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and minilaparoscopy ML are still lacking. We present the first prospective double-blind randomized study to compare between LESS and ML for treatment of different upper urinary tract pathologies. METHODS: During the period of January 2013 and June 2015, patients with different upper urinary pathologies who were candied for laparoscopic surgical intervension were blindly randomized to both LESS and CL. ML was done by 3-mm instruments; including 3-mm laparoscope. All procedures were done by a single experienced laparoscopist. Exclusion criteria included children less than 3 years and absolute contraindications of laparoscopy. Both groups were compared regarding patients demographic data, operative time, intraoperative and postoperative complications, estimated blood loss (EBL), hospital stay, analgesic requirement, visual analogue pain scale (VAS) on discharge and cosmetic outcome. Cosmetic outcome was assessed at 6 months postoperatively using the patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS: Included were 60 patients with mean age of 40.7
9.2 years and 39.6
16.7 years both in LESS and ML, respectively. Mean BMI was 29.5
3.4 and 28.6
4.37 kg/m2 in LESS and ML groups, respectively. In LESS group there were 2 adrenalectomies, 9 nephrectomies (5 simple and 4 radical), 9 pyeloplasties and 9 cyst marsuplizations and a case of retrocaval ureter. While in ML group there were 3 adrenalectomies, 9 nephrectomies (5 simple and 4 radical), 9 pyeloplasties and 9 cyst marsuplizations. Operative time in LESS was 167
24 min which was longer than that of ML group (145
39 min) but statistically insignificant. EBL in LESS was 59
34 ml Vs 43
42 ml in ML and the difference was statistically insignificant. VAS was significantly less in LESS group (1.7
0.6 in LESS and 2.8
0.5 in ML). In LESS group, PSAS was 5.9
0.85 while OSAS was 10.6
1.98. Meanwhile, In ML group, PSAS was 8.9
0.9 and OSAS 13.5
6.3. The difference was statistically significant. There were no intra-operative complications in both groups. Postoperative complications were reported in 6.6% and 3.3% both in LESS and ML groups; respectively. Mean hospital stay was 1.8
1.3 days in LESS Vs 2.1
0.8 days in ML. Mean analgesic requirements in the post-operative period was 151.7
35.6 mg of Diclofenac Na in LESS Vs 169.7
47.3 mg in ML. There were no conversions to either open surgery or conventional laparoscopy in both groups. 5-mm extra port was added in 4 cases of LESS. Meanwhile, in ML group we used a 10-mm port in 12 cases in order to use the Hem-O-lock clip applier. CONCLUSIONS: Both LESS and ML are feasible and safe options for treatment of different upper urinary tract pathologies with comparable operative time, blood loss, hospital stay and complication rate. However, LESS is associated with less analgesic requirement and better cosmetic outcome. Each procedure has its own technical limitations. Source of Funding: none

MP23-17 IMPROVED OUTCOMES DURING ROBOTIC PROSTATECTOMY UTILIZING AIRSEAL TECHNOLOGY Mona Yezdani*, Sue-Jean Yu, Alexandra Lee, Benjamin Taylor, Alice McGill, Kelly Monahan, David Lee, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Airseal is a newer technology utilizing an integrated access system during minimally invasive surgery. Its goal is to provide stable pneumoperitoneum and continuous smoke evacuation. A few small volume studies have compared Airseal to the standard multi-component insufflation system and have shown an improvement in stable pneumoperitoneum and ease of manipulating objects through the Airseal port. In this study, we compare the standard system to the Airseal system to evaluate potential benefits in a larger cohort. METHODS: We performed a single-institution, single-surgeon prospective study of 149 consecutive patients who underwent robotic

