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Yukio Homma - One of the best experts on this subject based on the ideXlab platform.
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accessibility to surgical robot technology and prostate cancer patient behavior for Prostatectomy
Japanese Journal of Clinical Oncology, 2017Co-Authors: Toru Sugihara, Hideo Yasunaga, Hiroki Matsui, Go Nagao, Akira Ishikawa, Tetsuya Fujimura, Hiroshi Fukuhara, Kiyohide Fushimi, Makoto Ohori, Yukio HommaAbstract:Background To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical Prostatectomy focusing on geographical accessibility. Methods In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical Prostatectomy (divided by mean interval in 2011: % interval days to radical Prostatectomy) were calculated for individual radical Prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical Prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. Results % Interval days to radical Prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the Prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical Prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-Prostatectomy provider and temporal progress were other significant factors related to % interval days to radical Prostatectomy widening (P < 0.05 for all). Conclusions Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was.
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Accessibility to surgical robot technology and prostate-cancer patient behavior for Prostatectomy.
Japanese journal of clinical oncology, 2017Co-Authors: Toru Sugihara, Hideo Yasunaga, Hiroki Matsui, Go Nagao, Akira Ishikawa, Tetsuya Fujimura, Hiroshi Fukuhara, Kiyohide Fushimi, Makoto Ohori, Yukio HommaAbstract:To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical Prostatectomy focusing on geographical accessibility. In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical Prostatectomy (divided by mean interval in 2011: % interval days to radical Prostatectomy) were calculated for individual radical Prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical Prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. % Interval days to radical Prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the Prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical Prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-Prostatectomy provider and temporal progress were other significant factors related to % interval days to radical Prostatectomy widening (P < 0.05 for all). Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Toru Sugihara - One of the best experts on this subject based on the ideXlab platform.
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accessibility to surgical robot technology and prostate cancer patient behavior for Prostatectomy
Japanese Journal of Clinical Oncology, 2017Co-Authors: Toru Sugihara, Hideo Yasunaga, Hiroki Matsui, Go Nagao, Akira Ishikawa, Tetsuya Fujimura, Hiroshi Fukuhara, Kiyohide Fushimi, Makoto Ohori, Yukio HommaAbstract:Background To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical Prostatectomy focusing on geographical accessibility. Methods In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical Prostatectomy (divided by mean interval in 2011: % interval days to radical Prostatectomy) were calculated for individual radical Prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical Prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. Results % Interval days to radical Prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the Prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical Prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-Prostatectomy provider and temporal progress were other significant factors related to % interval days to radical Prostatectomy widening (P < 0.05 for all). Conclusions Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was.
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Accessibility to surgical robot technology and prostate-cancer patient behavior for Prostatectomy.
Japanese journal of clinical oncology, 2017Co-Authors: Toru Sugihara, Hideo Yasunaga, Hiroki Matsui, Go Nagao, Akira Ishikawa, Tetsuya Fujimura, Hiroshi Fukuhara, Kiyohide Fushimi, Makoto Ohori, Yukio HommaAbstract:To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical Prostatectomy focusing on geographical accessibility. In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical Prostatectomy (divided by mean interval in 2011: % interval days to radical Prostatectomy) were calculated for individual radical Prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical Prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. % Interval days to radical Prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the Prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical Prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-Prostatectomy provider and temporal progress were other significant factors related to % interval days to radical Prostatectomy widening (P < 0.05 for all). Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Jim C. Hu - One of the best experts on this subject based on the ideXlab platform.
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Salvage robotic assisted laparoscopic radical Prostatectomy: indications and outcomes
World Journal of Urology, 2013Co-Authors: Stephen B. Williams, Jim C. HuAbstract:Objectives Salvage robotic assisted laparoscopic radical Prostatectomy (SRALP) has now become a feasible alternative to open Prostatectomy in experienced hands. Herein we review the urologic literature for the indications and outcomes of SRALP. Methods A comprehensive review of the peer reviewed literature was performed for reported cases of salvage robotic and open Prostatectomy, with emphasis being on comparing oncologic outcomes. Results Salvage Prostatectomy, whether open or robotic, is a viable alternative for treatment of recurrent, localized, non-metastatic prostate cancer after failed primary radiotherapy. Although few reports of salvage robotic Prostatectomy have been published with limited long-term follow-up, initial oncologic results seem at least comparable to the salvage open Prostatectomy series. SRALP should be performed by centers with a dedicated and well experienced robotic urologic oncology program. Conclusions SRALP is a feasible surgical treatment option for patients with recurrence after primary radiotherapy with preliminary oncologic outcomes comparable to the open approach. Further long-term follow-up is needed to validate these results.
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robot assisted versus open radical Prostatectomy the differential effect of regionalization procedure volume and operative approach
The Journal of Urology, 2013Co-Authors: Jesse D Sammon, James O Peabody, Pierre I Karakiewicz, Shyam Sukumar, Praful Ravi, Khurshid R Ghani, Marco Bianchi, Shahrokh F Shariat, Paul Perrotte, Jim C. HuAbstract:Purpose: The use of robot-assisted radical Prostatectomy has increased rapidly despite the absence of randomized, controlled trials showing the superiority of this approach. While recent studies suggest an advantage for perioperative complication rates, they fail to account for the volume-outcome relationship. We compared perioperative outcomes after robot-assisted and open radical Prostatectomy, while considering the impact of this established relationship.Materials and Methods: Using the NIS (Nationwide Inpatient Sample), we abstracted data on patients treated with radical Prostatectomy in 2009. Univariable and multivariable logistic regression analyses were done to compare the rates of blood transfusion, intraoperative and postoperative complications, prolonged length of stay, increased hospital charges and mortality between robot-assisted and open radical Prostatectomy overall and across volume quartiles.Results: An estimated 77,616 men underwent radical Prostatectomy, including a robot-assisted and a...
