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HOW I DO IT


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  • How I do it: Aquablation of the prostate using the AQUABEAM system

    MacRae Catriona, Gilling Peter, MD Department of Urology, Tauranga Hospital, Tauranga, New Zealand

    Benign prostatic hyperplasia (BPH) represents one of the most common conditions encountered in urological practice. For many years, transurethral resection of the prostate (TURP) has been considered the gold standard for surgical management of symptoms in prostates of 30 cc-80 cc. Although TURP provides excellent functional outcomes, there is significant morbidity associated with the procedure, particularly with regards to bleeding, electrolyte imbalance and sexual dysfunction. Emerging technologies aim to maintain the excellent functional results of TURP whilst decreasing the adverse events experienced by the patient. Aquablation is a novel therapy using a high-velocity waterjet and real-time ultrasound imaging with robotic assistance for targeted removal of prostate tissue. We present our experiences with this new technique, the equipment required and steps involved.

    Keywords: benign prostatic hyperplasia, transurethral resection of prostate, ablation techniques, aquablation, bladder outlet obstruction,

    Dec 2016 (Vol. 23, Issue 6, Page 8590)
  • How I do it: prostate cryoablation (PCry)

    da Silva Donalisio Rodrigo , Jaworski Paulo , Gustafson Diedra , Nogueira Leticia , Molina Wilson , Kim J. Fernando, MD Denver Health Medical Center/University of Colorado Cancer Center, Denver, Colorado, USA

    Prostate cryoablation (PCry) is a well-established minimally invasive therapy for the treatment of prostate cancer. Unfortunately, PCry still carries the stigma of a high rate recto-urethral fistula procedure but with the advent of argon/helium gas technology, urethral warmer and high quality transrectal ultrasound imaging, complications decreased and efficacy increased. The Denver Health Medical Center's technique in prostate cryoablation is described as follows.

    Keywords: technique, prostate cryoablation,

    Apr 2014 (Vol. 21, Issue 2, Page 7251)
  • Use of blunt right angles to aid in intussusception of a Bricker ileal conduit

    Strigenz E. Michael , Uhlman A. Matthew , Brown A. James, MD University of Iowa, Iowa City, Iowa, USA

    The Bricker ileal conduit has been the most popular urinary diversion technique following a radical cystectomy since the 1950s. The procedure typically provides a high quality of life for patients. However, stomal complications occur in 16%-65% of ileal conduit cases. We describe an easy technique to aid in the intussusception of a Bricker ileal conduit. This technique produces stomas with a height of 2 cm-3 cm consistently. In our experience, we have had excellent results when using this technique.

    Keywords: surgical techniques, ileal conduit, surgical stoma, urinary bladder neoplasms, cystectomy,

    Feb 2014 (Vol. 21, Issue 1, Page 7171)
  • Robot assisted radical prostatectomy: how I do it. Part II: surgical technique

    Valdivieso F. Roger , Hueber Pierre-Alain , Zorn C. Kevin, MD Hopital St. Luc Montreal, Quebec, Canada

    The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.

    Keywords: surgical techniques, prostate cancer, robot assisted radical prostatectomy,

    Dec 2013 (Vol. 20, Issue 6, Page 7073)
  • Robot assisted radical prostatectomy: how I do it. Part I: patient preparation and positioning

    Valdivieso F. Roger , Hueber Pierre-Alain , Zorn C. Kevin, MD University of Montreal Hospital Center (CHUM)-Hopital St. Luc, Montreal, Quebec, Canada

    Radical prostatectomy remains the standard treatment for long term cure of clinically localized prostate cancer, offering excellent oncologic outcomes, with cancer-specific survival approaching 95% at 15 years after surgery. The introduction of the `da Vinci Robotic Surgical System` (Intuitive Surgical, Sunnyvale, CA, USA) has been another important step toward a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the surgeon and patient. In this first part of a two article series, we describe preoperative patient preparation and positioning protocols for robot assisted radical prostatectomy (RARP) that are currently used in our institution (University of Montreal Hospital Center (CHUM) – Hopital St-Luc). We use the four-arm da Vinci Si Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes.

    Keywords: surgical techniques, prostate cancer, robot assisted radical prostatectomy,

    Oct 2013 (Vol. 20, Issue 5, Page 6957)
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October 2017, Vol.24 No.5
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