvieto Department of Urology Clı´nica AlemanaSantiagoChile School of Medicine Clı´nica Alemana-Universidad del DesarrolloSantiagoChile Universidade de Sa˜o Paulo Instituto do Caˆncer do Estado de Sa˜o Paulo Brazil Department of Urology AdventHealth Global Robotics InstituteCelebrationFLUnited States

Objective:To review the most used robot-assisted cutaneous urinary diversion(CUD)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images Methods:A non-systematic review of the literature with the keywords“bladder cancer”,“cutaneous urinary diversion”,and“radical cystectomy”was ***:Twenty-four studies of intracorporeal ileal conduit(ICIC)and two of intracorporeal Indiana pouch(ICIP)were included in the *** ICIC,the patients’age ranged from 60 to 76 *** operative time to perform a urinary diversion ranged from 60 to 133 *** total estimated blood loss ranged from 200 to 1117 *** rate of positive surgical margins ranged from 0%to 14.3%.Early minor and major complication rates ranged from 0%to 71.4%and from 0%to 53.4%,*** minor and major complication rates ranged from 0%to 66%and from 0%to 32%,*** ICIP data are limited to one case report and one clinical ***:The most frequent type of CUD is *** studies comparing the performance of the different types of CUD,the performance in an intra-or extracorporeal manner,or the performance of a CUD versus orthotopic ileal neobladder are lacking in the *** this day,there are not enough quality data to determine the supremacy of one *** manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images for each technique.

关键词： Bladder cancer Ileal conduit Indiana pouch Intracorporeal urinary diversion Robot-assisted radical cystectomy Surgical technique

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Overall rate, location, and predictive factors for positive surgical margins after robot-assisted laparoscopic radical prostatectomy for high-risk prostate cancer

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Asian Journal of Andrology 2016年第1期18卷 123-128页

作者： Sung Gu Kang Oscar Schatloff Abdul Muhsin Haidar Srinivas Samavedi Kenneth J Palmer Jun Cheon vipul R patel Department of Urology Korea University School of Medicine Seoul Korea From the Global Robotics Institute Florida Hospital Celebration Health Celebration and University of Central Florida School of Medicine Orlando Florida USA.

We report the overall rate, locations and predictive factors of positive surgical margins （PSMs） in 271 patients with high-risk prostate cancer. Between April 2008 and October 2011, we prospectively collected data from patients classified as D＇Amico high-risk who underwent robot-assisted laparoscopic radical prostatectomy. Overall rate and location of PSMs were reported. Stepwise logistic regression models were fitted to assess predictive factors of PSM. The overall rate of PSMs was 25.1% （68 of 271 patients）. Of these PSM, 38.2% （26 of 68） were posterolateral （PL）, 26.5% （18 of 68） multifocal, 16.2% （11 of 68） in the apex, 14.7% （10 of 68） in the bladder neck, and 4.4% （3/68） in other locations. The PSM rate of patients with pathological stage pT2 was 8.6% （12 of 140）, 26.6% （17 of 64） of pT3a, 53.3% （32/60） of pT3b, and 100% （7 of 7） of pT4. In a logistic regression model including pre-, intra-, and post-operative parameters, body mass index （odds ratio [OR]. 1.09; 95% confidence interval [CI]： 1.01-1.19, P = 0.029）, pathological stage （pT3b or higher vs pT2; OR： 5.14; 95% Ch 1.92-13.78; P = 0.001） and percentage of the tumor （OR： 46.71; 95% CI： 6.37-342.57; P 〈 0.001） were independent predictive factors for PSMs. The most common location of PSMs in patients at high-risk was the PL aspect, which reflects the reported tumor aggressiveness. The only significant predictive factors of PSMs were pathological outcomes, such as percentage of the tumor in the specimen and pathological stage.

关键词： prostate prostatectomy prostatic neoplasm residual robotics

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The robot-assisted ureteral reconstruction in adult:A narrative review on the surgical techniques and contemporary outcomes

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Asian Journal of Urology 2021年第1期8卷 38-49页

作者： Kulthe Ramesh Seetharam Bhat Marcio Covas Moschovas vipul R.patel Young Hwii Ko Department of Urology AdventHealth Global Robotics InstituteCelebrationFLUnited States Department of Urology Yeungnam UniversityDaeguRepublic of Korea

