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.

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Source:
Journal of Robotic Surgery, Volume 2, Number 3 / September, 2008

Conclusions

We report a large, multi-institutional series of RPN for renal tumors, confirming safety and feasibility reported in previous small, single-institution studies. Although we report the initial experience in RPN at each center, immediate oncologic results and perioperative outcomes approached those of more mature laparoscopic series. Robotic assistance may facilitate the technical challenges of precise tumor resection and renal reconstruction within acceptable warm ischemia times. Long-term outcomes are needed to establish the role of RPN in nephron-sparing surgery.

This was a large multi-institutional study that I was part of. This was the largest robotic partial nephrectomy study reported.

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Source: UroToday

The mean total operative time (140 vs 156 minutes, P = .04), warm ischemia time (19 vs 25 minutes, P = .03), and length of stay (2.5 vs 2.9 days, P = .03) were significantly shorter for RPN than for LPN, respectively.

RPN can produce results comparable to LPN but has disadvantages, such as cost and assistant control of the renal hilum. Additional randomized trials are needed.

A friend and expert robotic renal surgeon, Dr Bhayani, discusses his results with robotic partial nephrectomy.

The most important finding is the improvement in warm ischemia time, the amount of time the kidney is not receiving blood supply.

Another important finding is that the operation can be done quicker robotically, which can translate into a cost savings that will partially offset the increased cost of the robotic equipment.

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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

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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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Man's kidney removed by robot | The Daily Telegraph

IT sounds like science fiction - but a NSW man has become the first person in the southern hemisphere to have a kidney removed by a robot.

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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.

Robotic Kidney and adrenal specimen: click to enlarge

Continue reading "First Live Robotic Kidney Removal Surgery at the AUA" »

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UroToday - Renal Artery Occlusion During Nephron-Sparing Surgery: Retrospective Review of 301 Cases

The authors report on 301 patients who underwent nephron sparing surgery for a localized renal tumor. Of these, 181 patients had renal artery occlusion with cold ischemia, while the remaining 120 patients were managed with external compression alone to control hemorrhage. Mean tumor size was 3.56cm and there was a higher incidence of centralized tumors in the arterial occlusion group (p less than 0.05). The authors noted no difference in blood loss, transfusion rates, tumor size, or complications between the two groups. Two renal units (1.2%) were "lost" due to ischemic damage in the renal artery occlusion group, which was not a complication in the external compression group. More importantly, there was a significantly higher incidence of positive margins in the external compression group (4.2%) relative to the group with renal artery occlusion during resection (0.6%), (p less than 0.05).

Renal artery occlusion during partial nephrectomy may result in ischemic damage to the remaining renal parenchyma, particularly if prolonged, but is clearly superior for optimal visualization during tumor resection. This study demonstrates that external compression (the "grip of death") does not significantly minimize morbidity over renal artery clamping, and may, in fact, be associated with an increased positive margin rate due to poor visibility during tumor resection.

Continue reading "Partial nephrectomy for kidney cancer" »

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UroToday - Laparoscopic Versus Open Radical Nephrectomy for Xanthogranulomatous Pyelonephritis: Contemporary Outcomes Analysis

BERKELEY, CA (UroToday.com) - It was not until 9 years after the initial laparoscopic nephrectomy, that the first report on using this technique for xanthogranulomatous pyelonephritis (XGP) emerged from Washington University. At that time, we noted the procedures were much longer than the open, with no benefits in pain control or hospital stay, and were associated with a high rate of complications. Over the years, has the laparoscopic approach to this condition improved? The answer is "a bit" but only "a bit". In this sobering report the authors compare 6 laparoscopic to 6 open nephrectomies for XGP. The procedure time was 2 hours longer in the laparoscopic group (p = 0.03). One of the 6 laparoscopic patients was converted to open and 2 cases were converted to hand-assist. Complications were higher in the laparoscopic group (3 vs. 2).

Continue reading "Surgery for Xanthogranulomatous Pyelonephritis" »

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