Background: The majority of institutions follow a protocol whereby urgent add-on cases are scheduled into a designated operating room. An alternative method is the bump model, whereby urgent cases displace previously scheduled cases in a fully booked operating suite without a designated acute care room. Institutions may refrain from employing the latter model due to increased tardiness for bumped cases. Here, we propose a modification to the traditional bump policy termed first-in, first-out (FIFO) bump policy, whereby bumped cases from multiple operating rooms are queued and released sequentially in accordance with their originally scheduled start time. The operational team at the University of Vermont Medical Center implemented this policy in a subset of eligible operating rooms during a challenging day. In this paper, we analyze the differences in operating room tardiness between the traditional bump policy and the FIFO bump policy implemented on this day at our institution. Materials and methods: We extracted the scheduled and actual start times of all operating room cases provided by the Department of Anesthesiology for January 18, 2019 using WiseOR (R) (Palo Alto, CA). Microsoft Excel (Redmond, WA) was used for data entry. We looked at operating room tardiness for the cases on that day, which followed first-in, first-out policy. We also simulated two other potential scenarios, which followed the traditional bump policy, and calculated their total tardiness. Results: The total tardiness for FIFO policy, tradition bump scenario 1, and traditional bump scenario 2 were 1188 min, 1256 min, and 1417 min respectively. In the FIFO scenario, total tardiness was lower compared to the projected traditional bump policy scenarios. Conclusions: This case study demonstrates that the FIFO scenario resulted in a lower amount of total tardiness compared with bumping one surgeon or service for the entire day. Although the FIFO scenario resulted in case delays for two different surgeons, the overall tardiness was lower than having a single surgeon bumped for the entire day, as would be in the case of the traditional bump scenario. This paper provides the theoretical framework for future large-scale studies and potential implementation of FIFO policy.

In the last several decades, with the advent of the Internet and globalization, the world has seen unprecedented information dissemination and exchange. Accompanying this explosion of information has been an unquestionable and previously unparalleled increase in the development and propagation of technology and techniques in medicine and, in particular, in minimally invasive surgery. Urology has long remained at the forefront of the development and implementation of such technologies. Its involvement in the improvement and distribution of these techniques worldwide is not surprising. Urology has long been a discipline with a dependence on innovative technology to minimize the invasive nature of our procedures. The nature of the urinary tract within the human body seems to spur innovation and has allowed urologists to keep at the leading edge of minimally invasive technological revolutions. In their simplest forms, single-site surgery and even NOTES procedures have been used by urologists for decades with the use of percutaneous nephrolithotomy via a single small incision and a multitude of transurethral endoscopic procedures. The application of similar principles to surgeries traditionally performed via open, or more recently laparoscopic and robotic-assisted, approaches is simply a natural extension of the urologist’s current armamentarium to continue on his or her quest to minimize access-related trauma and improve outcomes.

An excluded calyx is a rare, acquired urologic condition where there is discontinuity between a portion of the renal collecting system with the remainder of the collecting system. Re-establishment of reliable long-term communication between the excluded calyx and the remaining collecting system is crucial for preservation of renal function and possible relief of symptoms. In this manuscript, we discuss two such cases where a previously undescribed novel procedure is used for treatment of this uncommon condition, where percutaneous antegrade transcatheter techniques were used to establish long-term urinary drainage. The first case discusses an excluded calyx in a 17-year-old male who suffered left renal injury after a high speed motor vehicle accident, where the kidney was divided by the injury and subsequently required creation of a neoinfundibulum in order to maintain continuity of the collecting system. The second case involves a 39-year-old female who underwent resection of a renal cell carcinoma, later developing an excluded calyx where radiofrequency wire recanalization was performed and the neoinfundibular track underwent serial retrograde balloon dilation, resulting in a continuous collecting system. Both patients have done well for more than 2 years after neoinfundibulum creation, showing that this novel technique should be considered a viable and safe procedure in the treatment of this rare condition.

Benefits of early diagnosis and treatment remain debatable for men with low-risk prostate cancer. Active surveillance (AS) is an alternative to treatment. The goal of AS is to identify patients whose cancer is progressing rapidly while avoiding treatment in the majority of patients. The purpose of this study was to explore cognitive and affective representations of AS within a clinical environment that promotes AS a viable option for men with low-risk prostate cancer. Participants included patients for whom AS and active treatment were equally viable options, as well as practitioners who were involved in consultations for prostate cancer. Data were generated from semistructured interviews and audits of consultation notes and were analyzed using thematic analysis. Nineteen patients and 16 practitioners completed a semistructured interview. Patients generally viewed AS as a temporary strategy that was largely equated with inaction. There was variation in the degree to which inaction was viewed as warranted or favorable. Patient perceptions of AS were generally malleable and able to be influenced by information from trusted sources. Encouraging slow deliberation and multiple consultations may facilitate greater understanding and acceptance of AS as a viable treatment option for low-risk prostate cancer.

INTRODUCTION:To analyze the most recent temporal trends in the adoption of urologic laparoendoscopic single-site (LESS), to identify the perceived limitations associated with its decline, and to determine factors that might revive the role of LESS in the field of minimally invasive urologic surgery.MATERIALS AND METHODS:A 15 question survey was created and sent to members of the Endourological Society in September 2016. Only members who performed LESS procedures in practice were asked to respond.RESULTS:In total, 106 urologists responded to the survey. Most of the respondents were from the United States (35%) and worked in an academic hospital (84.9%). Standard LESS was the most popular approach (78.1%), while 14.3% used robotics, and 7.6% used both. 2009 marked the most popular year to perform the initial (27.6%) and the majority (20%) of LESS procedures. The most common LESS procedure was a radical/simple nephrectomy (51%) followed by pyeloplasty (17.3%). In the past 12 months, 60% of respondents had performed no LESS procedures. Compared to conventional laparoscopy, respondents only believed cosmesis to be better, however, this enthusiasm waned over time. Worsening shifts in enthusiasm for LESS also occurred with patient desire, marketability, cost, safety, and robotic adaptability. The highest rated factor to help LESS regain popularity was a new robotic platform.CONCLUSION:The decline of LESS is apparent, with few urologists continuing to perform procedures attributed to multiple factors. The availability of a purpose-built robotic platform and better instrumentation might translate into a renewed future interest of LESS.

