Glen Denmer Santok

Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size.

To investigate the effect of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius‐sparing robot‐assisted laparoscopic radical prostatectomy (RS‐RALP).

Stratified analysis of 800 Asian patients after robot-assisted radical prostatectomy with a median 64 months of follow up.

To report the 5‐year oncological outcomes of robot‐assisted radical prostatectomy from the largest series ever reported from Asia.

Simultaneous Retzius-sparing robot-assisted radical prostatectomy and partial nephrectomy

We present a 61-year-old man who was diagnosed with synchronous prostate cancer and suspicious renal cell carcinoma of the right kidney, treated with combined Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and robot-assisted partial nephrectomy (RAPN). The combined approach using RS-RARP and RAPN is technically feasible and safe surgical option for treatment of concomitant prostate cancer and suspicious renal cell carcinoma.

Robot-assisted partial nephrectomy confers excellent long-term outcomes for the treatment of complex cystic renal tumors: Median follow up of 58 months

To analyze long‐term outcomes of robot‐assisted partial nephrectomy for treatment of complex cystic renal tumors.

Prostate-specific antigen 10–20 ng/mL: A predictor of degree of upgrading to ≥8 among patients with biopsy Gleason score 6

Purpose This study aimed to identify the predictors of upgrading and degree of upgrading among patients who have initial Gleason score (GS) 6 treated with robot-assisted radical prostatectomy (RARP). Materials and Methods A retrospective review of the data of 359 men with an initial biopsy GS 6, localized prostate cancer who underwent RARP between July 2005 to June 2010 was performed. They were grouped into group 1 (nonupgrade) and group 2 (upgraded) based on their prostatectomy specimen GS. Logistic regression analysis of studied cases identified significant predictors of upgrading and the degree of upgrading after RARP. Results The mean age and prostate-specific antigen (PSA) was 63±7.5 years, 8.9±8.77 ng/mL, respectively. Median follow-up was 59 months (interquartile range, 47–70 months). On multivariable analysis, age, PSA, PSA density and ≥2 cores positive were predictors of upgrading with (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01–1.06; p=0.003; OR, 1.006; 95% CI, 1.01–1.11; p=0.018; OR, 0.65; 95% CI, 0.43–0.98, p=0.04), respectively. On subanalysis, only PSA level of 10–20 ng/mL is associated with upgrading into GS ≥8. They also had lower biochemical recurrence free survival, cancer specific survival, and overall survival (p≤0.001, p=0.003, and p=0.01, respectively). Conclusions Gleason score 6 patients with PSA (10–20 ng/mL) have an increased risk of upgrading to pathologic GS (≥8), subsequently poorer oncological outcome thus require a stricter follow-up. These patients should be carefully counseled in making an optimal treatment decision.

Proctorship and mentoring: Its backbone and application in robotic surgery.

In pursuit of continuing medical education in robotic surgery, several forms of training have been implemented. This variable application of curriculum has brought acquisition of skills in a heterogeneous and unstandardized fashion from different parts of the world. Recently, efforts have been made to provide cost effective and well-structured curricula with the aim of bridging the gap between formal fellowship training and short courses. Proctorship training has been implicated on some curriculum to provide excellent progression during the learning curve while ensuring patient safety.

Yonsei nomogram: A predictive model of new‐onset chronic kidney disease after on‐clamp partial nephrectomy in patients with T1 renal tumors

To develop a predictive nomogram for chronic kidney disease‐free survival probability in the long term after partial nephrectomy.

Robotic surgery an evolution of future direction

Demands of surgeons and patients have been going hand in hand with minimally invasive surgery. Its known benefits of having less postoperative pain, shorter hospital stay, better cosmesis and reduced morbidity while offering equivalent therapeutic results were considered of interest. Besides modification in laparoscopy, robotic system has also been extensively described in the literature showing that it improves surgical outcomes owing to its inherent advantages. The cost that entails in obtaining robot along with consumables and maintenance are always part of the hurdle against the advantages it offers. Further introduction of new robotic platforms may offer reduction in costs, training, and acquisition of robot in different parts of the world. With the recent technologies at hand, surgical learning, steps, and procedures have been redefined in order to achieve better results. Over the years, enhancement of treatment armamentarium for our patients has been our goal. This only shows how far we have gotten in terms of further enhancing our surgical options. Our goal here is to provide evidence based advancements in robotic surgery technique aimed towards a standardized procedure. Adoption of minimally invasive surgery has been widely embraced by urologist in their field of subspecialty. The first review, “Past, present, and future of laparoscopic renal surgery” by Cwach and Kavoussi [1] provides insight on how technological advancements have brought rapid evolution on our surgical care especially in the field of minimally invasive surgery. It has continuously proven to have better perioperative outcome than open technique. Having equivalent oncologic outcome and superior functional results have pushed urologists towards laparoscopic renal surgery. Aside from natural orifice transluminal endoscopic surgery and laparoendoscopic single-site surgery, future evolution in robotic technology might further decrease the learning curve and enhance its application in renal surgery. Authors have Robotic surgery an evolution of future direction Editorial

Estimated glomerular filtration rate's time to nadir after robot-assisted partial nephrectomy: Predictors and clinical significance on renal functional recovery

To investigate the impact of postoperative time to nadir of estimated glomerular filtration rate on renal functional changes after robot‐assisted partial nephrectomy.

Human and robot: an amity not a discord

Since the use of robot-assisted laparoscopic prostatectomy (RALP) was first reported in 2000, there has been rapid adoption of robotic surgery for men with prostate cancer (PCa). In the USA, more than 85% of prostatectomies are done robotically over open, and although the proportion is lower in the UK and Europe, it is increasing (1). Despite the cost and inherent minimally invasive advantage of the former over the latter this has gone exponential application without a strong evidence of benefit overcoming the costs. Recently, Yaxley et al . (2), has disclosed that the early outcomes of a well conducted prospective randomized trial. This has become a ringing bell, which triggered a lot of discussion about the flaws and strengths of this revelation in the field of urology. This study included of men with localized PCa who were electronically randomized to receive robot assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP). The surgery was performed by a young robotic surgeon with 200-case and an experienced open surgeon with 1,500 cases. The primary endpoints were sexual and urinary function at 6 weeks, 12 weeks, and 24 months and oncological outcome. Their results showed that urinary and sexual function did not significantly differ at 12 weeks (83.80 vs . 82.50; P=0.48 and 35.00 vs . 38.90; P=0.18, respectively). However, RARP took the edge on the surgery time, occurrence of intraoperative adverse event, blood loss and length of hospital days (P vs . 7, P=0.05).