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prostatectomy from June 2014 to April 2015. Gas insufflation with CO2 was performed using either standard multi-component insufflation with a 12mm Covidien Versaport bladeless trocar from June 2014 to October 2014 or with Airseal system from November 2014 to April 2015. Multiple data points were assessed including total operative time, estimated blood loss, length of stay, and pain score at 0-6 hours, 6-12 hours, 1218 hours. RESULTS: 149 patients were analyzed with 79 in the control arm and 70 in the study arm. There was no significant difference between the study and control groups in mean age (62 vs. 61) or BMI (28 vs. 27). A significant difference was seen in total operative time with 146 minutes in the Airseal group and 167 minutes in the control (p¼0.0002) and in intraoperative blood loss with mean of 132 ml in Airseal group versus 215 ml in the control (p¼.0031). Pain scores for time 6-12 hours were significantly lower (3.3 vs. 4.1) in the Airseal group compared to the control but were not significant for 0-6 or 6-18 hours (1.9 vs. 2.4 and 2.9 vs. 3.6, respectively). However, across all times, the numerical level given for pain was always less with Airseal. CONCLUSIONS: This prospective study shows an advantage to using Airseal compared to standard insufflation. There is significantly less operative time, intraoperative blood loss, and pain scores at 6-12 hours. This is most likely attributable to the stable pneumoperitoneum and improved visibility without the need for bedside interruption with suction or cleaning of the camera. Improved pain scores may be associated with the stable pneumoperitoneum without intermittent stretching of the muscles and incisions. Thus, the results of this study show that Airseal can be advantageous during robotic prostatectomy. Further larger volume studies are required to assess for the utility of Airseal in all robotic procedures. Source of Funding: None

MP23-18 INTER-HOSPITAL TELEMENTORING FOR ROBOTIC SURGERY Thomas G. Clifford*, Daoud Dajani, Peter Khooshabeh, Eric Hwang, Mihir M. Desai, Inderbir S. Gill, Andrew J. Hung, Los Angeles, CA INTRODUCTION AND OBJECTIVES: We had demonstrated that remote telementoring can be performed within a medical campus. We describe the second phase of our study, where we evaluate the feasibility and technical requirements of telementoring over a greater distance. METHODS: Via a secure virtual private network link, we connected a robotic telementor (AJH) at Keck Hospital of USC with a surgeon operating at a center 48 miles away. We randomized the connection to bandwidths of 3200 Mb/s or 800 Mb/s and compared technical data. Expert robotic surgeons (75 console cases) also reviewed and quality rated recorded video of steps performed remotely. Anchors for the assessment of these video clips are shown (Figure). Still images from remote cases were further analyzed using an image quality assessment computational algorithm. The model uses spatial and spectral entropy to classify the extent of image distortion; performance of the computational model is also correlated with human perceptual ratings of image quality. T-test and chi square analyses were used to compare image quality assessment (IQA) scores, technical data, and expert assessments. RESULTS: We connected to 11 prostatectomies and 2 nephrectomies. A total of 8 and 5 cases were proctored at the high/low bandwidths, respectively. Connection time was not significantly different on the different bandwidths (p¼0.33). Latency (ms) and number of data packets lost were significantly lower on the high bandwidth (p<0.004). Experts gave 98.7% of high bandwidth clips a visual score of 3 compared to 22.5% of low bandwidth clips (p<0.001) (Figure). 98.7% and 11.3% of high and low bandwidth clips, respectively, received procedure scores of 3 (p<0.001). When asked what step of the operation was shown, more incorrect answers were

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provided for low bandwidth clips (p<0.001). IQA scores that are closer to zero indicate that there are fewer distortions in an image. The IQA computational algorithm suggested that high bandwidth images were less distorted (M¼46.9) compared to low bandwidth images (M¼57.8, p¼0.045). CONCLUSIONS: This ongoing study demonstrates the feasibility of a first step towards telementoring over greater geographic regions. A high bandwidth provides superior connection parameters, which translates to improved viewing and following of the telementor. Such an assessment is confirmed with an objective computational algorithm.

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RESULTS: Sealing time took 30-100 seconds (Mean 47). Blood loss was negligible. Hemoglobin and Creatinine levels were stable in all groups before and after the procedure. There were no unscheduled deaths, no systemic effects, no uncontrolled bleeding, no urine leakage and no re-operations. Histopathologic comparison of the Day 3 and Week 8 showed progression from acute to chronic tissue reactions, compatible with a foreign body response and a definite healing process. CONCLUSIONS: The LTW procedure was deemed to be safe resulting in an FDA human phase I study approval. Source of Funding: Supported by NIDDK Grant Number: R44 DK094619