Despite the rapid increase in the use of robotic surgery in urology,the majority of ureteric reconstruction procedures are still performed using laparoscopic or open *** is primarily due to uncertainty regarding the advantages of robotic approaches over conventional ones,and the unique difficulty in identifying the specific area of interest due to the lack of tactile feedback from the current robotic ***,with the potential benefits of minimal invasiveness,several pioneering reports have been published on robotic surgery in *** reviewing the literature on this topic,we aimed to summarize the techniques,considerations,and consistent findings regarding robotic ureteral reconstruction in *** applications for ureteral surgery have been primarily reported for pediatric urology,especially in the context of relieving a congenital obstruction in the ureteral pelvic ***,contemporary studies have also consistently demonstrated that robotic surgery could be a reliable option for malignant,iatrogenic,and traumatic conditions,which generally occur in adult ***,the lack of comparative studies on heterogeneous hosts and disease conditions make it difficult to determine the benefit of the robotic approach over the conventional approach in the general population;thus,qualified prospective trials are needed for wider ***,contemporary reports have demonstrated that the robotic approach could be an alternative option for ureteral construction,even in the absence of haptic feedback,which can be compensated by various surgical techniques and enhanced three-dimensional visualization.

关键词： Robotic reconstructive surgery Ureteric reconstruction Surgical techniques Robotic pyeloplasty

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Robtic-assisted radical cystectomy:Literature review

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Asian Journal of Urology 2021年第1期8卷 14-19页

作者： Marcio Covas Moschovas Kulthe Ramesh Seetharam Bhat Cathy Jenson vipul R.patel Gabriel Ogaya-Pinies Department of Urology AdventHealth Global Robotics InstituteCelebrationFLUnited States Department of Urology Hospital Rey Juan CarlosMadridSpain Lyx Instituto de Urologia MadridSpain

Radical cystectomy(RC)with pelvic lymph node dissection(PLND)is the standard treatment for localized muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC)with recurrence or high risk of ***,the robotic approach to this type of surgery is well established in the *** objective is to summarize in this manuscript the most relevant articles related to the robotic-assisted radical cystectomy for prostate *** performed a literature review of articles describing the robotic approach to RC in patients with bladder ***,we described the procedure since the patient selection until the bladder *** reconstructive techniques were not included in this ***-five articles were used to divide our manuscript into key points such as preoperative patient selection and protocols,surgical technique,pathology report,oncological outcomes,complication rates,and quality of life after the ***-assisted radical cystectomy is feasible and safe with satisfactory oncological *** robotic approach is related to lower blood loss and fewer transfusion ***,when compared to open surgery,the use of this technology increases the operative time.

关键词： Bladder cancer Radical cystectomy Robotic-assisted radical cystectomy

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The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy： experience of a single surgeon with 500 cases in Taiwan, China

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Asian Journal of Andrology 2014年第5期16卷 728-734,I0009页

作者： Yen-Chuan OU Chun-Kuang Yang Kuangh-Si Chang John Wang Siu-Wan Hung Min-Che Tung Ashutosh K Tewari vipul R patel Division of Urology Department of Surgery Taichung Veterans General Hospital Taichung Taiwan China School of Medicine National Yang-Ming University Taipei Taiwan China Department of Research Taichung Veterans General Hospital Taichung Taiwan China Department of Pathology Taichung Veterans General Hospital Taichung Taiwan China Department of Radiation Taichung Veterans General Hospital Taichung Taiwan China Division of Urology Department of Surgery Tungs' Taichung MetroHarbor Hospita Taichung Taiwan China New York Presbyterian Hospital Weill Cornell Medical College New York NY USA Global Robotics Institute Florida Hospital Orlando Florida USA

To analyze the learning curve for cancer control from an initial 250 cases （Group I） and subsequent 250 cases （Group II） of robotic-assisted laparoscopic radical prostatectomy （RALP） performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups, Positive surgical margin （PSM） and biochemical recurrence （BCR） were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I （22.2% vs 14.2%, respectively, with Gleason score 8-10, P = 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P = 0.017）. The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group Ih A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle （NVB） preservation was significantly influenced by the PSM in high-risk patients （84.1% in the preservation group vs 43.9% in the nonpreservation group）. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.

