K. Jacob

Use of Anti-Skid Material and Patient-Positioning To Prevent Patient Shifting during Robotic-Assisted Gynecologic Procedures

STUDY OBJECTIVE To estimate patient shifting with the current practice of use of an antiskid material and patient positioning during robotic procedures in gynecology. DESIGN Pilot observational study (Canadian Task Force classification). SETTING Tertiary referral center. PATIENTS Twenty-two women undergoing robotic-assisted gynecologic procedures. INTERVENTION Antiskid material (egg-crate pink foam) was placed beneath patients and patient positioning was used during robotic-assisted procedures. MEASUREMENTS AND MAIN RESULTS Patient position was marked before and after surgery. Measurements of shift distance before and after surgery were determined for each patient. Median (range) shift distance was 1.3 (0-7.5) cm. There was no significant association between shift in position and either body mass index or duration of the Trendelenburg position. No shoulder neuropathic injuries were observed during the study. CONCLUSION Minimal patient shifting is observed with the use of an antiskid material and patient positioning described, without the use of shoulder braces and straps.

IGFBP ratio confers resistance to IGF targeting and correlates with increased invasion and poor outcome in breast tumors

Purpose: To improve the significance of insulin-like growth factor–binding protein 5 (IGFBP-5) as a prognostic and potentially predictive marker in patients with breast cancer. Experimental Design: Increased IGFBP-5 expression was identified in MCF-7 cells resistant (MCF-7R4) to the IGF-1R/insulin receptor (InsR) inhibitor BMS-536924 and its role examined by targeted knockdown and overexpression in multiple experimental models. Protein expression of IGFBP-5 was measured by immunohistochemistry in a cohort of 76 patients with breast cancer to examine correlative associations with invasive tumor fraction and outcome. The use of a combined IGFBP-5/IGFBP-4 (BPR) expression ratio was applied to predict anti-IGF-1R/InsR response in a panel of breast cancer lines and outcome in multiple breast tumor cohorts. Results: IGFBP-5 knockdown decreased BMS-536924 resistance in MCF-7R4 cells, whereas IGFBP-5 overexpression in MCF-7 cells conferred resistance. When compared with pathologically normal reduction mammoplasty tissue, IGFBP-5 expression levels were upregulated in both invasive and histologically normal adjacent breast cancer tissue. In both univariate and multivariate modeling, metastasis-free survival, recurrence free survival (RFS), and overall survival (OS) were significantly associated with high IGFBP-5 expression. Prognostic power of IGFBP-5 was further increased with the addition of IGFBP-4 where tumors were ranked based upon IGFBP-5/IGFBP-4 expression ratio (BPR). Multiple breast cancer cohorts confirm that BPR (high vs. low) was a strong predictor of RFS and OS. Conclusion: IGFBP-5 expression is a marker of poor outcome in patients with breast cancer. An IGFBP-5/IGFBP-4 expression ratio may serve as a surrogate biomarker of IGF pathway activation and predict sensitivity to anti-IGF-1R targeting. Clin Cancer Res; 18(6); 1808–17. ©2012 AACR.

Robotic transperitoneal infrarenal aortic lymphadenectomy for gynecologic malignancy: a left lateral approach.

OBJECTIVE To describe the technique and report patient outcomes of a left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy with subsequent pelvic surgery in patients with gynecologic malignancy. METHODS Outcome data were collected retrospectively from March 2009 to September 2010 for all patients undergoing a left lateral approach for robotic transperitoneal aortic lymphadenectomy using a right lateral decubitus position by a single surgeon. Outcomes were analyzed and compared. RESULTS The median total operating time was 213 minutes (range, 186-265). The median body mass index was 25.2 kg/m(2) (range, 22.5-32.1). The median estimated blood loss was 150 mL (range, 50-550). The median length of hospital stay was 1 day (range, 1-2). The mean number of para-aortic lymph nodes was 8.2 (range 4-17). There were no conversions or perioperative complications in this 5-patient series. The mean follow-up was 12.8 months (range, 8-20). All patients underwent concomitant robotic hysterectomy and pelvic lymphadenectomy. CONCLUSIONS A left lateral approach for robotic transperitoneal infrarenal aortic lymphadenectomy using a right lateral decubitus position is safe and feasible. Minimal patient repositioning provides access for pelvic surgery using the same abdominal trocar placement.

The effect of rectal distension on bladder function in patients with overactive bladder.

To investigate the effect of rectal distension on bladder sensation volumes and the number of detrusor contractions in patients with overactive bladder (OAB) symptoms.

Robotic presacral neurectomy - technique and results

The feasibility, safety and outcomes of robotic presacral neurectomy were evaluated.