Mark Louie-Johnsun

Implications of laparoscopic inguinal hernia repair on open, laparoscopic, and robotic radical prostatectomy

Purpose: There have been anecdotal reports of surgeons having to abandon radical prostatectomy (RP) after laparoscopic inguinal hernia repair (LIHR) due to obliteration of tissue planes by mesh. Nodal dissection may also be compromised. We prospectively collected data from four experienced prostate surgeons from separate institutions. Our objective was to evaluate the success rate of performing open RP (ORP), laparoscopic RP (LRP) and robotic assisted RP (RALRP) and pelvic lymph node dissection (PLND) after LIHR, and the frequency of complications. Methods: A retrospective analysis of prospectively maintained databases of men who underwent RP after LIHR between 2004 and 2010 at four institutions was undertaken. The data recorded included age, preoperative prostate-specific antigen, preoperative Gleason score, and clinical stage. The operative approach, success or failure to perform RP, success or failure to perform PLND, pathological stage, and complications were also recorded. Results: A total of 1,181 men underwent RP between 2004 and 2010. Fifty-seven patients (4.8%) underwent RP after LIHR. An ORP was attempted in 19 patients, LRP in 33, and RALRP in 5. All 57 cases were able to be successfully completed. Ten of the 18 open PLND were able to be completed (55.6%). Four of the 22 laparoscopic LND were able to be completed (18.2%). Robotic LND was possible in 5 of 5 cases (100%). Therefore, it was not possible to complete a LND 56.8% of patients. Complications were limited to ten patients. These complications included one LRP converted to ORP due to failure to progress, and one rectourethral fistula in a salvage procedure post failed high intensity focused ultrasound. Conclusions: LIHR is an increasingly common method of treating inguinal hernias. LIHR is not a contra-indication to RP. However PLND may not be possible in over 50% of patients who have had LIHR. Therefore, these patients may be under-staged and under treated.

The use of portable video media vs standard verbal communication in the urological consent process: a multicentre, randomised controlled, crossover trial.

To determine if portable video media (PVM) improves patients knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC), as informed consent is a crucial component of patient care and PVM is an emerging technology that may help improve the consent process.

The Australian laparoscopic non robotic radical prostatectomy experience – analysis of 2943 cases (USANZ supplement)

To analyse the Australian experience of high‐volume Fellowship‐trained Laparoscopic Radical Prostatectomy (LRP) surgeons.

Unusual retroperitoneal splenosis confirmed by laparoscopic retroperitoneal excisional biopsy

A 40-year-old man had an incidental finding of a solid enhancing 33-mm mass in the retroperitoneum posterior to the upper pole of the right kidney on abdominal computed tomography (CT) (Fig. 1). This is on a background of a trauma splenectomy via a midline laparotomy 25 years ago. The CT and a Technetium-99m labelled red cell scintigraphy confirmed multiple intraperitoneal nodules consistent with benign splenosis, but there was no appreciable uptake in the retroperitoneal mass. Given the unusual location and indeterminate nature of the mass, the patient opted for a laparoscopic retroperitoneal excisional biopsy. This was performed using three ports with balloon insufflation of the right retroperitoneal space. The operative duration was 55 min and there was minimal blood loss. The patient was discharged within 24 h without complication. The subsequent histopathology confirmed benign splenosis. Splenosis is a benign condition that commonly occurs following open splenic trauma with autotransplantation of splenic tissue typically on serosal surfaces within the abdominal cavity such as the mesentery, omentum and peritoneum. Although there are reports of extraperitoneal locations of splenosis such as intrahepatic, intrathoracic and even intracranial, this is unusual. In our case, given the indeterminate nature of the lesion, excisional biopsy was offered. Given our familiarity with laparoscopic retroperitoneal adrenal and renal surgery this was the preferred approach, which was able to be performed without complication. The location of the mass and the patient’s previous surgery would have made a transperitoneal laparoscopic approach unnecessarily more difficult.