关键词： cancer control learning curve prostate cancer prostatectomy robotics surgical margin

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Robot-assisted endoscopic inguinal lymphadenectomy:A review of current outcomes

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Asian Journal of Urology 2021年第1期8卷 20-26页

作者： Gilberto Jose´Rodrigues Giuliano Betoni Guglielmetti Marcelo Orvieto Kulthe Ramesh Seetharam Bhat vipul R.patel Rafael Ferreira Coelho Sao Paulo State Cancer Institute University of Sao Paulo School of MedicineSao PauloBrazil Clı´nica Alemana SantiagoChile Department of Urology AdventHealth Global Robotics InstituteCelebrationFLUnited States

Objective:To review the role of robot-assisted endoscopic inguinal lymphadenectomy(RAIL)in the management of penile ***:A PubMed search for all relevant publications regarding RAIL series up until August 2019 was performed using the keyword“robotic”,“inguinal lymph node dissection”,and“penile cancer”.Weighted mean was calculated in the largest series for all outcomes using the number of patients included in each study as the weighting ***:We identified 23 articles,of note the three largest series that included 102,27,and 20 RAIL in 51,14,and 10 patients,*** vein was spared in 88.93%of RAIL cases in these series and node yield was 11.42 per groin;35.28%of patients had positive pathological *** weighted mean of operative time was 87.98 min per RAIL and the estimated blood loss was 37.08 mL per *** mean length of hospital stay was 1.29 days and the drain was kept in place for 17.02 days;the major complication rate was only 5.31%in these *** mean follow-up was 33.46 months with a recurrence-free survival of 96.33%.Conclusion:The literature regarding RAIL describes promising results,although it has shorter follow-up and higher costs when compared to historically series from the open *** series reported lower cutaneous complications compared to conventional approach,without compromising oncological ***,long-term results and larger trials are crucial to validate those findings.

关键词： Penile tumor Minimally invasive surgery Robotic-assisted inguinal lymphadenectomy

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Robotic surgery techniques to approach benign prostatic hyperplasia disease:A comprehensive literature review and the state of art

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Asian Journal of Urology 2021年第1期8卷 81-88页

作者： Marcio Covas Moschovas Frederico Timo´teo Leonardo Lins Ose´as de Castro Neves Kulthe Ramesh Seetharam Bhat vipul R.patel Department of Robotic Surgery AdventHealth Global Robotics InstituteFLUSA Faculdade de Medicina do ABC Sa˜o PauloBrazil

Objective:The robotic-assisted approach to simple prostatectomy(RASP)was conceived,essentially reproducing the fundaments of open simple *** the first report,RASP underwent several technical *** study aims to identify and describe the current robotic surgery techniques to approach benign prostatic hyperplasia(BPH).Methods:The paper performed a non-systematic literature review accessing PubMed and Embase databases for all full-text articles published from 2008 to May 2020,assessing robot-assisted surgical techniques for BPH treatment using the terms“robot-assisted simple prostatectomy”OR“robotic simple prostatectomy”OR“RASP”AND“surgical technique”.Results:After careful review of 180 studies in PubMed and 198 in Embase,16 papers reporting different RASP *** the first procedure described by Sotelo et al.[9],several authors contributed to the development of the RASP *** et al.[24]proposed the extraperitoneal access,and Yuh et al.[23]first reported the adenoma transcapsular *** modifications were proposed by Coelho et al.[31]on trigonization,posterior reconstruction,and urethro-vesical *** groups focused on urethral-preserving *** et al.[28]and Clavijo et al.[32]recently described an intrafascial RASP with the removal of the entire prostatic ***,Kaouk et al.[29]reported the feasibility and safety of the da Vinci Single Port ***:In the last eighteen years,the robotic-assisted approach to BPH disease has been evolved,and different techniques have been *** review details all the technical developments on RASP that distinctive groups have proposed since the multiport robotic platforms until the new da Vinci Single Port.

关键词： Simple prostatectomy Benign prostatic hyperplasia Robotic-assisted Minimally invasive

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Robotic renal and adrenal oncologic surgery:A contemporary review

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Asian Journal of Urology 2021年第1期8卷 89-99页

作者： Kulthe Ramesh Seetharam Bhat Marcio Covas Moschovas Fikret Fatih Onol Travis Rogers Shannon Roof vipul R.patel Oscar Schatloff Global Robotics Institute AdventHealth Celebration HealthCelebrationFLUSA Sudmedica Health Chile

Robot-assisted surgery has evolved over *** nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I,II and III thrombus in high volume *** it is feasible for level IV thrombus,this procedure needs a multi-departmental ***,the safety of robot-assisted procedures in this subset is still ***-assisted partial nephrectomy has been universally approved and found oncologically *** adrenalectomy has been increasingly utilized for select cases,especially in bilateral tumors and for retroperitoneal adrenalectomy.

关键词： Inferior vena cava thrombectomy Robotic nephrectomy Partial nephrectomy Adrenalectomy

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Operative Atlas of Laparoscopic Reconstructive Urology 2009

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2009年

作者： Manickam Ramalingam vipul R. patel

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