MP23-20 BLUE LIGHT CYSTOSCOPY FOR DIAGNOSIS OF UROTHELIAL BLADDER CANCER: RESULTS FROM A PROSPECTIVE MULTICENTER REGISTRY Soroush T Bazargani*, Thomas G. Clifford, Hooman Djaladat, Anne Schuckman, Los Angeles, CA; Brian Willard, West Columbia, SC; Badrinath Konety, Minneapolis, MN; Siamak Daneshmand, Los Angeles, CA

Source of Funding: Intuitive research grant

MP23-19 SUTURELESS PARTIAL NEPHRECTOMY USING LASER TISSUE WELDING Gilad Amiel*, Haifa, Israel; Tung Shu, Yasmin Wadia, Houston, TX INTRODUCTION AND OBJECTIVES: Currently partial nephrectomy requires suture closure. The renal artery is clamped for up to 20 minutes or more to avoid bleeding and to allow closure of the kidney defect with sutures, resulting in renal ischemia and dysfunction. Sealing the resected surface of the kidney may considerably shorten ischemia time. Laser Tissue Welding (LTW) is a combination class III surgical device intended to join and seal tissues instantly. It uses thermal energy created when a laser excites photosensitive dye molecules to coagulate the protein albumin which transforms from a liquid to a solid instantly. METHODS: Preclinical GLP animal safety and efficacy testing in 24 domestic pigs out to 8 weeks was conducted to evaluate biocompatibility, safety and efficacy. D-Albumin Lamina and AlbuGreen Solder applied to seal the kidney of pigs after laparoscopic partial nephrectomy. Twenty-four pigs (12 males and 12 females) were assigned to two treatment groups. Six animals were terminated at 3 days and six at 8 weeks post-treatment from each group. Using laparoscopic procedures, the control group and the test group underwent temporary occlusion of the renal artery of one kidney and the test group also had one-third of the respective kidney resected. The surface area was sealed using the LTW method. The amount of solder used for each case was 5-8 ml. Biocompatibility, safety and efficacy of the LTW was assessed.

INTRODUCTION AND OBJECTIVES: Blue Light Cystoscopy (BLC) using hexaminolevulinate (Cysview) improves the detection of non-muscle invasive bladder cancer (NMIBC) compared to white light cystoscopy (WLC) alone. However, it is not approved for immediate post-BCG therapy or for repeat use. We report on our experience from the prospective Blue Light Cystoscopy with Cysview Registry and its utility in these scenarios. METHODS: Under IRB approval, we prospectively enrolled consecutive patients undergoing transurethral resection of bladder lesions into the registry at three different centers. Patients who refused catheter insertion (3) or were lost to follow up (7) were excluded from the study. RESULTS: A total of 548 separate lesions were identified from 220 BLC procedures on 175 patients at three different centers between April 2014 and Oct 2015. Mean age was 74 with 84% being male. 40 patients underwent repeat use (2-3). The sensitivity of WL, BL and the combination for any malignant lesion was 73%, 91% and 98% respectively. The addition of BL to standard WL cystoscopy increased the detection rate by 12% in any papillary lesions and 46% for CIS (Table 1). Within the WL negative group, an additional 82 lesions in 51 patients were detected uniquely with the addition of blue light. BL resulted in upgrading or upstaging of tumors in 18 (10%) patients of the whole cohort. Overall false-positive (FP) proportion was 21% for WL and 25% in BL (p¼0.96). 60 (34%) patients received BCG at least 6 weeks prior to BLC, with a positive predictive value (PPV) of 67% for malignancy (FP¼25%) (Figure 1). 46 biopsies were taken from margins of a previous resection site (with more than 6 weeks interval), wherein the PPV of BLC was 54% (FP¼28%). There were 8 (4.5%) minor complications after Cysview instillation (all mild irritative urinary symptoms), but no hypersensitivity reaction. 22 patients eventually underwent cystectomy, 2 (1.2%) of whom exclusively because of lesions detected by BLC. CONCLUSIONS: Our experience with a prospective registry confirms that BLC significantly increases detection rates of CIS and papillary lesions over WL cystoscopy alone. Prior BCG therapy appears to have no effect on BLC accuracy. Bluelight is very useful in detecting residual or recurrent malignancy at margins of prior resection and can result in upgrading or upstaging in a significant fraction of patients. Repeat use of Cysview for bluelight cystoscopy appears to be safe.