BACKGROUND:Active surveillance is a management strategy for men diagnosed with early-stage, low-risk prostate cancer in which their cancer is monitored and treatment is delayed. This study investigated the primary coping mechanisms for men following the active surveillance treatment plan, with a specific focus on how these men interact with their social network as they negotiate the stress and uncertainty of their diagnosis and treatment approach.METHODS:Thematic analysis of semi-structured interviews at two academic institutions located in the northeastern US. Participants include 15 men diagnosed with low-risk prostate cancer following active surveillance.RESULTS:The decision to follow active surveillance reflects the desire to avoid potentially life-altering side effects associated with active treatment options. Men on active surveillance cope with their prostate cancer diagnosis by both maintaining a sense of control over their daily lives, as well as relying on the support provided them by their social networks and the medical community. Social networks support men on active surveillance by encouraging lifestyle changes and serving as a resource to discuss and ease cancer-related stress.CONCLUSIONS:Support systems for men with low-risk prostate cancer do not always interface directly with the medical community. Spousal and social support play important roles in helping men understand and accept their prostate cancer diagnosis and chosen care plan. It may be beneficial to highlight the role of social support in interventions targeting the psychosocial health of men on active surveillance.

You have accessJournal of UrologyStone Disease: Evaluation II1 Apr 2014PD32-09 MULTICENTER VALIDATION OF S.T.O.N.E. NEPHROLITHOMETRY Zhamshid Okhunov, Daniel Moreira, Arvin George, Arash Akhavein, Sammy Elsamra, Brian Duty, Hector Motato, Michael Del Junco, Fotima Askarova, Michael Rothberg, Mantu Gupta, Chad Tracy, Kevan Sternberg, Brian Irwin, Benjamin King, Edan Shapiro, Jorge Moreno, Arun Srinivasan, Sero Andonian, Vincent Bird, Arthur Smith, Jaime Landman, and Zeph Okeke Zhamshid OkhunovZhamshid Okhunov More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , Arvin GeorgeArvin George More articles by this author , Arash AkhaveinArash Akhavein More articles by this author , Sammy ElsamraSammy Elsamra More articles by this author , Brian DutyBrian Duty More articles by this author , Hector MotatoHector Motato More articles by this author , Michael Del JuncoMichael Del Junco More articles by this author , Fotima AskarovaFotima Askarova More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Mantu GuptaMantu Gupta More articles by this author , Chad TracyChad Tracy More articles by this author , Kevan SternbergKevan Sternberg More articles by this author , Brian IrwinBrian Irwin More articles by this author , Benjamin KingBenjamin King More articles by this author , Edan ShapiroEdan Shapiro More articles by this author , Jorge MorenoJorge Moreno More articles by this author , Arun SrinivasanArun Srinivasan More articles by this author , Sero AndonianSero Andonian More articles by this author , Vincent BirdVincent Bird More articles by this author , Arthur SmithArthur Smith More articles by this author , Jaime LandmanJaime Landman More articles by this author , and Zeph OkekeZeph Okeke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2280AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The STONE nephrolithometry was previously developed as a stone complexity scoring system and prospectively validated in a single center percutaneous nephrolithotomy (PCNL) cohort. We sought to validate the nephrolithometry score in a multicenter database of patients undergoing PCNL. METHODS We performed a multicenter retrospective study of patients undergoing PCNL. Preoperative CT images were reviewed and STONE score was assigned to each patient. The association of STONE score with patient demographics, stone characteristics and surgical outcomes was performed. RESULTS Of the 850 patients who underwent PCNL in 8 institutions between 2009 and 2012, 706 had complete data and were included in the analysis. The mean overall nephrolithometry score was 8.2 (SD=2.2). Overall stone-free rate after was 67%. STONE score was significantly associated with postoperative stone-free status (P<0.001). Stone-free patients had statistically lower STONE scores than patients with residual stones (mean STONE score=7.7 vs. 9.1, respectively; P<0.001). There were 36 complications including postoperative sepsis and bleeding. STONE score was significantly associated with overall complication rate (P=0.0008), estimated blood loss (P=0.001), operative time (P<0.001), and fluoroscopy time and length of hospital stay(P=0.001, Table 1). CONCLUSIONS In a multicenter study including data from multiple surgeons, STONE nephrolithometry accurately predicted surgical outcomes following PCNL, including stone-free rate and complications. The easy-to-use STONE scoring system obtained from computed tomography imaging may be utilized in preoperative patient counseling, surgical planning, and as standardized measure to evaluate surgical outcomes across different studies and institutions. Table 1: Association of STONE nephrolithometry score and PCNL outcomes. Outcome N OR or Coefficient 95% CI P Stone-free rate 706 OR = 0.72 0.66-0.78 <0.001 Complications 706 OR = 1.16 1.04-1.29 0.008 Transfusion 706 OR = 1.10 0.90-1.33 0.348 Length of stay (days) 706 Coefficient = 4.00 2.59-5.41 <0.001 OR time (min) 706 Coefficient = 9.0 7.3-13.8 <0.001 Estimated blood loss(mL) 706 Coefficient = 10.0 4.2-15.7 <0.001 © 2014FiguresReferencesRelatedDetailsCited byLabadie K, Okhunov Z, Akhavein A, Moreira D, Moreno-Palacios