Ashutosh Tewari - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic radical Prostatectomy: Conventional and robotic
Urology, 2005Co-Authors: Mani Menon, Alok Shrivastava, Ashutosh TewariAbstract:By 2015, prostate cancer will become the most commonly diagnosed cancer in men. Radical Prostatectomy reduces disease-specific mortality in patients with localized prostate cancer; however, the invasiveness of surgery and its resultant side effects cause many men to seek other treatments. In 2000, laparoscopic radical Prostatectomy emerged as a minimally invasive alternative to open surgery; it has been refined recently by the addition of robotic technology. To examine the outcomes of robotic radical Prostatectomy and compare them with those from open and conventional laparoscopic radical Prostatectomy, we prospectively collected baseline demographic data on all patients undergoing surgery for prostate cancer over a 4-year period at our center. Urinary function and sexual function were evaluated using standardized criteria as well as a questionnaire preoperatively and at 1, 3, 6, 12, and 18 months after their procedure. Operative and postoperative outcomes were compared using values for open radical Prostatectomy as the reference standard. A total of 100 men underwent open radical Prostatectomy with conventional laparoscopic radical Prostatectomy (n = 50) and robotic radical Prostatectomy (n = 500). The odds ratios for operative times, blood loss, postoperative pain, complications, and median times to urinary continence and resumption of sexual activity all were lower for robotic than for open or laparoscopic radical Prostatectomy. It appears safe to conclude that conventional laparoscopic radical Prostatectomy is a reasonable alternative to open radical Prostatectomy in the surgical treatment of patients with clinically localized prostate cancer. The incorporation of robotics may result in even better surgical outcomes than conventional laparoscopy. However, the surgical robot is expensive; few centers have access to the technology and even fewer have expertise in the technique. For robotic radical Prostatectomy to become the standard of care for the treatment of localized prostate cancer will require economies of cost, dissemination of surgical expertise, and data from randomized trials.
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laparoscopic and robot assisted radical Prostatectomy establishment of a structured program and preliminary analysis of outcomes
The Journal of Urology, 2002Co-Authors: Mani Menon, Alok Shrivastava, Ashutosh Tewari, Richard Sarle, Ashok K Hemal, James O Peabody, G VallancienAbstract:ABSTRACTPurpose: The technique of laparoscopic radical Prostatectomy is difficult to master and is associated with a steep learning curve. We hypothesized that a structured approach to establishing a laparoscopic Prostatectomy program would diminish complications during the learning process and that robotic technology would be useful in learning the operation.Materials and Methods: A structured laparoscopic radical Prostatectomy program was introduced at the Vattikuti Urology Institute on October 23, 2000. One of 2 surgeons with a combined experience of more than 500 laparoscopic radical prostatectomies performed or supervised the first prostatectomies, training a third surgeon with extensive “open” surgical skills but no laparoscopic experience. The “trained” surgeon then started performing the operation independently with robotic assistance. The results of this approach were analyzed at the end of 12 months.Results: We performed 48 laparoscopic radical prostatectomies and 50 robot assisted prostatectomi...
Hideo Yasunaga - One of the best experts on this subject based on the ideXlab platform.
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accessibility to surgical robot technology and prostate cancer patient behavior for Prostatectomy
Japanese Journal of Clinical Oncology, 2017Co-Authors: Toru Sugihara, Hideo Yasunaga, Hiroki Matsui, Go Nagao, Akira Ishikawa, Tetsuya Fujimura, Hiroshi Fukuhara, Kiyohide Fushimi, Makoto Ohori, Yukio HommaAbstract:Background To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical Prostatectomy focusing on geographical accessibility. Methods In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical Prostatectomy (divided by mean interval in 2011: % interval days to radical Prostatectomy) were calculated for individual radical Prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical Prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. Results % Interval days to radical Prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the Prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical Prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-Prostatectomy provider and temporal progress were other significant factors related to % interval days to radical Prostatectomy widening (P < 0.05 for all). Conclusions Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was.
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Accessibility to surgical robot technology and prostate-cancer patient behavior for Prostatectomy.
Japanese journal of clinical oncology, 2017Co-Authors: Toru Sugihara, Hideo Yasunaga, Hiroki Matsui, Go Nagao, Akira Ishikawa, Tetsuya Fujimura, Hiroshi Fukuhara, Kiyohide Fushimi, Makoto Ohori, Yukio HommaAbstract:To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical Prostatectomy focusing on geographical accessibility. In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical Prostatectomy (divided by mean interval in 2011: % interval days to radical Prostatectomy) were calculated for individual radical Prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical Prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. % Interval days to radical Prostatectomy became wider for distance to nearest surgical robot <30 km. When a surgical robot emerged within 30 and 10 km, the Prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P < 0.01 for all) Multivariate analyses including 9759 open and 5052 non-robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical Prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot <10 km), while younger age, high-volume hospital, open-Prostatectomy provider and temporal progress were other significant factors related to % interval days to radical Prostatectomy widening (P < 0.05 for all). Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