Laparoscopic pyelolithotomy and pyeloplasty in a horseshoe kidney.

transhepatic cholangioscopic lithotripsy (PTCSL) and POCSL can be used to access the intrahepatic ducts. Large case series of these procedures have validated these interventions as useful definitive procedures in some elderly patients or those with multiple intrahepatic stones. Stones can be completely removed by PTCSL and POCSL in 80% and 78% of cases, with an average of 5.12 and 4.1 procedures per patient. The recurrence of symptoms and cancer is significantly higher in patients with stones left behind. Surgery is usually indicated when stones are inaccessible to minimally invasive techniques. The procedure is usually a left hepatectomy, and for this indication, the procedure is often performed at open surgery, although it has been described laparoscopically. While RPC is rare, its presentation is similar to the more common forms of biliary calculi known in the West. Key points to remember are to watch for intrahepatic stones and intrahepatic biliary dilatation. Secondly, prompt referral for urgent biliary decompression is vital for cases presenting with sepsis. Finally, definitive therapy can be achieved surgically and also with less invasive techniques.

Does magnetic resonance imaging–guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy

Background The increase in the use of multiparametric magnetic resonance imaging for the detection of prostate cancer has led to the rapid adoption of MRI-guided biopsies (MRGBs). To date, there is limited evidence in the use of MRGB and no direct comparisons between the different types of MRGB. We aimed to assess whether multiparametric MRGBs with MRI-US transperineal fusion biopsy (FB) and cognitive biopsy (CB) improved the management of prostate cancer and to assess if there is any difference in prostate cancer detection with FB compared with CB. Methods Patients who underwent an MRGB and a systematic biopsy (SB) from June 2014 to August 2016 on the Central Coast, NSW, Australia, were included in the study. The results of SB were compared with MRGB. The primary outcome was prostate cancer detection and if MRGB changed patient management. Results A total of 121 cases were included with a mean age of 65.5 years and prostate-specific antigen 7.4 ng/mL. Seventy-five cases (62%) had a Prostate Imaging and Reporting Data System 4–5 lesions and 46 (38%) had a Prostate Imaging and Reporting Data System 3 lesions. Fifty-six cases underwent CB and 65 underwent FB. Of the 93 patients with prostate cancer detected, 19 men (20.5%) had their management changed because of the MRGB results. Eight men (9%) had prostate cancer detected on MRGB only and 12 men (13%) underwent radical prostatectomy or radiotherapy based on the MRGB results alone. There was a trend to a higher rate of change in management with FB compared with CB (29% vs. 18%). Conclusions This is one of the first Australian studies to assess the utility of MRGB and compare FB with CB. MRGB is a useful adjunct to SB, changing management in over 20% of our cases, with a trend toward FB having a greater impact on patient management compared with CB.

Portable Video Media Versus Standard Verbal Communication in Surgical Information Delivery to Nurses: A Prospective Multicenter, Randomized Controlled Crossover Trial