J, del Junco M, Okeke Z, Bird V, Smith A and Landman J (2018) Evaluation and Comparison of Urolithiasis Scoring Systems Used in Percutaneous Kidney Stone SurgeryJournal of Urology, VOL. 193, NO. 1, (154-159), Online publication date: 1-Jan-2015. Volume 191Issue 4SApril 2014Page: e839 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Zhamshid Okhunov More articles by this author Daniel Moreira More articles by this author Arvin George More articles by this author Arash Akhavein More articles by this author Sammy Elsamra More articles by this author Brian Duty More articles by this author Hector Motato More articles by this author Michael Del Junco More articles by this author Fotima Askarova More articles by this author Michael Rothberg More articles by this author Mantu Gupta More articles by this author Chad Tracy More articles by this author Kevan Sternberg More articles by this author Brian Irwin More articles by this author Benjamin King More articles by this author Edan Shapiro More articles by this author Jorge Moreno More articles by this author Arun Srinivasan More articles by this author Sero Andonian More articles by this author Vincent Bird More articles by this author Arthur Smith More articles by this author Jaime Landman More articles by this author Zeph Okeke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTechnology & Instruments: Robotics: Benign & Malignant Disease (I)1 Apr 2013848 ROBOT-ASSISTED PARTIAL NEPHRECTOMY IN 2500+ CONSECUTIVE CASES: A FIVE YEAR MULTI-INSTITUTIONAL EXPERIENCE FROM THE ROBOT-ASSISTED PARTIAL NEPHRECTOMY INTEGRATED DATABASE (RAPID) STUDY GROUP Ravi Munver, Ronney Abaza, Paul Andrews, Ketan Badani, Ari Bergman, Erik Castle, Kai Dallas, Keara Decotiis, Joseph Del Pizzo, Ithaar Derweesh, Scott Eggener, Daniel Eun, R. Sherburne Figenshau, Reza Ghavamian, Shay Golan, Dragan Golijanin, Ashok Hemal, Brian Irwin, Samay Jain, David Johnson, Jean Joseph, Adam Kadlec, Costas Lallas, Benjamin Lee, James L'Esperance, Richard Link, Alexandre Mottrie, Christopher Nelsen, Rafael Nunez, Michael Palese, Gyan Pareek, Amit Patel, Jonathan Peterson, John Phillips, Keng-Siang Png, Marcus Quek, Hani Rashid, Matthew Raynor, Aria Razmaria, Arieh Shalhav, Alex Small, Li-Ming Su, Chandru Sundaram, David Thiel, Edouard Trabulsi, Ramakrishna Venkatesh, Alon Weizer, Michael Woods, Guan Wu, and Jennifer Yates Ravi MunverRavi Munver Hackensack, NJ More articles by this author , Ronney AbazaRonney Abaza Columbus, OH More articles by this author , Paul AndrewsPaul Andrews Scottsdale, AZ More articles by this author , Ketan BadaniKetan Badani New York, NY More articles by this author , Ari BergmanAri Bergman New York, NY More articles by this author , Erik CastleErik Castle Scottsdale, AZ More articles by this author , Kai DallasKai Dallas New York, NY More articles by this author , Keara DecotiisKeara Decotiis Hackensack, NJ More articles by this author , Joseph Del PizzoJoseph Del Pizzo New York, NY More articles by this author , Ithaar DerweeshIthaar Derweesh La Jolla, CA More articles by this author , Scott EggenerScott Eggener Chicago, IL More articles by this author , Daniel EunDaniel Eun Philadelphia, PA More articles by this author , R. Sherburne FigenshauR. Sherburne Figenshau St. Louis, MO More articles by this author , Reza GhavamianReza Ghavamian Bronx, NY More articles by this author , Shay GolanShay Golan Chicago, IL More articles by this author , Dragan GolijaninDragan Golijanin Providence, RI More articles by this author , Ashok HemalAshok Hemal Winston-Salem, NC More articles by this author , Brian IrwinBrian Irwin Burlington, VT More articles by this author , Samay JainSamay Jain Hackensack, NJ More articles by this author , David JohnsonDavid Johnson Chapel Hill, NC More articles by this author , Jean JosephJean Joseph Rochester, NY More articles by this author , Adam KadlecAdam Kadlec Maywood, IL More articles by this author , Costas LallasCostas Lallas Philadelphia, PA More articles by this author , Benjamin LeeBenjamin Lee New Orleans, LA More articles by this author , James L'EsperanceJames L'Esperance San Diego, CA More articles by this author , Richard LinkRichard Link Houston, TX More articles by this author , Alexandre MottrieAlexandre Mottrie Aalst, Belgium More articles by this author , Christopher NelsenChristopher Nelsen Gainesville, FL More articles by this author , Rafael NunezRafael Nunez Scottsdale, AZ More articles by this author , Michael PaleseMichael Palese New York, NY More articles by this author , Gyan PareekGyan Pareek Providence, RI More articles by this author , Amit PatelAmit Patel Chicago, IL More articles by this author , Jonathan PetersonJonathan Peterson Ann Arbor, MI More articles by this author , John PhillipsJohn Phillips Valhalla, NY More articles by this author , Keng-Siang PngKeng-Siang Png Indianapolis, IN More articles by this author , Marcus QuekMarcus Quek Maywood, IL More articles by this author , Hani RashidHani Rashid Rochester, NY More articles by this author , Matthew RaynorMatthew Raynor Chapel Hill, NC More articles by this author , Aria RazmariaAria Razmaria Chicago, IL More articles by this author , Arieh ShalhavArieh Shalhav Chicago, IL More articles by this author , Alex SmallAlex Small New York, NY More articles by this author , Li-Ming SuLi-Ming Su Gainesville, FL More articles by this author , Chandru SundaramChandru Sundaram Indianapolis, IN More articles by this author , David ThielDavid Thiel Jacksonville, FL More articles by this author , Edouard TrabulsiEdouard Trabulsi Philadelphia, PA More articles by this author , Ramakrishna VenkateshRamakrishna Venkatesh Lexington, KY More articles by this author , Alon WeizerAlon Weizer Ann Arbor, MI