Is the Complication Rate of Radical Cystectomy Predictive of the Complication Rate of Other Urological Procedures?

Source: UroToday

A higher hospital radical cystectomy volume appears to lead to a lower risk of complications only after other common urological oncological procedures, namely radical prostatectomy and nephrectomy, but not after nononcological urology procedures.

This abstract found that hospitals that performed radical cystectomy (removal of the bladder and surrounding tissue for bladder cancer) had less complcations for kidney and prostate cancer surgery as well.

I have been perfoming radical cystecomies my whole career and started perfoming these robotically 3 1/2 years ago. Although I thought performing the more complex surgery helpe me in other surgeries, I didnt realize that a study would show less complications for these other procedures.

Best of AUA Orlando 2008 for Prostate Cancer

Source: Urology Times
Robotic Surgery
Presented by Ashutosh K. Tewari, MD,
Weill-Cornell Medical College, New York.


* Robot-assisted laparoscopic partial nephrectomy is associated with shorter hospital stay and less bleeding, but the warm ischemia time is still around 30 minutes.

* Studies comparing robot-assisted laparoscopic cystectomy and open radical cystectomy show similar oncologic outcomes. At a high-volume tertiary care center, the robotic technique was more cost-efficient, but that finding needs to be confirmed at other centers. Other remaining issues regarding the robotic procedure include the need to define how the reconstruction should be performed, the extent of the lymphadenectomy, and ensuring clear margins at lateral areas.

* A study of almost 4,000 patients reaffirms the safety of robotic-assisted laparoscopic prostatectomy (RALP). Rates of major surgical, major medical, and minor medical complications were all ≤0.7%, and the rate of minor surgical complications was 3.3%.

* Studies comparing open and RALP show the surgeon is the most important variable in determining outcome.

* Extended lymph node dissection should be performed in high-risk prostate cancer patients, and can be done with RALP.

* A total reconstruction procedure including anterior and posterior restoration of the vesicourethral junction is associated with early return to continence and improvement in overall continence rates.

Some of the highlights from the AUA
Of interest is the growing application of robotic surgery for smaller kidney cancers (partial nephrectomy) and bladder cancer, which I have been performing since 2005 myself.

The other very important adaption is the posterior and anterior reconstruction of the urinary tract during robotic prostatectomy, which I have performing for over a year after attending Dr Tewari’s conference.

New for kidney cancer: robotic surgery

Source: Washington University Website

“Robotic surgery is more efficient and precise than either open or laparoscopic surgery for tumors confined to the kidney,” says Bhayani, assistant professor of surgery and a leader in the field of robotic surgery. “Rather than operate with two hands, I can simultaneously control four robotic instruments with mechanical “wrists” that rotate more than 360 degrees, giving me far greater maneuverability than human hands or laparoscopic instruments.” Bhayani led a team at Washington University to develop the procedure for kidney tumors.


Dr Bhayani is a friend and excellent surgeon. Check out his website for a video clip of the partial nephrectomy. I was recently invited as a guest faculty at his conference (First Annual World Robotic Renal Symposium) and had the privilege of watching him perform 2 live surgeries, a robotic nephrectomy and a robotic partial nephrectomy. Both went very well.

Waiting Time From Initial Urological Consultation to Nephrectomy for Renal Cell Carcinoma-Does it Affect Survival?

From UroToday

Surgical waiting time from initial urological consultation to operative intervention does not adversely affect the outcome of renal cell carcinoma within the time frames analyzed in this study, in which 94% of cases occurred within 3 months. Individual urologist judgment remains a critical factor in the appropriate and timely care of the patient with a suspicious renal mass.

Patients often ask how soon they have to have surgery when diagnosed with a likely cancer. This study shows that for kidney cancer it does not seem to make much of a diffference. The main problem with tihs study is that patients with larger tumors often get counselled to have surgery right away, whereas smaller ones are often given the option to wait a few months if the patient wants to.

Robotic Renal Symposium

First Annual Worldwide Robotic Renal Symposium
I had the honor of being selected on the faculty for the 1st robotic conference dedicated to kidney surgery. This should be an excellent conference for urologists who are performing robotic surgery for prostate cancer and would like to learn about current techniques for kidney surgery including partial nephrectomy. Transplant surgeons who currently perform laparoscopic donor nephrectomies and would like to learn about robotic surgery are also good candidates.
Location:
Eric P. Newman Education Center
Washington University Medical Center – St. Louis, Missouri
Course Chair:
Sam B. Bhayani, M.D.
Presented By:
The Division of Urologic Surgery
Sponsored By:
Washington University School of Medicine
Continuing Medical Education

My Robotic nephrectomy on you tube?

As my friends and readers know, in May of 2007 I performed a live right kidney and adrenal gland removal for intuitive surgical. This was telecast to the AUA conference in Anaheim. My hospital helped me edit the video which I did a voice-over for and made into a nice 7 minute piece. I was told it was going on our hospitals website.

I then received an email that it was put on you tube. I am not sure how I feel about this. Exposure is good, but is this the correct forum? I have personally put videos on google video before, but not you tube.

I think the piece is pretty neat and can be viewed below.

I welcome comments about using youtube or other media to promote work. I think surgeons can learn by watching this piece and will find it interesting, but I wonder how it will be perceived.
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New medicine against advanced kidney cancer

FDA approves third new targeted therapy for advanced RCC – UrologyTimes

The FDA has approved the enzyme inhibitor temsirolimus (Torisel) for the treatment of advanced renal cell carcinoma.
The approval of temsirolimus follows the December 2005 approval of sorafenib (Nexavar) and the January 2006 approval of sunitinib (Sutent), which represent a new class of targeted therapies for advanced RCC.

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First Live Robotic Kidney Removal Surgery at the AUA

I was honored to be chosen by Intuitive Surgical to perform the first live robotic kidney removal surgery at this years American Urologic Association conference (press release). This was the second year in a row that I have been chosen to perform l a live surgery.
Intuitive has been broadcasting live surgeries for 3 years now. I was one of 3 surgeons to perform a dvP (robotic prostatectomy) at the 2006 AUA convention. This year there were 4 live dvPs and my nephrectomy.

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Robotic Donor Nephrectomy for donating a kidney for transplant

UroToday – AUA 2007 – Experience with Robotic-Assisted Laparoscopic Living Donor Nephrectomy

This series demonstrates that robotic-assisted laparoscopic donor nephrectomy can be performed safely with low complication rates and outcomes similar to standard laparoscopic living donor nephrectomy.

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