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MP-06.02: Robotic equipment malfunction during robotic prostatectomy: a multi-institutional study
MODERATED POSTER SESSIONS
during a daVinci prostatectomy to identify the neurovascular bundles. Confirmation of nerve preservation was demonstrated during and at the completion of nerve sparing by intact nerve action potentials. Conclusions: By measuring nerve action potentials, a surgeon can identify the neurovascular bundles in real time without having to wait for a tumescence response in the end organ. The author recognizes that although this device and method may assist in identifying the neurovascular bundle, it is too early to make the conclusion that this device improves erectile function. However, it is the author’s belief that the ability to easily and efficiently identify the neurovascular bundles has potential benefits including allowing for a wider resection in the case of more aggressive disease while still preserving some neurovascular tissue. In addition, this technique and device may allow surgeons who are less experienced in nerve sparing, to offer their patients the potential for improved sexual function outcomes. MP-06.02 Robotic equipment malfunction during robotic prostatectomy: a multiinstitutional study Lavery HJ1, Ahlering T2, Tewari A3, Smith JA4, Shalhav A5, Albala D6, Wiklund P7, Costello AJ8, Palmer KJ1, Shah K1, Thaly R1, Patel V1 1 Center for Robotic and Computer-Assisted Surgery, The Ohio State University; 2 University of California at Irvine, CA; 3 Cornell University, NY; 4Vanderbilt University, TN; 5University of Chicago, IL; 6 Duke University, NC; 7Karolinska Institutet, Sweden; 8University of Melbourne, Australia Introduction: Robotic-assisted laparoscopic prostatectomy (RALP) is growing in popularity and questions regarding the safety and reliability of the robotic system have arisen. Intraoperative system malfunction may lead conversion to open, laparoscopic or even abortion of the procedure. We report the first large scale, multi-institutional review of robotic system malfunction. Methods: High volume, experienced robotic surgeons completed a questionnaire based upon retrospective analysis of their data. Malfunctions were sub-categorized as critical or recoverable system failures and part of system malfunction. Results: A total of 6426 cases from 9 institutions participated in the study. Median surgeon experience was 460 cases
(325-1500). Critical and recoverable failures occurred in 20 and 124 cases, respectively, causing the cancellation of ten cases and conversion to 1 laparoscopic and 9 open procedures. The robotic optical system and surgical arms were the most common sites of equipment malfunction. Conclusions: System malfunction is extremely rare in institutions performing high volume RALPs and although technical problems can occur, they do not seem to greatly affect the completion of the operation. Abstract Withdrawn MP-06.04 Hem-o-lok polymer ligating clip for vascular control of the renal pedicle: points of controversy Izaki H, El-Moula MG, Fukumori T, Takahashi M, Taue R, Kishimoto T, Kagawa S, Kanayama H Department of Urology, Institute of Health Bioscience the University of Tokushima Graduate School, Tokushima, Japan Introduction: Hem-o-lok clips have been routinely used for the control of the renal pedicle during laparoscopic nephrectomy in many institutions. We evaluated its cost-effectiveness and whether the safety vascular cuff that was left after vessels transection influence the occurrence of serious vascular complications. Material & Method: Since April 2004, we used Hem-o-lok clips to control the renal pedicle in 100 laparoscopic nephrectomies. We used one XL pack (6 clips) in case of one renal artery and 2 (XL and L) in case of multiple renal arteries. Two clips were placed on the patient side and 1 clip on the specimen side. We measured the safety vasucular cuff after transection of both the artery and the vein. Result: Vascular control using Hem-o-lok clips was successful in all cases without any slipping of clips by follow-up CT or uncontrolled bleeding. The malfunction of Hem-o-lok clips occurred in only one case in which the renal artery could not be ligated because the locking tip of the clip has been broken in the setting applier. The mean safety cuff of the right artery was 2.35⫾0.52 mm (range,2-4 mm) and it was significantly longer than that of the right vein ( mean, 1.21⫾0.83 mm and range, 0-3 mm), p⬍0.0001. The mean safety cuff of the left artery was 2.32⫾0.60 mm ( range, 1-4 mm) and it was significantly longer than that of the
