I attended the PACRIM conference Sponsored by the Univ. of California, Irvine in early January. There were several interesting presentations and I plan to post a summary of different ones from time to time. The first in the series is regarding a presentation made by Dr. Randy Fagin from Austin, TX, on “Achieving a Time Efficient Procedure in the Private Practice Setting”. There have been criticisms leveled at robotic prostatectomy stating that it isn’t time efficient compared to open surgery. In our hospital my partner (280+ cases) and I (150+) are completing cases in 2.5 -3 hoursfrom the time the patient is wheeled into the room until he is wheeled out to recovery. That is already competitive with some other surgeons’ times for open radicals. Dr. Fagin is doing even better than we are it would appear.
I have noticed after several recent cases that my eyes feel dry and itchy. I think it is due to a reduced blink reflex, a well reconized problem for those working with computer monitors and sometimes called Computer Vision Syndrome.
“Research has shown that the blink rate of VDT workers dropped very significantly during work at a VDT compared to before and after work. Possible explanations for the decreased blink rate include concentration on the task or a relatively limited range of eye movements.”
I was recently faced with a case of a right sided UPJ stenosis with good renal preservation and two 5 mm stones in the upper pole. Having done at least a half dozen robotic pyeloplasties I felt that that would be the appropriate treatment for the UPJ but was not sure how to address the stones. I did not want to leave them in place and have to address them later. A separate percutaneous nephrostolithotomy seemed like overkill for the size of the stones. A PNL could be combined with an antegrade endopyelotomy, but the stones were in upper pole calyces and the combined procedure might require two separate entry points for adequate access (lower pole entry point to reach the upper-pole and a mid- or upper-pole entry point to reach the UPJ).