More articles by this author , Michael WoodsMichael Woods Chapel Hill, NC More articles by this author , Guan WuGuan Wu Rochester, NY More articles by this author , and Jennifer YatesJennifer Yates Hackensack, NJ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.416AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The transition from open to robot-assisted partial nephrectomy (RAPN) has been gaining momentum in recent years. Despite its more established position for prostate cancer surgery, the role for the da Vinci™ Surgical System in laparoscopic renal surgery continues to evolve. Advances in instrumentation and technology has resulted in its increasing application for nephron-sparing surgery. We report on the largest collaborative multi-institutional experience with robot-assisted partial nephrectomy (RAPN) to date, at a total of 27 high volume academic institutions. METHODS A retrospective review of all consecutive robot-assisted partial nephrectomies was performed at 27 institutions between 2007-2012. Of 33 primary surgeons, approximately 80% had received advanced training in minimally invasive/endourology (76%) or urologic oncology (24%) fellowships. The surgeons had a collective experience of more than 3000 pure or hand-assisted laparoscopic partial nephrectomies. Demographic and perioperative data were prospectively collected and analyzed. RESULTS A total of 2507 patients that underwent RAPN were evaluated. The mean patient age was 58.0 years (range 19-89) and included 1490 men (59%) and 1017 women (41%). Procedures were performed for tumors in the left in 1251 patients (49.9%) or right in 1256 patients (51.1%) kidney. The mean operative time was 199.6 min (range 52-447 min) and warm ischemia time was 22.5 min (range 5-77 min). Estimated blood loss was 204 mL (range 5-2800 mL) and the mean hospital stay was 2.6 days (range 1-89 days). The mean tumor size was 2.9 cm (range 0.5-15 cm) and 95.7% of the specimens had negative surgical margins. The mean and median R.E.N.A.L. scores were 6.54 (range 4-12) and 7 (median). The overall postoperative complication rate was 16.0% (n=402) of which 59% were Clavien I and II complications. CONCLUSIONS Robot-assisted laparoscopic partial nephrectomy is gaining popularity among surgeons with various levels of expertise in laparoscopic and robotic surgery. The benefits of robotic-assistance for experienced laparoscopic renal surgeons are beginning to become evident. This 5 year study across several major institutions is a truly unbiased multiinstitutional experience that has generated significant data demonstrating the advantages and limitations of robotic technology. We report on our intermediate experience with RAPN and will continue to report our ongoing evaluation with robot-assisted partial nephrectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e348-e349 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravi Munver Hackensack, NJ More articles by this author Ronney Abaza Columbus, OH More articles by this author Paul Andrews Scottsdale, AZ More articles by this author Ketan Badani New York, NY More articles by this author Ari Bergman New York, NY More articles by this author Erik Castle Scottsdale, AZ More articles by this author Kai Dallas New York, NY More articles by this author Keara Decotiis Hackensack, NJ More articles by this author Joseph Del Pizzo New York, NY More articles by this author Ithaar Derweesh La Jolla, CA More articles by this author Scott Eggener Chicago, IL More articles by this author Daniel Eun Philadelphia, PA More articles by this author R. Sherburne Figenshau St. Louis, MO More articles by this author Reza Ghavamian Bronx, NY More articles by this author Shay Golan Chicago, IL More articles by this author Dragan Golijanin Providence, RI More articles by this author Ashok Hemal Winston-Salem, NC More articles by this author Brian Irwin Burlington, VT More articles by this author Samay Jain Hackensack, NJ More articles by this author David Johnson Chapel Hill, NC More articles by this author Jean Joseph Rochester, NY More articles by this author Adam Kadlec Maywood, IL More articles by this author Costas Lallas Philadelphia, PA More articles by this author Benjamin Lee New Orleans, LA More articles by this author James L'Esperance San Diego, CA More articles by this author Richard Link Houston, TX More articles by this author Alexandre Mottrie Aalst, Belgium More articles by this author Christopher Nelsen Gainesville, FL More articles by this author Rafael Nunez Scottsdale, AZ More articles by this author Michael Palese New York, NY More articles by this author Gyan Pareek Providence, RI More articles by this author Amit Patel Chicago, IL More articles by this author Jonathan Peterson Ann Arbor, MI More articles by this author John Phillips Valhalla, NY More articles by this author Keng-Siang Png Indianapolis, IN More articles by this author Marcus Quek Maywood, IL More articles by this author Hani Rashid Rochester, NY More articles by this author Matthew Raynor Chapel Hill, NC More articles by this author Aria Razmaria Chicago, IL More articles by this author Arieh Shalhav Chicago, IL More articles by this author Alex Small New York, NY More articles by this author Li-Ming Su Gainesville, FL More articles by this author Chandru Sundaram Indianapolis, IN More articles by this author David Thiel Jacksonville, FL More articles by this author Edouard Trabulsi Philadelphia, PA More articles by this author Ramakrishna Venkatesh Lexington, KY More articles by this author Alon Weizer Ann Arbor, MI More articles by this author Michael Woods Chapel Hill, NC More articles by this author Guan Wu Rochester, NY More articles by this author Jennifer Yates