Troy Gianduzzo

KTP Laser Nerve Sparing Radical Prostatectomy: Comparison of Ultrasonic and Cold Scissor Dissection on Cavernous Nerve Function

PURPOSE Energy sources used during nerve sparing radical prostatectomy are known to compromise cavernous nerve function. Lasers offer the potential for accurate dissection while minimizing collateral injury to delicate neural structures. We evaluated cavernous nerve function following KTP laser dissection and compared outcomes to those of ultrasonic shears and cold scissor dissection. MATERIALS AND METHODS Laparoscopic unilateral neurovascular bundle mobilization was performed in 36 survival dogs using a KTP laser, ultrasonic shears and an athermal technique with cold scissors and clips in 12 each. Peak intracavernous pressure upon cavernous nerve stimulation, expressed as a percent of mean arterial pressure, was measured acutely and at 1 month. Thermal spread from the KTP laser and ultrasonic shears was assessed histologically ex vivo in harvested peritoneum. RESULTS Median peak intracavernous pressure as a percent of mean arterial pressure was similar immediately and 1 month after laser and athermal dissection, and significantly decreased after dissection with ultrasonic shears. Acute peak intracavernous pressure as a percent of mean arterial pressure was 53%, 96% and 98% for ultrasonic shears, laser and the athermal technique, respectively (laser vs athermal p = 0.51, ultrasonic shears vs laser p <0.001 and ultrasonic shears vs athermal p <0.001). Chronic peak intracavernous pressure as a percent of mean arterial pressure was 56%, 98% and 100% for ultrasonic shears, laser and the athermal technique, respectively (laser vs athermal p = 0.38, ultrasonic shears vs laser p = 0.016 and ultrasonic shears vs athermal p = 0.013). The median depth of acute laser injury was 600 microm compared to 1.2 mm for ultrasonic shear dissection and 450 microm crush injury due to the athermal technique. Thermography revealed less collateral thermal spread from the laser than from the ultrasonic shears (median greater than 60C thermal spread 1.07 vs 6.42 mm, p <0.01). CONCLUSIONS The KTP laser was comparable to the athermal technique and superior to the ultrasonic shears for preserving cavernous nerve function.

Robotic assisted radical prostatectomy: surgical techniques and outcomes

Robotic assisted radical prostatectomy (RARP) is gaining acceptance and popularity among urologists all over the world. Early oncologic and functional results are encouraging. In this manuscript, we describe in detail both approaches for RARP and show the results of the robotic surgery program with over 300 RARP performed at our institution.

Determination of selenium in red blood cells by inductively coupled plasma mass spectrometry (ICP-MS) after microwave digestion

Selenium is an essential trace element and its levels in blood have been widely used for assessing Se status in humans. The aim of this present study is to develop a suitable method for the determination of Se in red blood cells (RBC) using ICP-MS after microwave digestion. The blood samples were obtained from patients with benign prostatic hyperplasia (BPH), who attended urology clinics at the Princess Alexandra hospital, Brisbane, Australia. No apparent polyatomic and matrix interferences were encountered when 82Se isotope was used for the analysis of Se levels in RBC. Whole Blood Seronorm Trace Elements (SERO, Norway) and dogfish muscle (DORM-1, NRCC) were used as reference materials for method validation. The method was rapid and accurate, and ideal for routine analysis of Se in RBC, and in particular for assessing of Se status in humans.

Is transperineal prostate biopsy more accurate than transrectal biopsy in determining final Gleason score and clinical risk category? A comparative analysis

To assess the degree of upgrading and increase in clinical risk category of transperineal template biopsy (TTB) compared with transrectal ultrasonography‐guided prostate biopsy (TRUSB). Upgrading of TRUSB Gleason grade and sum after radical prostatectomy (RP) is well recognised. TTB may offer a more thorough mapping of the prostate than TRUSB, as well as a more accurate assessment of the tumour. In this retrospective cohort study of prospectively collected data, we compare the initial TRUSB and TTB Gleason grade and sum with the final assessment at RP.

Laser robotically assisted nerve-sparing radical prostatectomy: a pilot study of technical feasibility in the canine model

To examine the feasibility of using laser energy during nerve‐sparing robotically assisted radical prostatectomy (RARP), as the energy sources currently used for haemostasis in RARP adversely affect cavernous nerve function, while clips require application by a skilled assistant, but laser energy potentially allows precise dissection with minimal collateral tissue injury.

