Camilo Giedelman

Prostate histoscanning in clinically localized biopsy proven prostate cancer: an accuracy study.

PURPOSE To assess the accuracy of prostate histoscanning (PHS) for spatial detection and localization of prostate cancer (PCa). PATIENTS AND METHODS Prospective, single center study from January to September 2012 was conducted. Inclusion criterion was biopsy confirmed PCa in patients scheduled for radical prostatectomy. In total, 98 patients were included in the study. Results of PHS were compared against whole-mount step sectioning by the Stanford technique. A lower limit of 0.1 cm(3) was used for PHS. A dedicated 12-sector form was used for spatial correlation. The urologist and pathologist were blinded for each others results. Sensitivity, specificity, and receiver operating characteristic curves were calculated with a logistic regression model for covariates. RESULTS PHS performance for detection of PCa lesions ≥0.1 cm(3) had sensitivity of 60%, specificity of 66%, and area under the curve (AUC) of 0.63. Posterior and anterior sectors achieved sensitivity of 77%, specificity of 39%, and 28% and 84%, respectively. The model containing PHS positivity within a given sector reached sensitivity of 73.4%, specificity of 65.7%, and AUC of 0.75. In a ogistic regression model, the performance of PHS was affected by sector location, rectal distance, index, and total cancer volume (all P<0.0001) and bladder fullness (P=0.02). The best PHS accuracy was present in midposterior sectors. CONCLUSIONS PHS has a potential for clinical practice, especially if PHS positivity within given sectors is taken into account. A trained operator is important. More studies are necessary to test different detection limits in various clinical settings, such as targeted biopsies and image guided focal therapy.

Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery

BACKGROUND The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video. OBJECTIVE We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care. DESIGN, SETTING, AND PARTICIPANTS Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015. SURGICAL PROCEDURE Surgical footage was available for a variety of complications during RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined. RESULTS AND LIMITATIONS As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable. CONCLUSIONS Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve. PATIENT SUMMARY Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.

Perioperative and early oncological outcomes after robot-assisted radical prostatectomy (RARP) in morbidly obese patients: a propensity score-matched study.

To evaluate the perioperative and pathological outcomes associated with robot‐assisted radical prostatectomy (RARP) in morbidly obese men.

Proposal of a method to assess and report the extent of residual neurovascular tissue present in radical prostatectomy specimens

To propose a method to assess and report the amount of neurovascular tissue present in radical prostatectomy (RP) specimens.

Complication of Minimally Invasive Radical Cystectomy

Abstract Introduction and Objectives: Open radical cystectomy (ORC) is the standard treatment for high-grade and muscle invasive bladder cancer, with the significant potential of early complications even in the most experienced hands and in high-volume center. Over the last decade, we have witnessed the emergence and progression of minimally invasive surgery in urology, including radical cystectomy. Any new technique applied to the treatment of invasive bladder cancer should be safe, should maintain similar oncological principles as ORC, and should provide similar options for lower urinary tract reconstruction. While many complications of radical cystectomy are shared between approaches, recognition and management in the robotic and laparoscopic surgery environment poses unique challenges. The goal of this video is to present graphic illustrations of complications during robotic or laparoscopic radical cystectomy (LRC). Methods: A multi-institutional collection of surgical videos was compiled. These video...

Difficulties in Laparoscopic Radical Prostatectomy

Olympus laparoscopic video tower (21-in. monitor, EXERA II image processor with light source) (Olympus Medical Systems, Tokyo, Japan) High-definition laparoscopic EndoEye 30° “chip-on-a-stick” laparoscope (Olympus Medical Systems, Tokyo, Japan)

Urinary Bladder and Prostate

New operating procedures that spare the important neural structures of the urogenital tract have led to improved functional results in terms of bladder function, urinary continence and erectile potency. Well-described examples are nerve-sparing radical prostatectomy [1–3] and cystectomy (continence, potency) [3, 4], ureteric antireflux surgery (bladder function) [5], extended radical hysterectomy with total mesometrial resection (bladder function) [6] and rectal resection (continence, bladder function, potency) [7].

Vesico-Vaginal Fistula Repair: Our Robotic Technique

Abstract Introduction: Vesico-vaginal fistula presents difficulties in urogynecologic surgeries. The incidence is estimated to range between 0.3% and 2% in 90% of cases after abdominal hysterectomy. Some patients do not improve with conservative measures, and it becomes necessary to perform additional surgery. We want to show that robotic repair technique is a minimal invasive alternative to surgical treatments on this pathology. Materials and Methods (including a description of the video): Based on our experience of laparoscopic vesico-vaginal fistula repair, we have had successfully extrapolated the technique to robotic surgeries. Robotic fistula repair was performed in one patient. In this case, cystoscopy-assisted technique was practiced, with fistulous tract catheterization, resection, bladder and vaginal closure in two layers, as well as flap interposition of epiploic appendix. Results: The patient had had previous hysterectomy and transobturator (TOT) placement for suspected urinary incontinence, t...