Hackensack, NJ More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized (II)1 Apr 20131317 INCIDENCE AND CRITICAL ANALYSIS OF POSITIVE MARGINS FOLLOWING PARTIAL NEPHRECTOMY: RESULTS FROM THE ROBOT-ASSISTED PARTIAL NEPHRECTOMY INTEGRATED DATABASE (RAPID) STUDY GROUP Ravi Munver, Ronney Abaza, Paul Andrews, Ketan Badani, Ari Bergman, Erik Castle, Kai Dallas, Keara Decotiis, Joseph Del Pizzo, Ithaar Derweesh, Scott Eggener, Daniel Eun, R. Sherburne Figenshau, Reza Ghavamian, Shay Golan, Dragan Golijanin, Ashok Hemal, Brian Irwin, Samay Jain, David Johnson, Jean Joseph, Adam Kadlec, Costas Lallas, Benjamin Lee, James L'Esperance, Richard Link, Alexandre Mottrie, Christopher Nelsen, Rafael Nunez, Michael Palese, Gyan Pareek, Amit Patel, Jonathan Peterson, John Phillips, Keng-Siang Png, Marcus Quek, Hani Rashid, Matthew Raynor, Aria Razmaria, Arieh Shalhav, Alex Small, Li-Ming Su, Chandru Sundaram, David Thiel, Edouard Trabulsi, Ramakrishna Venkatesh, Alon Weizer, Michael Woods, Guan Wu, and Jennifer Yates Ravi MunverRavi Munver Hackensack, NJ More articles by this author , Ronney AbazaRonney Abaza Columbus, OH More articles by this author , Paul AndrewsPaul Andrews Scottsdale, AZ More articles by this author , Ketan BadaniKetan Badani New York, NY More articles by this author , Ari BergmanAri Bergman New York, NY More articles by this author , Erik CastleErik Castle Scottsdale, AZ More articles by this author , Kai DallasKai Dallas New York, NY More articles by this author , Keara DecotiisKeara Decotiis Hackensack, NJ More articles by this author , Joseph Del PizzoJoseph Del Pizzo New York, NY More articles by this author , Ithaar DerweeshIthaar Derweesh La Jolla, CA More articles by this author , Scott EggenerScott Eggener Chicago, IL More articles by this author , Daniel EunDaniel Eun Philadelphia, PA More articles by this author , R. Sherburne FigenshauR. Sherburne Figenshau St. Louis, MO More articles by this author , Reza GhavamianReza Ghavamian Bronx, NY More articles by this author , Shay GolanShay Golan Chicago, IL More articles by this author , Dragan GolijaninDragan Golijanin Providence, RI More articles by this author , Ashok HemalAshok Hemal Winston-Salem, NC More articles by this author , Brian IrwinBrian Irwin Burlington, VT More articles by this author , Samay JainSamay Jain Hackensack, NJ More articles by this author , David JohnsonDavid Johnson Chapel Hill, NC More articles by this author , Jean JosephJean Joseph Rochester, NY More articles by this author , Adam KadlecAdam Kadlec Maywood, IL More articles by this author , Costas LallasCostas Lallas Philadelphia, PA More articles by this author , Benjamin LeeBenjamin Lee New Orleans, LA More articles by this author , James L'EsperanceJames L'Esperance San Diego, CA More articles by this author , Richard LinkRichard Link Houston, TX More articles by this author , Alexandre MottrieAlexandre Mottrie Aalst, Belgium More articles by this author , Christopher NelsenChristopher Nelsen Gainesville, FL More articles by this author , Rafael NunezRafael Nunez Scottsdale, AZ More articles by this author , Michael PaleseMichael Palese New York, NY More articles by this author , Gyan PareekGyan Pareek Providence, RI More articles by this author , Amit PatelAmit Patel Chicago, IL More articles by this author , Jonathan PetersonJonathan Peterson Ann Arbor, MI More articles by this author , John PhillipsJohn Phillips Valhalla, NY More articles by this author , Keng-Siang PngKeng-Siang Png Indianapolis, IN More articles by this author , Marcus QuekMarcus Quek Maywood, IL More articles by this author , Hani RashidHani Rashid Rochester, NY More articles by this author , Matthew RaynorMatthew Raynor Chapel Hill, NC More articles by this author , Aria RazmariaAria Razmaria Chicago, IL More articles by this author , Arieh ShalhavArieh Shalhav Chicago, IL More articles by this author , Alex SmallAlex Small New York, NY More articles by this author , Li-Ming SuLi-Ming Su Gainesville, FL More articles by this author , Chandru SundaramChandru Sundaram Indianapolis, IN More articles by this author , David ThielDavid Thiel Jacksonville, FL More articles by this author , Edouard TrabulsiEdouard Trabulsi Philadelphia, PA More articles by this author , Ramakrishna VenkateshRamakrishna Venkatesh Lexington, KY More articles by this author , Alon WeizerAlon Weizer Ann Arbor, MI More articles by this author , Michael WoodsMichael Woods Chapel Hill, NC More articles by this author , Guan WuGuan Wu Rochester, NY More articles by this author , and Jennifer YatesJennifer Yates Hackensack, NJ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2671AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Advances in instrumentation is resulting in an increasing interest in robotic nephron-sparing surgery. As robot-assisted partial nephrectomy (RAPN) is gaining popularity, the lack of tactile feedback may be offset by enhanced magnification, 3D visualization, and high definition, which offer the surgeon unparalleled intraoperative visibility. We report on the outcomes of a multi-institutional series of patients undergoing RAPN with respect to pathologic margins. METHODS An IRB-approved collaborative database of prospectively collected data from 27 high volume robotic institutions was reviewed. Patients that underwent RAPN between 2007-2012 with a minimum of 6 month follow-up were included in the study. Demographic and perioperative variables were assessed. RESULTS Results: A total of 2497 consecutive robot-assisted partial nephrectomies met inclusion criteria. 