UROLOGY 70 (Supplment 3A), September 2007
left vein (mean, 1.98⫾0.60 mm and range, 0-3 mm), p⬍0.014. In addition, the mean renal vein cuff on the left side was significantly longer than that of the right side (p⬍0.0001). Surprisingly, 13 veins had less than 1 mm vascular cuff. Using Hemo-lok clips markedly decreases the operative cost of renal vein ligation by ⬎90% compared to endovascular GIA stapling (US$30 for 3 Hem-o-lok clips vs. US$409 for GIA). Conclusions: The safety vascular cuff of the renal vein was shorter than expected, however, using 2 clips on the patient side of the vessels is mandatory. The Hem-olok is a reliable and economical device for vascular control in laparoscopic renal surgery. MP-06.05 Laparoscopic partial cystectomy for malignant and benign bladder conditions Kinoshita H, Kawa G, Yasuda K, Kawakita S, Hiura Y, Muguruma K, Yoshida K, Masuda T, Murota T, Matsuda T Kansai Medical University, Osaka, Japan Introduction: Many urologic operations conventionally conducted by open operation are currently performed under laparoscopy. We presented our experience of the laparoscopic partial cystectomy for benign and malignant conditions of bladder. Methods: We performed laparoscopic partial cystectomy in 4 patients who were diagnosed as inflammatory psuedotumor, leiomyoma, urachal abscess and urachal cancer. Trans-peritoneal and retroperitoneal approaches were chosen according to the tumor site. Four or five ports including a camera port were used. After the bladder was fully mobilized, incision line was monitored by flexible cystoscopy. In the case of urachal cancer, enblock resection of urachus and peritoneum was performed. In order to minimize urine leakage, we used EndoGIA when partial cystectomy was performed (non-spillage technique) in the operation of urachal cancer. Results: Operation time was from 195 to 510 min. Blood loss was less than 100 ml except one case. Post-operative course was uneventful in all 4 cases with minimum use of analgesia. Pathologic findings showed a negative surgical margin in three neoplasm cases. At three months after the operation the capacity of bladder was more than 300ml and no urinary symptoms were observed. No recurrence was observed in all cases. Conclusion: Although the indication of
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during a daVinci prostatectomy to identify the neurovascular bundles. Confirmation of nerve preservation was demonstrated during and at the completion of nerve sparing by intact nerve action potentials. Conclusions: By measuring nerve action potentials, a surgeon can identify the neurovascular bundles in real time without having to wait for a tumescence response in the end organ. The author recognizes that although this device and method may assist in identifying the neurovascular bundle, it is too early to make the conclusion that this device improves erectile function. However, it is the author’s belief that the ability to easily and efficiently identify the neurovascular bundles has potential benefits including allowing for a wider resection in the case of more aggressive disease while still preserving some neurovascular tissue. In addition, this technique and device may allow surgeons who are less experienced in nerve sparing, to offer their patients the potential for improved sexual function outcomes. MP-06.02 Robotic equipment malfunction during robotic prostatectomy: a multiinstitutional study Lavery HJ1, Ahlering T2, Tewari A3, Smith JA4, Shalhav A5, Albala D6, Wiklund P7, Costello AJ8, Palmer KJ1, Shah K1, Thaly R1, Patel V1 1 Center for Robotic and Computer-Assisted Surgery, The Ohio State University; 2 University of California at Irvine, CA; 3 Cornell University, NY; 4Vanderbilt University, TN; 5University of Chicago, IL; 6 Duke University, NC; 7Karolinska Institutet, Sweden; 8University of Melbourne, Australia Introduction: Robotic-assisted laparoscopic prostatectomy (RALP) is growing in popularity and questions regarding the safety and reliability of the robotic system have arisen. Intraoperative system malfunction may lead conversion to open, laparoscopic or even abortion of the procedure. We report the first large scale, multi-institutional review of robotic system malfunction. Methods: High volume, experienced robotic surgeons completed a questionnaire based upon retrospective analysis of their data. Malfunctions were sub-categorized as critical or recoverable system failures and part of system malfunction. Results: A total of 6426 cases from 9 institutions participated in the study. Median surgeon experience was 460 cases
