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HOW I DO IT
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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) -
Partial nephrectomy: novel closure technique using bovine pericardium
Uhlman A. Matthew , Brown A. James, MD Department of Urology, University of Iowa, Iowa City, Iowa, USA
Partial nephrectomy (PN) has gained popularity over the past two decades as an alternative to radical nephrectomy (RN) in patients with small renal masses. Morbidity and mortality from PN have been shown to be lower than from RN, while oncologic outcomes have been shown to be equivalent for tumors < 7 cm. PN has become increasingly popular in academic centers, but the general urologic community continues to lag behind. The reason for this is not known, but may be related to the relatively high complication rate, including delayed complications associated with inadequate closure. Here we describe a novel PN closure technique that provides additional strength and hemostasis by incorporating bovine pericardium.
Keywords: surgical techniques, novel closure, penile carcinoma, laparoscopy, robotics,
Oct 2012 (Vol. 19, Issue 5 , Page 6485) -
Sacral nerve stimulation for neuromodulation of the lower urinary tract
Hubsher P. Chad , Jansen Robert , Riggs R. Dale , Jackson J. Barbara , Zaslau Stanley, MD Division of Urology, Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
Sacral neuromodulation (SNM) has become a standard treatment option for patients suffering from urinary urge incontinence, urgency-frequency, and/or nonobstructive urinary retention refractory to conservative and pharmacologic treatment. Since its initial development, the manufacturer of InterStim therapy (Medtronic, Inc., Minneapolis, MN, USA), has introduced technical modifications, while surgeons and researchers have adapted and published various innovations and alterations of the implantation technique. In this article, we feature our SNM technique including patient selection, comprehensive dialogue/evaluation, procedure details, and appropriate follow up. Although there is often great variability in patients with lower urinary tract dysfunction, we maintain that great success can be achieved with a systematic and methodical approach to SNM.
Keywords: bovine pericardium, renal cancer, partial nephrectomy,
Oct 2012 (Vol. 19, Issue 5 , Page 6480) -
Novel knot tying technique for robot-assisted surgery
Guru A. Khurshid, Sheikh Raashid Mohd, Raza J. Syed, Stegemann P. Andrew, Nyquist John, MD Department of Urology, Roswell Park Cancer Institute, Buffalo, New York, USA
Robot-assisted surgery has seen significant advancements in recent years, with dedicated training opportunities to acquire adequate skills. With improved degree of rotation and movement offered by the robot arm, newer techniques of knot tying need to be developed. Here we present a novel method of knot tying to help place a secure knot, especially with short suture length.
Keywords: testosterone, hypogonadism, diagnosis,
Aug 2012 (Vol. 19, Issue 4 , Page 6401)
Humber River Health