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Ashok K. Hemal - One of the best experts on this subject based on the ideXlab platform.
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Intraoperative ICG-fluorescence imaging for robotic-assisted Urologic Surgery: current status and review of literature
International Urology and Nephrology, 2019Co-Authors: Ram A. Pathak, Ashok K. HemalAbstract:Purpose With the availability of near-infrared fluorescence (NIRF) imaging using indocyanine green dye (ICG) to the robotic platform, utility of this imaging technology has evolved significantly across the board for ablative and reconstructive procedures. Herein, we describe the potential indications of indocyanine green for both oncologic and non-oncologic applications in robot-assisted laparoscopic Urologic Surgery. Methods A narrative mini-review was performed in November 2018 using PubMed, Scopus, EMBASE, and Web of Science databases utilizing the following search phrase: “indocyanine green fluorescence robotic Surgery” resulting in 104 articles of which 30 articles had Urologic-pertinent applications. All 30 articles, and the references within, were reviewed and judged for scientific integrity and merit. Articles with non-novel findings or similar conclusions to original papers were omitted. Results ICG does not have a Urologic FDA indication, though it has been used off-label for Urologic Surgery since 2006. Fluorescence-augmented Surgery with ICG can facilitate oncologic Surgery in the adrenal gland, kidney, bladder, prostate, and retroperitoneum, in addition to lymph node dissection for various malignant pathologies. ICG-NIRF can enhance non-oncologic Surgery including ureterolysis, ureteroureterostomy, ureteral re-implantation, pyeloplasty, and urinary diversion in both the adult and pediatric populations. Conclusions Although it is not necessary to utilize fluorescence-enhanced Surgery in all cases, the authors find the utilization of ICG-NIRF in complex and highly technical surgeries useful.
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cost effectiveness and robot assisted Urologic Surgery does it make dollars and sense
The Italian journal of urology and nephrology, 2017Co-Authors: Ryan W Dobbs, Ashok K. Hemal, Brenden P Magnan, Nikita Abhyankar, Ben Challacombe, Prokar Dasgupta, Francesco Porpiglia, Simone CrivellaroAbstract:Introduction The introduction of the robotic surgical platform has led to distinct changes in practice patterns and the utilization of minimally invasive Surgery in urology. While use of the robotic system is associated with improvements in perioperative outcomes such as estimated blood loss and hospital stay, there are significant fixed and variable costs with the purchase, maintenance and use of the robotics system that has led many authors to investigate the cost effectiveness of robotic Urologic Surgery. We sought to examine the best current available evidence for the cost effectiveness of robotic Urologic Surgery. Evidence acquisition Comprehensive electronic literature searches were conducted without language restriction to identify reports of published studies within PubMed/Medline, SCOPUS and Web of Science. Relevant articles were examined and reference lists cross referenced to find additional pertinent publications. Evidence synthesis PubMed literature searches of "robot urology cost" (304 articles) "robotic prostatectomy cost" (215 articles), "robotic nephrectomy cost" (87 articles), "robotic cystectomy cost" (44 articles) and "robotic pyeloplasty cost" (41 articles) were initially reviewed in abstract form to find appropriate articles for inclusion. Given that robotic cystectomy (559 articles), robotic pyeloplasty (344 articles) robotic retroperitoneal lymph node dissection (59 articles) are less frequently performed than robotic prostatectomy, all available articles published from January 1st 2000 until July 31st 2016 were reviewed for potential inclusion. After excluding duplicates, appropriate articles were pulled for full text review. 49 articles were used for the final analysis. Conclusions The available literature on the cost effectiveness of robotic Urologic Surgery is somewhat limited by heterogeneity of research methods, local cost variations and methods for determining costs associated with surgical outcomes. The introduction of the robotic surgical platform has led to a dramatic change in the availability and utilization of laparoscopic Surgery and is associated with both favorable perioperative outcomes as well as significantly greater fixed costs related to instrumentation and equipment expenses. Well-designed trials comparing open and robotic approaches in the contemporary era of widespread robotic adoption with quality of life and validated economic metrics will be necessary to provide evidence for continued use of this valuable technology.