Laser nerve-sparing laparoscopic radical prostatectomy: a feasibility study

To examine, in a pilot study, the feasibility of laser dissection of the neurovascular bundle (NVB) during nerve‐sparing laparoscopic radical prostatectomy (NSLRP). NSLRP demands precise NVB mobilization with minimal collateral tissue trauma and optimal haemostasis. Unlike other methods of delivering energy, lasers have the potential to provide rapid, precise dissection with good haemostasis and minimal adjacent tissue injury.

Impact of branding on public awareness of healthcare‐related governing bodies: a pilot study of the Urological Society of Australia and New Zealand brand

To assess the general publics understanding of urologists and of the Urological Society of Australian and New Zealand (USANZ) and gauge the effectiveness with which the USANZ disseminates health information about urological conditions to health consumers.

Anatomical and electrophysiological assessment of the canine periprostatic neurovascular anatomy: Perspectives as a nerve sparing radical prostatectomy model

PURPOSE Although the dog is often used as a radical prostatectomy model, precise descriptions of canine prostate and neurovascular bundle anatomy are lacking. We describe canine prostate and neurovascular bundle anatomical and electrophysiological characteristics. MATERIALS AND METHODS The canine prostate and pelvic neurovascular structures were dissected in 6 canine cadavers and 12 anesthetized dogs. Pelvic plexus branches were stimulated using a CaverMap probe and peak intracavernous pressure responses were recorded as a percent of mean arterial pressure. RESULTS The canine pelvic plexus lies 5 to 10 mm lateral to the prostate. It is supplied by the hypogastric nerve cranially and the pelvic nerve laterally. The neurovascular bundles course distal from the pelvic plexus along the posterolateral aspect of the prostate, including a dominant cavernous nerve along its lateral aspect. CaverMap stimulation of the efferent branches of the pelvic plexus confirmed their roles in tumescence. Histology revealed extensive neurovascular tissue along the posterolateral aspect of the prostate beneath the periprostatic fascia. Notable differences to human anatomy were the absence of seminal vesicles, the lateral positions of the pelvic plexus, the dominant cavernous nerve and the circumferential urethral distribution of the cavernous nerves. CONCLUSIONS Canine neurovascular anatomy resembles that of humans and it is a suitable model in which to assess prostatectomy related erectile dysfunction. However, there are key differences in neurovascular relationships that must be considered when the canine prostate is used as a radical prostatectomy model.

The ISUP system of staging, grading and classification of renal cell neoplasia

There have been significant changes in the staging, classification and grading of renal cell neoplasia in recent times. Major changes have occurred in our understanding of extra-renal extension by renal cell cancer and how gross specimens must be handled to optimally display extra-renal spread. Since the 1981 World Health Organization (WHO) classification of renal tumors, in which only a handful of different entities were reported, many new morphological types have been described in the literature, resulting in 50 different entities reported in the 2004 WHO classification. Since 2004, further new entities have been recognized and reported necessitating an update of the renal tumor classification. There have also been numerous grading systems for renal cell carcinoma with Fuhrman grading, the most widely used system. In recent times, the prognostic value and the applicability of the Fuhrman grading system in practice has been shown to be, at best, suboptimal. To address these issues and to recommend reporting guidelines, the International Society of Urological Pathology (ISUP) undertook a review of adult renal neoplasia through an international consensus conference in Vancouver in 2012. The conduct of the conference was based upon evidence from the literature and the current practice amongst recognized experts in the field. Working groups selected to deal with key topics evaluated current data and identified points of controversy. A pre-meeting survey of the ISUP membership was followed by the consensus conference at which a formal ballot was taken on each key issue. A 65% majority vote was taken as consensus. This review summarizes the outcome and recommendations of this conference with regards to staging, classification and grading of renal cell neoplasia.

Treatment of localised prostate cancer using high‐intensity focused ultrasound

Obesity is cited as a limiting factor in laparoscopy, and can limit instrument movements by the greater degree of port fixity, but this does not preclude this approach in obese patients. However, performing a radical or partial nephrectomy through an 8cm incision in an obese patient might compromise access and prove extremely difficult; the body mass index of the patients in the authors’ series is not mentioned. These patients often benefit the most from a laparoscopic procedure, having otherwise a greater risk of wound complications after open surgery.