Haidar Abdul-Muhsin

Critical review of ' pentafecta ' outcomes after robot-assisted laparoscopic prostatectomy in high-volume centres

Whats known on the subject? and What does the study add?

The Economic Implications of a Reusable Flexible Digital Ureteroscope: A Cost-Benefit Analysis

Purpose: Questions remain regarding the durability and longevity of flexible ureteroscopes. The objective of this study was to estimate the potential economic benefits of single use, flexible digital ureteroscopes compared to our recent experience with reusable flexible digital ureteroscopes using cost‐benefit analysis. Materials and Methods: Ureteroscopic procedures were prospectively recorded over the 12‐month period of February 2014 to February 2015. All flexible ureteroscopies were performed using Flex XC digital ureteroscopes (Karl Storz Endoscopy‐America, El Segundo, California). Cost assessment was based on the original purchasing cost and repair‐exchange fees divided by the number of cases. An algorithm was created to include per case reprocessing costs and calculate the benefit‐to‐cost ratio. This cost was compared to potential costs of the LithoVue™, a single use digital ureteroscope. Results: In 160 cases a flexible reusable ureteroscope was used. There was damage to 11 ureteroscopes during this time with an average of 12.5 cases to failure. Excluding original purchasing costs, the cost analysis revealed an amortized cost of

Robot-assisted retroperitoneal lymph node dissection in testicular cancer.

848.10 per use. After 99 ureteroscope cases the cost‐benefit analysis favored reusable ureteroscopes compared to disposable ureteroscopes. Conclusions: Digital ureteroscopes are the latest trend in the evolution of endourology. It appears that a disposable ureteroscope may be cost beneficial at centers with a lower case volume per year. However, institutions with a high volume of cases may find reusable ureteroscopes cost beneficial.

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

Robotic surgical techniques are now being applied in the setting of retroperitoneal lymphadenectomy (RPLND) for testicular cancer. While laparoscopic RPLND has not been widely accepted, reports of robot assisted RPLND (RARPLND) are emerging. This manuscript will review the application of RPLND for testicular cancer, evolution of minimally invasive techniques, the controversies, and current status of RARPLND. J. Surg. Oncol. 2015;112:736–740.

Analysis of Benign Prostatic Hyperplasia Patients' Perspective Through a Third Party-administered Survey

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

A New Laser Platform for Holmium Laser Enucleation of the Prostate: Does the Lumenis Pulse 120H Laser Platform Improve Enucleation Efficiency?†

OBJECTIVE To assess patient-reported functional and quality-of-life (QoL) outcomes associated with various surgical treatments for benign prostate hyperplasia (BPH). MATERIALS AND METHODS An independent third-party survey was sent to all patients who underwent any surgical treatment for BPH at our institution from January 2007 through January 2013. Overall satisfaction and urinary and sexual outcomes were evaluated using Sexual Health Inventory for Men (SHIM), International Prostate Symptoms Score (IPSS) for urinary function, and International Continence Society-Short Form (ICSmaleSF) questionnaires. RESULTS Four hundred and seventy-nine respondents (response rate, 55.6%) had undergone holmium laser enucleation of the prostate (HoLEP; n = 214), transurethral resection of the prostate (n = 210), holmium laser ablation of the prostate (n = 21), photoselective vaporization (n = 18), transurethral incision of the prostate (n = 9), and open simple prostatectomy (n = 7). Postoperatively, Sexual Health Inventory for Men scores were not different. However, total IPSS varied significantly among surgical techniques (P < .001). Mean (standard deviation) IPSS was lowest for open simple prostatectomy (4.0 [2.6]), followed by HoLEP (5.8 [5.4]). For individual domains, significant differences were in intermittency (P < .001), weak stream (P = .003), straining (P < .001), and QoL (P = .001). In all these domains, HoLEP had the lowest scores. Regarding International Continence Society-Short Form, we observed a significant difference favoring transurethral resection of the prostate in incontinence (P < .001) and favoring HoLEP in voiding (P = .02) and QoL domains (P = .03). Most patients were satisfied with their surgical intervention, independent of the procedure type. Regret was least in patients who underwent HoLEP (P = .02). CONCLUSION Patients generally expressed satisfaction with various interventions for BPH. However, those who underwent HoLEP had the best outcomes.

Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis

OBJECTIVE To determine whether the recently introduced Lumenis Pulse 120H laser platform, which offers a dual-pedal footswitch and preset energy modes to easily switch among laser settings, facilitates a more efficient process in holmium laser enucleation of the prostate (HoLEP) for surgical treatment of benign prostatic hyperplasia. PATIENTS AND METHODS Patients at a single institution who underwent HoLEP with the new Lumenis Pulse 120H laser platform were matched 1:2 with patients who underwent the procedure with the previously used 100-watt VersaPulse single-pedal laser platform. Matching was performed by using propensity scores calculated by a logistic model that considered preoperative transrectal ultrasound prostate volume and patient age. The primary outcome was enucleation efficiency of each platform, determined by the weight of prostate tissue resected and enucleation time. The McNemar test and a conditional logistic model were used to associate predictors and cases. RESULTS Twenty-nine patients who underwent HoLEP with the Lumenis Pulse 120H platform were matched with 58 patients who underwent the procedure with the 100-watt platform. We observed statistically significant differences in operating room total time, procedure time, and enucleation time. Other perioperative and postoperative outcomes were comparable between the 2 groups. Enucleation efficiency was similar between the 2 laser platforms (0.89 g per minute in the control group vs 0.84 g per minute in the Lumenis Pulse 120H group). CONCLUSION The efficiency of the new Lumenis Pulse 120H laser platform is comparable to the 100-watt VersaPulse laser platform in HoLEP when comparing g of tissue enucleated per minute.

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

Vesico-urethral anastomosis (VUA) is a technically challenging step in robotic-assisted laparoscopic prostatectomy (RALP) in obese individuals. We describe technical modifications to facilitate VUA encountered in obese individuals and in patients with a narrow pelvis. A Pubmed literature search was performed between 2000 and 2012 to review all articles related to RALP, obesity and VUA for evaluation of technique, complications and outcomes of VUA in obese individuals. In addition to the technical modifications described in the literature, we describe our own experience to encounter the technical challenges induced by obesity and narrow pelvis. In obese patients, technical modifications like use of air seal trocar technology, steep Trendlenburg positioning, bariatric trocars, alterations in trocar placement, barbed suture and use of modified posterior reconstruction facilitate VUA in robotic-assisted radical prostatectomy. The dexterity of the robot and the technical modifications help to perform the VUA in challenging patients with lesser difficulty. The experience of the surgeon is a critical factor in outcomes in these technically challenging patients, and obese individuals are best avoided during the initial phase of the learning curve.

Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting

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

Safety of Live Robotic Surgery: Results from a Single Institution

Purpose: Holmium laser enucleation of the prostate can also be applied in the re‐treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re‐treatment setting. Materials and Methods: We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re‐treatment and primary holmium laser enucleation of the prostate. Results: Of the 360 of 2,242 men (16%) who underwent re‐treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re‐treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re‐treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re‐treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7% vs 1.8%, p = 0.01) and urethral stricture (3.3% vs 1.5%, p = 0.043) was slightly higher in the re‐treatment group. Conclusions: Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re‐treatment setting were no different from those in the primary setting. While re‐treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.