109 (4.3%) final pathology specimens had positive surgical margins. Mean patient age of these patients was 57 years (range 24-86). Procedures were performed on the left (52%)/right (48%) kidney. Mean operative time was 215 min (range 95-328 min) and mean warm ischemia time was 22.6 min (range 0-59 min). Estimated blood loss was 199 mL (range 5-1200 mL). Mean tumor size was 2.9 cm (range 0.7-10.0 cm) and mean/median R.E.N.A.L. nephrometry scores were 6.8 (range 4-11) and 7 respectively. Pathology revealed renal cell carcinoma (n=95) [clear cell (63), papillary (22), chromophobe (10)], AML (n=7), oncocytoma (n=5), and other (n=2). Five (4.5%) of 109 patients with positive margins developed recurrence in the ipsilateral kidney during surveillance. No patients developed metastatic disease. CONCLUSIONS Robot-assisted partial nephrectomy is being performed by surgeons with various levels of expertise in laparoscopic/robotic surgery. In this multi-institutional study of experienced high volume robotic surgeons, the positive margin rate of 4.3% remained relatively constant over the 5 year period. Positive margins did not correlate with patient age, surgeon experience, tumor size, complexity, or laterality. The observed positive margin rate in this series is comparable to the data from large open and laparoscopic partial nephrectomy series. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e538 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravi Munver Hackensack, NJ More articles by this author Ronney Abaza Columbus, OH More articles by this author Paul Andrews Scottsdale, AZ More articles by this author Ketan Badani New York, NY More articles by this author Ari Bergman New York, NY More articles by this author Erik Castle Scottsdale, AZ More articles by this author Kai Dallas New York, NY More articles by this author Keara Decotiis Hackensack, NJ More articles by this author Joseph Del Pizzo New York, NY More articles by this author Ithaar Derweesh La Jolla, CA More articles by this author Scott Eggener Chicago, IL More articles by this author Daniel Eun Philadelphia, PA More articles by this author R. Sherburne Figenshau St. Louis, MO More articles by this author Reza Ghavamian Bronx, NY More articles by this author Shay Golan Chicago, IL More articles by this author Dragan Golijanin Providence, RI More articles by this author Ashok Hemal Winston-Salem, NC More articles by this author Brian Irwin Burlington, VT More articles by this author Samay Jain Hackensack, NJ More articles by this author David Johnson Chapel Hill, NC More articles by this author Jean Joseph Rochester, NY More articles by this author Adam Kadlec Maywood, IL More articles by this author Costas Lallas Philadelphia, PA More articles by this author Benjamin Lee New Orleans, LA More articles by this author James L'Esperance San Diego, CA More articles by this author Richard Link Houston, TX More articles by this author Alexandre Mottrie Aalst, Belgium More articles by this author Christopher Nelsen Gainesville, FL More articles by this author Rafael Nunez Scottsdale, AZ More articles by this author Michael Palese New York, NY More articles by this author Gyan Pareek Providence, RI More articles by this author Amit Patel Chicago, IL More articles by this author Jonathan Peterson Ann Arbor, MI More articles by this author John Phillips Valhalla, NY More articles by this author Keng-Siang Png Indianapolis, IN More articles by this author Marcus Quek Maywood, IL More articles by this author Hani Rashid Rochester, NY More articles by this author Matthew Raynor Chapel Hill, NC More articles by this author Aria Razmaria Chicago, IL More articles by this author Arieh Shalhav Chicago, IL More articles by this author Alex Small New York, NY More articles by this author Li-Ming Su Gainesville, FL More articles by this author Chandru Sundaram Indianapolis, IN More articles by this author David Thiel Jacksonville, FL More articles by this author Edouard Trabulsi Philadelphia, PA More articles by this author Ramakrishna Venkatesh Lexington, KY More articles by this author Alon Weizer Ann Arbor, MI More articles by this author Michael Woods Chapel Hill, NC More articles by this author Guan Wu Rochester, NY More articles by this author Jennifer Yates Hackensack, NJ More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The objective was to give a general overview of common complications and rates reported in the current literature during performance of a variety of urologic procedures using laparo-endoscopic single-site surgery or LESS. A search of published reports using Pubmed and MEDLINE was performed with the following search terms: laparo-endoscopic single-site surgery, LESS or laparo-endoscopic single-site surgery complications within the date range of 2005--2011. Studies that were deemed appropriate and relevant to the current symposium were chosen for review. Overall complication rates were reported as ranging between 10% and 25%. In general, reconstructive procedures had consistently higher rates of complications than their extirpative/ablative counterparts (27% vs. 8%). There remain insufficient data to comment on differences in the rates or types of complications related to variations in the approach (transperitoneal vs. retroperitoneal), site of surgery (upper tract vs. lower tract) or specific technique used (instruments, access devices, robotic platforms, etc.). Complication rates associated with LESS in urology appear only slightly higher than with conventional laparoscopy. However, with proper patient selection and careful application of these techniques, proofs of concept and technical feasibility have been shown in several series. There continues to be a need for more standardization of the technique and reporting as well as more collaborative efforts to fully address questions of safety and efficacy of these new procedures.

