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HOW I DO IT
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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) -
Intradetrusor onabotulinumtoxinA injection: how I do it
Shenot J. Patrick , Mark Ryan J., MD Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Overactive bladder is a highly prevalent condition that may have significant impact on quality of life. This condition may be idiopathic or may have a neurogenic etiology. Antimuscarinics have long been the preferred agents for the treatment of this condition. OnabotulinumtoxinA, an injectible agent that prevents presynaptic release of acetylcholine at the neuromuscular junction, has emerged as an important option in the management of patients with urinary incontinence caused by refractory detrusor overactivity. This manuscript describes our technique for performing utilizing this therapy, describes key equipment needed and provides technical tips for avoiding common pitfalls.
Keywords: overactive bladder, urinary incontinence, onabotulinumtoxinA,
Feb 2013 (Vol. 20, Issue 1 , Page 6649)