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robot assisted Urologic Surgery in 2010 advancements and future outlook
Urology Annals, 2011Co-Authors: Paurush Babbar, Ashok K. HemalAbstract:Robotic Surgery is a cutting edge and minimally invasive procedure, which has generated a great deal of excitement in the Urologic community. While there has been much advancement in this emerging technology, it is safe to say that robotic Urologic Surgery holds tremendous potential for progress in the near future. Hence, it is paramount that urologists stay up-to-date regarding new developments in the realm of robotics with respect to novel applications, limitations and opportunities for incorporation into their practice. Robot-assisted Surgery provides an enhanced 3D view, increased magnification of the surgical field, better manual dexterity, relatively bloodless field, elimination of surgeon's tremor, reduction in a surgeon's fatigue and mitigation of scattered light. All these factors translate into greater precision of surgical dissection, which is imperative in providing better intraoperative and postoperative outcomes. Pioneering work assessing the feasibility of robotic Surgery in urology began in the early 2000's with robot-assisted radical prostatectomy and has since expanded to procedures such as robot-assisted radical cystectomy, robot-assisted partial nephrectomy, robot-assisted nephroureterectomy and robot-assisted pyeloplasty. A MEDLINE search was used to identify recent articles (within the last two years) and publications of specific importance, which highlighted the recent developments and future direction of robotics. This review will use the aforementioned Urologic surgeries as vehicles to evaluate the current status and future role of robotics in the advancement of the field of urology.
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robotics in urology
Current Opinion in Urology, 2004Co-Authors: Ashok K. Hemal, Mani MenonAbstract:Purpose of reviewRobotic Urologic Surgery, an exciting and new emerging frontier in the field of urology, has tremendous potential to progress in the future. It is important, therefore, that urologists keep abreast of the new technologies, their limitations, and the possibility of incorporating them
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Robot-Assisted (Da Vinci) Urologic Surgery: An Emerging Frontier
Recent Advances in Endourology, 1Co-Authors: Ashok K. Hemal, Mani MenonAbstract:Robotic Urologic Surgery is an interesting and new development in the field of urology that has tremendous possibilities for progress in the future. Reports from various centers worldwide of complex Urologic procedures in humans performed with robotic assistance have documented their safety, efficacy, efficiency, and feasibility. This review attempts to define the incorporation of robotics into laparoscopic Urologic Surgery and also reflects on our experience with over 900 cases of robotic Surgery. Most of the recent reports pertaining to robotic Surgery have been in the domain of localized cancer of the prostate (radical prostatectomy), bladder cancer (radical cystectomy and urinary diversion for muscle-invasive bladder cancer), kidney Surgery (nephrectomy, donor nephrectomy, and pyeloplasty), and adrenal Surgery. There are also reports in other areas of urology such as male infertility.
Francesco Porpiglia - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness and robot assisted Urologic Surgery does it make dollars and sense
The Italian journal of urology and nephrology, 2017Co-Authors: Ryan W Dobbs, Ashok K. Hemal, Brenden P Magnan, Nikita Abhyankar, Ben Challacombe, Prokar Dasgupta, Francesco Porpiglia, Simone CrivellaroAbstract:Introduction The introduction of the robotic surgical platform has led to distinct changes in practice patterns and the utilization of minimally invasive Surgery in urology. While use of the robotic system is associated with improvements in perioperative outcomes such as estimated blood loss and hospital stay, there are significant fixed and variable costs with the purchase, maintenance and use of the robotics system that has led many authors to investigate the cost effectiveness of robotic Urologic Surgery. We sought to examine the best current available evidence for the cost effectiveness of robotic Urologic Surgery. Evidence acquisition Comprehensive electronic literature searches were conducted without language restriction to identify reports of published studies within PubMed/Medline, SCOPUS and Web of Science. Relevant articles were examined and reference lists cross referenced to find additional pertinent publications. Evidence synthesis PubMed literature searches of "robot urology cost" (304 articles) "robotic prostatectomy cost" (215 articles), "robotic nephrectomy cost" (87 articles), "robotic cystectomy cost" (44 articles) and "robotic pyeloplasty cost" (41 articles) were initially reviewed in abstract form to find appropriate articles for inclusion. Given that robotic cystectomy (559 articles), robotic pyeloplasty (344 articles) robotic retroperitoneal lymph node dissection (59 articles) are less frequently performed than robotic prostatectomy, all available articles published from January 1st 2000 until July 31st 2016 were reviewed for potential inclusion. After excluding duplicates, appropriate articles were pulled for full text review. 49 articles were used for the final analysis. Conclusions The available literature on the cost effectiveness of robotic Urologic Surgery is somewhat limited by heterogeneity of research methods, local cost variations and methods for determining costs associated with surgical outcomes. The introduction of the robotic surgical platform has led to a dramatic change in the availability and utilization of laparoscopic Surgery and is associated with both favorable perioperative outcomes as well as significantly greater fixed costs related to instrumentation and equipment expenses. Well-designed trials comparing open and robotic approaches in the contemporary era of widespread robotic adoption with quality of life and validated economic metrics will be necessary to provide evidence for continued use of this valuable technology.