To describe the Chinese experience of natural orifice transluminal endoscopic surgery (NOTES) in urology.From December 2008 to May 2017, 35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions (NOSE) were performed in China. The animal experiments included five kidney biopsies, 24 nephrectomies and six partial nephrectomies. The clinical surgeries included 12 transvaginal NOSE (TV-NOSE), 266 hybrid transvaginal NOTES (TV-NOTES) and 27 pure TV-NOTES. The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site (U-LESS) nephrectomies, four suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephroureterectomies, and three laparoscopic radical cystectomies. The hybrid TV-NOTES procedure included 210 nephrectomies, 31 adrenalectomies, eight nephroureterectomies, 13 partial nephrectomies, and four heminephrectomies. The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies.A total of 29 animal experiments were successfully performed. One partial nephrectomy was converted to standard laparoscopic surgery. Two kidney biopsies and two nephrectomies were unsuccessful. A total of 297 clinical surgeries were successfully performed. Six patients who underwent hybrid TV-NOTES were converted to open surgery. Two patients who underwent pure TV-NOTES were converted to SA-LESS. There were 22 major complications, 16 occurred intraoperatively and six postoperatively. The mean visual analog score (VAS) of 48 h after the operation was 2.5 points in TV-NOSE, 2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES. The mean follow-up of 50.6 (3.0–87.0) months showed that all patients were in good condition. The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES. The vaginal incision healed well.TV-NOSE and TV-NOTES are feasible, safe, and effective with little injury, low pain, fast recovery, and good cosmetic outcomes in properly selected patients. They are worth consideration for urological clinical practice.

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2011V501 LAPARO-ENDOSCOPIC SINGLE SITE TRANSVESICAL BLADDER CUFF EXCISION Rene Javier Sotelo, Juan Arriaga, Oswaldo Carmona, Robert De Andrade, Camilo Giedelman, Zehnder Pascal, Brian Irwin, Aron Monish, Mihir Desai, Inderbir Gill, and Jose Saavedra Rene Javier SoteloRene Javier Sotelo Caracas, Venezuela More articles by this author , Juan ArriagaJuan Arriaga Caracas, Venezuela More articles by this author , Oswaldo CarmonaOswaldo Carmona Caracas, Venezuela More articles by this author , Robert De AndradeRobert De Andrade Caracas, Venezuela More articles by this author , Camilo GiedelmanCamilo Giedelman Caracas, Venezuela More articles by this author , Zehnder PascalZehnder Pascal Los Angeles, CA More articles by this author , Brian IrwinBrian Irwin Burlington, VT More articles by this author , Aron MonishAron Monish Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , Inderbir GillInderbir Gill Los Angeles, CA More articles by this author , and Jose SaavedraJose Saavedra Caracas, Venezuela More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.597AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present a novel technique for the management of the bladder cuff during distal ureterectomy under pneumovesicum using a single port device inserted transvesically. BACKGROUND A variety of techniques have been used to manage the distal ureter during minimally invasive nephroureterectomy for benign and malignant diseases. Each technique has distinct advantages and disadvantages that may impact intra-operative and post-operative outcomes. A general concensus has not been established. METHODS We present two cases. The first case demonstrates the technique in a patient with malignant disease in an 80 year old man with a 5cm left renal pelvic tumor. The second case shows the techniques application in a benign disease in a 25 year old woman with history of recurrent urinary tract infections in whom a CT scan showed complete duplication of the left collecting system with upper pole hydroureteronephrosis. RESULTS The first patient underwent left laparoendoscopic single site (LESS) radical nephroureterectomy with retroperitoneal lymph node dissection and bladder cuff excision under pneumovesicum for a left renal pelvic transitional cell carcinoma; final histopathology revealed pathologic G3 T3 N0 with 7 negative nodes. The operative time was 375 minutes including 45 minutes for bladder cuff excision, and estimated blood loss was 250cc. Length of stay was one day. No post-operative complications or evidence of recurrence were noted after one year of follow up. The second patient underwent LESS upper pole heminephroureterectomy for treatment of a duplicated left collecting system and upper pole hydronephrosis. Final pathology revealed chronic pyelonephritis. The operative time was 210 minutes including 30 minutes for bladder cuff excision and estimated blood loss was 400cc. The patients length of stay was three days. Postoperatively the patient was found to have lower pole renal vein thrombosis at her first postoperative visit. CONCLUSIONS LESS transvesical bladder cuff excision may offer many advantages including the ability to allow precise marking of the bladder cuff, avoiding potential injury to the contralateral ureteral orifice, and allowing water-tight closure of the bladder. It can be performed trough a small suprapubic skin incision with a small cystotomy pubic incision it can be also then used to assist the laparoscopic dissection. Additional studies are needed to identify the best approach for managing the distal ureter at the time of laparoscopic nephroureterectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e203-e204 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rene Javier Sotelo Caracas, Venezuela More articles by this author Juan Arriaga Caracas, Venezuela More articles by this author Oswaldo Carmona Caracas, Venezuela More articles by this author Robert De Andrade Caracas, Venezuela More articles by this author Camilo Giedelman Caracas, Venezuela More articles by this author Zehnder Pascal Los Angeles, CA More articles by this author Brian Irwin Burlington, VT More articles by this author Aron Monish Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Jose Saavedra Caracas, Venezuela More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

To present a novel technique for management of the bladder cuff during distal ureterectomy under pneumovesicum using a single port device inserted transvesically. A variety of techniques have been used to manage the distal ureter during minimally invasive nephroureterectomy for benign and malignant diseases. Each technique has distinct advantages and disadvantages that may impact intra-operative and postoperative outcomes. A general consensus has not been established.