Background Continuing education of health professionals is important for delivery of quality health care. Surgical nurses are often required to understand surgical procedures. Nurses need to be aware of the expected outcomes and recognize potential complications of such procedures during their daily work. Traditional educational methods, such as conferences and tutorials or informal education at the bedside, have many drawbacks for delivery of this information in a universal, standardized, and timely manner. The rapid uptake of portable media devices makes portable video media (PVM) a potential alternative to current educational methods. Objective To compare PVM to standard verbal communication (SVC) for surgical information delivery and educational training for nurses and evaluate its impact on knowledge acquisition and participant satisfaction. Design Prospective, multicenter, randomized controlled crossover trial. Setting Two hospitals: Gosford District Hospital and Wyong Hospital. Participants Seventy-two nursing staff (36 at each site). Intervention Information delivery via PVM––7-minute video compared to information delivered via SVC. Outcome Measures Knowledge acquisition was measured by a 32-point questionnaire, and satisfaction with the method of education delivery was measured using the validated Client Satisfaction Questionnaire (CSQ-8). Results Knowledge acquisition was higher via PVM compared to SVC 25.9 (95% confidence interval [CI] 25.2-26.6) versus 24.3 (95% CI 23.5-25.1), p = .004. Participant satisfaction was higher with PVM 29.5 (95% CI 28.3-30.7) versus 26.5 (95% CI 25.1-27.9), p = .003. Following information delivery via SVC, participants had a 6% increase in knowledge scores, 24.3 (95% CI 23.5-25.1) versus 25.7 (95% CI 24.9-26.5) p = .001, and a 13% increase in satisfaction scores, 26.5 (95% CI 25.1-27.9) versus 29.9 (95% CI 28.8-31.0) p < .001, when they crossed-over to information delivery via PVM. Linking Evidence to Action PVM provides a novel method for providing education to nurses that improves knowledge retention and satisfaction with the educational process.BACKGROUND Continuing education of health professionals is important for delivery of quality health care. Surgical nurses are often required to understand surgical procedures. Nurses need to be aware of the expected outcomes and recognize potential complications of such procedures during their daily work. Traditional educational methods, such as conferences and tutorials or informal education at the bedside, have many drawbacks for delivery of this information in a universal, standardized, and timely manner. The rapid uptake of portable media devices makes portable video media (PVM) a potential alternative to current educational methods. OBJECTIVE To compare PVM to standard verbal communication (SVC) for surgical information delivery and educational training for nurses and evaluate its impact on knowledge acquisition and participant satisfaction. DESIGN Prospective, multicenter, randomized controlled crossover trial. SETTING Two hospitals: Gosford District Hospital and Wyong Hospital. PARTICIPANTS Seventy-two nursing staff (36 at each site). INTERVENTION Information delivery via PVM--7-minute video compared to information delivered via SVC. OUTCOME MEASURES Knowledge acquisition was measured by a 32-point questionnaire, and satisfaction with the method of education delivery was measured using the validated Client Satisfaction Questionnaire (CSQ-8). RESULTS Knowledge acquisition was higher via PVM compared to SVC 25.9 (95% confidence interval [CI] 25.2-26.6) versus 24.3 (95% CI 23.5-25.1), p = .004. Participant satisfaction was higher with PVM 29.5 (95% CI 28.3-30.7) versus 26.5 (95% CI 25.1-27.9), p = .003. Following information delivery via SVC, participants had a 6% increase in knowledge scores, 24.3 (95% CI 23.5-25.1) versus 25.7 (95% CI 24.9-26.5) p = .001, and a 13% increase in satisfaction scores, 26.5 (95% CI 25.1-27.9) versus 29.9 (95% CI 28.8-31.0) p < .001, when they crossed-over to information delivery via PVM. LINKING EVIDENCE TO ACTION PVM provides a novel method for providing education to nurses that improves knowledge retention and satisfaction with the educational process.

Re: Transrectal ultrasound-guided biopsy sepsis and the rise in carbapenem antibiotic use.

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Portable Video Media Versus Standard Verbal Communication in Surgical Teaching: A Prospective, Multicenter, and Randomized Controlled Crossover Trial

OBJECTIVE This study aims to evaluate the effectiveness of portable video media (PVM) compared to standard verbal communication (SVC) as a novel adjunct for surgical education of junior medical officers and medical students, in terms of knowledge acquisition and participant satisfaction. BACKGROUND The effective, continued education of final year medical students and junior doctors is the foundation of quality healthcare. The development of new media technologies and rapid internet streaming has resulted in an opportunity for the integration of PVM into medical education. PVM is an educational platform with the advantage of being standardized, efficient, and readily available. DESIGN This is a multicenter, prospective, and randomized controlled crossover study. Participants completed a preintervention knowledge test and were then randomized in an allocation ratio of 1:1 to receive surgical education regarding cystoscopy and ureteric stenting for acute renal colic via either PVM or SVC. A 32-point knowledge test and a modified Client Satisfaction Questionnaire-8 were then administered and the participants were then crossed over to the other educational method. The knowledge and satisfaction tests were then readministered. RESULTS Fifty-four participants were recruited for this study with 27 participants in each group. Both groups had a 18% to 20% increase in knowledge scores following the first intervention p < 0.001 and on crossover there was a further 4% increase in knowledge scores, p < 0.01. There was no significant difference between the groups in knowledge scores before intervention, p = 0.23 after first intervention p = 0.74 or following crossover p = 0.09. After first intervention, participants in the group receiving PVM education first had a significant 8% higher satisfaction score compared to the SVC group, p = 0.023. CONCLUSIONS Our study has shown that PVM shows similar efficacy in information uptake to traditional forms of education. Furthermore, PVM was shown to have higher satisfaction scores compared to SVC. Further studies will need to evaluate the use of PVM for education in other surgical and medical domains and assess the long-term knowledge retention.

The Australian laparoscopic radical prostatectomy learning curve

International estimates of the laparoscopic radical prostatectomy (LRP) learning curve extend to as many as 1000 cases, but is unknown for Fellowship‐trained Australian surgeons.