(325-1500). Critical and recoverable failures occurred in 20 and 124 cases, respectively, causing the cancellation of ten cases and conversion to 1 laparoscopic and 9 open procedures. The robotic optical system and surgical arms were the most common sites of equipment malfunction. Conclusions: System malfunction is extremely rare in institutions performing high volume RALPs and although technical problems can occur, they do not seem to greatly affect the completion of the operation. Abstract Withdrawn MP-06.04 Hem-o-lok polymer ligating clip for vascular control of the renal pedicle: points of controversy Izaki H, El-Moula MG, Fukumori T, Takahashi M, Taue R, Kishimoto T, Kagawa S, Kanayama H Department of Urology, Institute of Health Bioscience the University of Tokushima Graduate School, Tokushima, Japan Introduction: Hem-o-lok clips have been routinely used for the control of the renal pedicle during laparoscopic nephrectomy in many institutions. We evaluated its cost-effectiveness and whether the safety vascular cuff that was left after vessels transection influence the occurrence of serious vascular complications. Material & Method: Since April 2004, we used Hem-o-lok clips to control the renal pedicle in 100 laparoscopic nephrectomies. We used one XL pack (6 clips) in case of one renal artery and 2 (XL and L) in case of multiple renal arteries. Two clips were placed on the patient side and 1 clip on the specimen side. We measured the safety vasucular cuff after transection of both the artery and the vein. Result: Vascular control using Hem-o-lok clips was successful in all cases without any slipping of clips by follow-up CT or uncontrolled bleeding. The malfunction of Hem-o-lok clips occurred in only one case in which the renal artery could not be ligated because the locking tip of the clip has been broken in the setting applier. The mean safety cuff of the right artery was 2.35⫾0.52 mm (range,2-4 mm) and it was significantly longer than that of the right vein ( mean, 1.21⫾0.83 mm and range, 0-3 mm), p⬍0.0001. The mean safety cuff of the left artery was 2.32⫾0.60 mm ( range, 1-4 mm) and it was significantly longer than that of the
UROLOGY 70 (Supplment 3A), September 2007
left vein (mean, 1.98⫾0.60 mm and range, 0-3 mm), p⬍0.014. In addition, the mean renal vein cuff on the left side was significantly longer than that of the right side (p⬍0.0001). Surprisingly, 13 veins had less than 1 mm vascular cuff. Using Hemo-lok clips markedly decreases the operative cost of renal vein ligation by ⬎90% compared to endovascular GIA stapling (US$30 for 3 Hem-o-lok clips vs. US$409 for GIA). Conclusions: The safety vascular cuff of the renal vein was shorter than expected, however, using 2 clips on the patient side of the vessels is mandatory. The Hem-olok is a reliable and economical device for vascular control in laparoscopic renal surgery. MP-06.05 Laparoscopic partial cystectomy for malignant and benign bladder conditions Kinoshita H, Kawa G, Yasuda K, Kawakita S, Hiura Y, Muguruma K, Yoshida K, Masuda T, Murota T, Matsuda T Kansai Medical University, Osaka, Japan Introduction: Many urologic operations conventionally conducted by open operation are currently performed under laparoscopy. We presented our experience of the laparoscopic partial cystectomy for benign and malignant conditions of bladder. Methods: We performed laparoscopic partial cystectomy in 4 patients who were diagnosed as inflammatory psuedotumor, leiomyoma, urachal abscess and urachal cancer. Trans-peritoneal and retroperitoneal approaches were chosen according to the tumor site. Four or five ports including a camera port were used. After the bladder was fully mobilized, incision line was monitored by flexible cystoscopy. In the case of urachal cancer, enblock resection of urachus and peritoneum was performed. In order to minimize urine leakage, we used EndoGIA when partial cystectomy was performed (non-spillage technique) in the operation of urachal cancer. Results: Operation time was from 195 to 510 min. Blood loss was less than 100 ml except one case. Post-operative course was uneventful in all 4 cases with minimum use of analgesia. Pathologic findings showed a negative surgical margin in three neoplasm cases. At three months after the operation the capacity of bladder was more than 300ml and no urinary symptoms were observed. No recurrence was observed in all cases. Conclusion: Although the indication of
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