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Several studies have shown the feasibility of performing both complex and reconstructive laparoendoscopic single site (LESS) surgical procedures in urology. To date, no studies have evaluated the rates of conversion to conventional laparoscopy and complications at the time of LESS procedures in urology. This study, a compilation of results from members of the NOTES working group, is the first study to address the rates of complications and conversions to conventional laparoscopy at the time of LESS surgery in urology. OBJECTIVE • To present complications and rates of conversion from LESS to conventional laparoscopy (CL) at the time of upper tract LESS urologic procedures. PATIENTS AND METHODS • Patients undergoing LESS upper tract procedures between September, 2007 and November, 2008 ( n = 125) were identified at six high‐volume academic centers pioneering urologic LESS procedures. All LESS procedures were performed transperitoneally via a single umbilical incision using either adjacent conventional trocars or a dedicated single‐site access device. Reconstructive procedures incorporating a single planned 2 mm accessory needle port were included as LESS procedures and were not considered conversions. • Patients, undergoing LESS procedures requiring conversion to CL with the placement of additional ports were identified. Conversion was defined as the placement of additional 5 or 10/12 mm ports beyond the primary incision. In each case the operative reports were reviewed, the reason for conversion was determined, and the number and types of additional ports and complications were noted. RESULTS • Upper tract LESS procedures were performed in 125 patients comprising 13.3% of the total 937 laparoscopic procedures performed at the participating institutions during this time period. Conversion to CL was necessary in 7 patients (5.6%) undergoing LESS requiring the addition of 2–5 ports. • Reasons for conversion included: facilitate dissection in 3 (43%), facilitate reconstruction in 3 (43%), and control of bleeding in 1 (14%). All attempted LESS cases were completed laparoscopically without need for open conversion. • Complications occurred in 15.2% of patients undergoing LESS surgery. Three of the 7 patients that required conversion to CL developed postoperative complications (Clavien grade II in two and IIIa in one). • Limitations of this study included the inability to standardize LESS patient selection criteria, instrumentation and surgical technique as well as the lack of available complete data from a CL control group for comparison. CONCLUSION • LESS surgery is technically feasible for a variety of upper urinary tract reconstructive and ablative procedures, although it appears to be associated with higher rates of complications than in mature CL series. Conversion to CL occurs infrequently and may be a reflection of stringent patient selection.

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2010423 RISK OF TRACT RECURRENCE FOLLOWING PERCUTANEOUS RESECTION FOR UPPER TRACT UROTHELIAL CARCINOMA: CLINICAL, PATHOLOGIC AND RADIOLOGIC EVALUATION Brian Irwin, Andre Berger, Ricardo Brandina, Robert Stein, Shetal Shah, Donna Hansel, and Mihir Desai Brian IrwinBrian Irwin Burlington, VT More articles by this author , Andre BergerAndre Berger Los Angeles, CA More articles by this author , Ricardo BrandinaRicardo Brandina Los Angeles, CA More articles by this author , Robert SteinRobert Stein Cleveland, OH More articles by this author , Shetal ShahShetal Shah Cleveland, OH More articles by this author , Donna HanselDonna Hansel Cleveland, OH More articles by this author , and Mihir DesaiMihir Desai Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.493AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Historically, urothelial carcinoma (UC) has been associated with wound and port-site recurrences following open and laparoscopic surgical interventions. The risk of percutaneous (PC)tract seeding after resection is largely unquantified. To date there have been a total of 5 tract recurrences reported in the literature at the site of PC manipulation of the upper tract for UC. We report data on pathologic examination of excised PC tracts in patients undergoing nephroureterectomy (NU) as well as clinical and radiographic evaluation following prior PC intervention. METHODS All charts were reviewed from 421 patients undergoing NU and 40 patients undergoing percutaneous resection for upper tract UC at a single institution since 1987. Four patients who had nephrostomy tubes placed for obstruction or PC resections prior to NU and tract excision were identified. Pathologic examination of the excised tracts was performed looking for evidence of tumor. Radiographic follow-up with CT scan imaging was available in 22 of 40 patients undergoing PC resections. All were reviewed for evidence of tract recurrences. Evidence of clinical tract recurrences and oncologic data was also recorded. RESULTS The nephrostomy tubes in the tract excision group were in place for a median of 6.5 months prior to NU. All patients had grade 3 lesions and ranged in pathologic stage from pT1 to pT3. All excised tracts showed evidence of fibrosis and chronic inflammation with one also showing focal giant cell reaction to foreign material. No evidence of tumor was seen in any of the tract specimens. While no patient showed clinical evidence of tract recurrence, radiographic review revealed two patients who almost certainly had tract seeding with mass formation in the region of the tract. CONCLUSIONS The number of patients who undergo PC resection and subsequent NU with nephrostomy tube site excision is low, even at large volume centers. Although there does not appear to be pathologic evidence of tumor cells within these tracts, we present two cases of tract site recurrence noted on follow-up CT imaging. Given the lack of tumor cells in these tracts, as well as the paucity of reports in the literature, PC resection for upper tract UC appears to be associated with a low, but not insignificant, risk of tract seeding. Table 1. Patient demographics and perioperative data from patients undergoing percutaneous resections for upper tract urothelial carcinoma Patient Demographics Number of patients 40 Age in years (±SD) 69.9(10.8) Male:Female ratio 29:11 Solitary kidney (%) 34(86%) Perioperative Data Complication rate (%) 7% Pre-op creatinine in mg/dl (±SD) 1.67(0.74) Post-op creatinine in mg/dl (±SD) 1.54(0.58) Median follow-up in months (±SD) 36(39.8) Oncologic Data Mean tumor size in cm (±SD) 2.34(1.21) High-grade (%) 25(62%) Invasive (%) 7(17%) Prior nephroureterectomy (%) 22(55%) Multifocal disease 10(25%) History of bladder tumors 17(43%) Associated cis 4(10%) Received BCG via neph tube 17(43%) Tract recurrences 2(5%) 1-year recurrence-free survival 76% 5-year cancer-specific survival 76% 5-year overall survival 57% © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e167 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Irwin Burlington, VT More articles by this author Andre Berger Los Angeles, CA More articles by this author Ricardo Brandina Los Angeles, CA More articles by this author Robert Stein Cleveland, OH More articles by this author Shetal Shah Cleveland, OH More articles by this author Donna Hansel Cleveland, OH More articles by this author Mihir Desai Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...