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padua and r e n a l nephrometry scores correlate with perioperative outcomes of robot assisted partial nephrectomy analysis of the vattikuti global quality initiative in robotic Urologic Surgery gqi rus database
BJUI, 2017Co-Authors: Riccardo Schiavina, Prokar Dasgupta, Francesco Porpiglia, Giacomo Novara, Rajesh Ahlawat, Benjamin Challacombe, Daniel Moon, Marco Borghesi, Vincenzo Ficarra, Eugenio BrunocillaAbstract:Objectives To evaluate and compare the correlations between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) and R.E.N.A.L. [Radius (tumour size as maximal diameter), Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior (a)/posterior (p) descriptor and the Location relative to the polar line] nephrometry scores and perioperative outcomes and postoperative complications in a multicentre, international series of patients undergoing robot-assisted partial nephrectomy (RAPN) for masses suspicious for renal cell carcinoma (RCC). Patients and Methods We retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international centres that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. All patients underwent preoperative computed tomography or magnetic resonance imaging to define the clinical stage and anatomical characteristics of the tumours. PADUA and R.E.N.A.L. scores were retrospectively assessed in each centre. Univariate and multivariate analyses were used to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumour size, PADUA and R.E.N.A.L. complexity group categories and warm ischaemia time (WIT) of >20 min, urinary calyceal system closure, and grade of postoperative complications. Results Overall, 277 patients were evaluated. The median (interquartile range) tumour size was 33.0 (22.0–43.0) mm. The median PADUA and R.E.N.A.L. scores were eight and seven, respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low-, intermediate- or high-complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low-, intermediate- or high-complexity group according to R.E.N.A.L. score, respectively. Both nephrometry tools significantly correlated with perioperative outcomes at univariate and multivariate analyses. Conclusion A precise stratification of patients before PN is recommended to consider both the potential threats and benefits of nephron-sparing Surgery. In our present analysis, both PADUA and R.E.N.A.L. were significantly associated with predicting prolonged WIT and high-grade postoperative complications after RAPN.
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current applications of near infrared fluorescence imaging in robotic Urologic Surgery a systematic review and critical analysis of the literature
Urology, 2014Co-Authors: Riccardo Autorino, Homayoun Zargar, Wesley M White, Giacomo Novara, F Annino, Sisto Perdona, Michele De Angelis, A Mottrie, Francesco PorpigliaAbstract:Herein, we provide a systematic review and critical analysis of the current evidence on the applications of near-infrared fluorescence in robotic Urologic Surgery. Article selection proceeded according to Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Overall, 14 studies were identified and included. Indocyanine green fluorescence imaging system has been tested for several applications, robotic partial nephrectomy representing the most studied one. Available evidence suggests this technology can be of aid in visually defining the surgical anatomy, thus ultimately facilitating the task of the console surgeon. Whether the added cost is justified by better outcomes remains to be determined.
Giacomo Novara - One of the best experts on this subject based on the ideXlab platform.
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padua and r e n a l nephrometry scores correlate with perioperative outcomes of robot assisted partial nephrectomy analysis of the vattikuti global quality initiative in robotic Urologic Surgery gqi rus database
BJUI, 2017Co-Authors: Riccardo Schiavina, Prokar Dasgupta, Francesco Porpiglia, Giacomo Novara, Rajesh Ahlawat, Benjamin Challacombe, Daniel Moon, Marco Borghesi, Vincenzo Ficarra, Eugenio BrunocillaAbstract:Objectives To evaluate and compare the correlations between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) and R.E.N.A.L. [Radius (tumour size as maximal diameter), Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior (a)/posterior (p) descriptor and the Location relative to the polar line] nephrometry scores and perioperative outcomes and postoperative complications in a multicentre, international series of patients undergoing robot-assisted partial nephrectomy (RAPN) for masses suspicious for renal cell carcinoma (RCC). Patients and Methods We retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international centres that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. All patients underwent preoperative computed tomography or magnetic resonance imaging to define the clinical stage and anatomical characteristics of the tumours. PADUA and R.E.N.A.L. scores were retrospectively assessed in each centre. Univariate and multivariate analyses were used to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumour size, PADUA and R.E.N.A.L. complexity group categories and warm ischaemia time (WIT) of >20 min, urinary calyceal system closure, and grade of postoperative complications. Results Overall, 277 patients were evaluated. The median (interquartile range) tumour size was 33.0 (22.0–43.0) mm. The median PADUA and R.E.N.A.L. scores were eight and seven, respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low-, intermediate- or high-complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low-, intermediate- or high-complexity group according to R.E.N.A.L. score, respectively. Both nephrometry tools significantly correlated with perioperative outcomes at univariate and multivariate analyses. Conclusion A precise stratification of patients before PN is recommended to consider both the potential threats and benefits of nephron-sparing Surgery. In our present analysis, both PADUA and R.E.N.A.L. were significantly associated with predicting prolonged WIT and high-grade postoperative complications after RAPN.
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robot assisted partial nephrectomy in cystic tumours analysis of the vattikuti global quality initiative in robotic Urologic Surgery gqi rus database
BJUI, 2016Co-Authors: Giacomo Novara, Prokar Dasgupta, Sabrina La Falce, Ronney Abaza, James M Adshead, Rajesh Ahlawat, Nicolomaria Buffi, Benjamin Challacombe, Daniel Moon, Dipen J ParekhAbstract:Objective To evaluate the outcomes of robot-assisted partial nephrectomy (RAPN) in cystic tumours, analysing a large, multi-institutional, retrospective series of RAPN, as limited data are available about the outcome of RAPN in cystic tumours. Patients and Methods We evaluated 465 patients who received RAPN for either cystic or solid tumours from 2010 to 2013 and included in the multi-institutional, retrospective Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. Univariable and multivariable linear and logistic regression models addressed the association of cystic tumours with perioperative outcomes. Results In all, 54 (12%) tumours were cystic. Cystic tumours were associated with significantly lower operative time (t −3.9; P < 0.001), once adjusted for the effect of covariates, whereas blood loss and warm ischaemia time were similar. Postoperative any grade complications were recorded in 66 solid (16%) and nine cystic (17%) tumours (P = 0.08). In multivariable analysis, cystic tumours were not associated with a significantly lower risk of any grade postoperative complications [odds ratio (OR) 0.9; P = 0.8]. Similarly, presence of tumours with cystic features was not associated with a significantly different risk of high-grade postoperative complications (OR 2.2; P = 0.1). Prevalence of cancer histology and positive surgical margin rates were similar in cystic and solid tumours. Cystic tumours were not associated with significantly different postoperative estimated glomerular filtration rate (t 0.4; P = 0.7), once adjusted for the effect of covariates. Conclusions RAPN can be performed in cystic renal tumours with perioperative, pathological, and functional outcomes similar to those achievable in solid tumours.
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current applications of near infrared fluorescence imaging in robotic Urologic Surgery a systematic review and critical analysis of the literature
Urology, 2014Co-Authors: Riccardo Autorino, Homayoun Zargar, Wesley M White, Giacomo Novara, F Annino, Sisto Perdona, Michele De Angelis, A Mottrie, Francesco PorpigliaAbstract:Herein, we provide a systematic review and critical analysis of the current evidence on the applications of near-infrared fluorescence in robotic Urologic Surgery. Article selection proceeded according to Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Overall, 14 studies were identified and included. Indocyanine green fluorescence imaging system has been tested for several applications, robotic partial nephrectomy representing the most studied one. Available evidence suggests this technology can be of aid in visually defining the surgical anatomy, thus ultimately facilitating the task of the console surgeon. Whether the added cost is justified by better outcomes remains to be determined.
Mani Menon - One of the best experts on this subject based on the ideXlab platform.
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robotics in urology
Current Opinion in Urology, 2004Co-Authors: Ashok K. Hemal, Mani MenonAbstract:Purpose of reviewRobotic Urologic Surgery, an exciting and new emerging frontier in the field of urology, has tremendous potential to progress in the future. It is important, therefore, that urologists keep abreast of the new technologies, their limitations, and the possibility of incorporating them
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Robot-Assisted (Da Vinci) Urologic Surgery: An Emerging Frontier
Recent Advances in Endourology, 1Co-Authors: Ashok K. Hemal, Mani MenonAbstract:Robotic Urologic Surgery is an interesting and new development in the field of urology that has tremendous possibilities for progress in the future. Reports from various centers worldwide of complex Urologic procedures in humans performed with robotic assistance have documented their safety, efficacy, efficiency, and feasibility. This review attempts to define the incorporation of robotics into laparoscopic Urologic Surgery and also reflects on our experience with over 900 cases of robotic Surgery. Most of the recent reports pertaining to robotic Surgery have been in the domain of localized cancer of the prostate (radical prostatectomy), bladder cancer (radical cystectomy and urinary diversion for muscle-invasive bladder cancer), kidney Surgery (nephrectomy, donor nephrectomy, and pyeloplasty), and adrenal Surgery. There are also reports in other areas of urology such as male infertility.
Riccardo Autorino - One of the best experts on this subject based on the ideXlab platform.
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a novel robotic system for single port Urologic Surgery first clinical investigation
European Urology, 2014Co-Authors: Jihad H Kaouk, Riccardo Autorino, Georgespascal Haber, Sebastien Crouzet, A Ouzzane, V Flamand, Arnauld VillersAbstract:Abstract Background The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery. Objective To determine the clinical feasibility and safety of single-port Urologic procedures by using a novel robotic surgical system. Design, setting, and participants This was a prospective institutional review board–approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major Urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. Intervention Different types of Urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port. Outcome measurements and statistical analysis The main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes. Results and limitations A total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38min. At 3-yr follow-up all patients presented a preserved renal function; none had tumor recurrence. Study limitations include the small sample and the lack of a control group. Conclusions We describe the first clinical application of a novel robotic platform specifically designed for single-port Urologic Surgery. Major Urologic procedures were successfully completed without conversions. Further assessment is warranted to corroborate these promising findings. Patient summary A novel purpose-built robotic system enables surgeons to perform safely and effectively a variety of major Urologic procedures through a single small abdominal incision. Trial registration The study was registered on www.ClinicalTrials.gov (NCT02136121).
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current applications of near infrared fluorescence imaging in robotic Urologic Surgery a systematic review and critical analysis of the literature
Urology, 2014Co-Authors: Riccardo Autorino, Homayoun Zargar, Wesley M White, Giacomo Novara, F Annino, Sisto Perdona, Michele De Angelis, A Mottrie, Francesco PorpigliaAbstract:Herein, we provide a systematic review and critical analysis of the current evidence on the applications of near-infrared fluorescence in robotic Urologic Surgery. Article selection proceeded according to Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Overall, 14 studies were identified and included. Indocyanine green fluorescence imaging system has been tested for several applications, robotic partial nephrectomy representing the most studied one. Available evidence suggests this technology can be of aid in visually defining the surgical anatomy, thus ultimately facilitating the task of the console surgeon. Whether the added cost is justified by better outcomes remains to be determined.
