Critical appraisal of technical problems with robotic urological surgery

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To record the technical problems and complications associated with the use of da Vinci S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) and to review previous reports.

METHODS

We analysed our records for all machine‐ or instrument‐related errors during the course of 340 consecutive robot‐assisted urological operations at our centre from July 2006 to March 2009, using one robotic machine. The cause of the error (machine or human), troubleshooting methods and consequences of the errors were evaluated.

RESULTS

The overall device failure rate was 10.9% (37/340). The most frequent technical problems were related to robotic instruments (23/37). Other failures included colour/hue changes in the console image, intermittent double vision, fused illuminator bulb and problems with the master tool‐manipulator device (hand‐piece unit), patient cart circuitry, patient‐side manipulator arm, closed‐circuit camera unit or camera cable. Of 37 problems, 28 (76%) were surmountable during the course of surgery. The overall conversions to standard open/laparoscopic procedure attributable to mechanical failures of the robot were 0.6% (2/340). There were no complications or direct harm to the patient in any case. Most faults could be corrected or bypassed with some addition to operating room time.

CONCLUSIONS

Despite an association of various types of new technical problems with robotic surgery, it provides a safe mode of minimally invasive surgery with very low conversion rates attributable to it, and no direct patient injury.     

Evolving role of positron emission tomography (PET) in urological malignancy

We present a review on the increasing indications for the use of positron emission tomography (PET) in uro‐oncology. In this review we describe the details of the different types of PET scans, indications for requesting PET scans in specific urological malignancy and the interpretation of the results.     

无痛理念对泌尿外科门诊手术患者术后疼痛及满意度的影响

［摘要］ 目的 探讨无痛理念对泌尿外科门诊手术患者术后疼痛及满意度的影响。方法 将2017年1月至2019年1月广东医科大学附属医院门诊部100例泌尿外科门诊手术患者作为研究对象,根据就诊单双顺序分为对照组与观察组（均n=50）,对照组给予常规护理,观察组在对照组基础上实施无痛理念护理,比较两组术后疼痛情况、术后2 h舒适度、术后留院时间和满意度。结果 观察组术后30 min数字评价量表（NRS）评分与对照组无显著差异（P>0.05）,术后1 h、术后1.5 h和术后2 h NRS评分均低于对照组（P<0.05）;观察组术后2 h生理舒适评分、心理舒适评分和舒适度总分均显著高于对照组（P<0.05）;观察组术后满意度高于对照组（P<0.05）;观察组术后留院时间短于对照组（P<0.05）。结论 无痛理念可减轻泌尿外科门诊手术患者术后疼痛,提高舒适度和患者满意度。     

78例泌尿外科腹腔镜技术的应用

目的 总结经腹腔、后腹腔途径泌尿外科腹腔镜技术的临床经验.方法 从2003年5月至2008年5月,78例患者施行了腹腔镜下泌尿外科手术,经腹腔9例,经后腹腔69例,其中肾上腺手术12例,单纯肾切除3例,根治性肾切除1例,肾囊肿去顶术52例,多囊肾去顶减压术2例,输尿管切开取石术3例,精索静脉高位结扎术5例.结果 74例患者手术顺利完成;中转开放手术4例,其中肾上腺手术1例,肾切除1例,输尿管切开取石术1例,多囊肾去顶减压术1例;无严重并发症发生,疗效满意.术后住院时间3～15d,平均6.5d.结论 腹腔镜手术治疗泌尿外科疾病,手术安全、有效、创伤小,患者痛苦轻,术后恢复快.     

A proposed guideline for the urological management of patients with spinal cord injury

OBJECTIVE

To develop a guideline for the urological management of patients with spinal cord injury (SCI).

METHODS

The existing practice in the UK was evaluated by a series of expert meetings. Previous publications on the subject were evaluated, and the information synthesized to produce a proposed guideline.

RESULTS

The literature review showed limited good‐quality data. As a result of the process a series of research questions was produced, the answers to which would allow a guideline to be established based on good‐quality evidence. In the absence of high‐quality evidence, the guideline was constructed using expert opinion. Urological care is described in the immediate, intermediate and long‐term phases after SCI.

CONCLUSION

The urological consequences of SCI can be devastating. Urological care is an important part of the holistic care of these patients, and should be delivered from SCI centres through a network of qualified clinicians.     

Urological symptom clusters and health‐related quality‐of‐life: results from the Boston Area Community Health Survey

OBJECTIVE

To determine whether urological symptom clusters, as identified in previous studies, were associated with health‐related quality‐of‐life (HRQoL) and use of healthcare.

SUBJECTS AND METHODS

The Boston Area Community Health Survey is a population‐based epidemiological study of 2301 male and 3201 female residents of Boston, MA, USA, aged 30–79 years. Baseline data collected from 2002 to 2005 were used in this analysis. Data on 14 urological symptoms were used for the cluster analysis, and five derived symptom clusters among men and four among women were used in multivariate linear regression models (adjusted for age group, race/ethnicity, and comorbidity) to determine their association with physical (PCS‐12) and mental health component scores (MCS‐12) calculated from the Medical Outcomes Study 12‐item Short Form Survey.

RESULTS

For both men and women, being in the most symptomatic cluster was associated with decrements in the PCS‐12 score (men, cluster 5, ?10.42; women, cluster 4, ?9.80; both P < 0.001) and the MCS‐12 score (men, cluster 5, ?9.35; women, cluster 4, ?6.24; both P < 0.001) compared with the asymptomatic groups. Both men and women in these most symptomatic clusters appeared to have adequate access to healthcare.

CONCLUSION

For men and women, those with the most urological symptoms reported poorer HRQoL in two domains after adjusting for age and comorbidity, and despite adequate access to care.     

Brachytherapy--an example of a urological minimally invasive robotic procedure

A review of the application of urological robots to the prostate is given, together with an examination of the conventional brachytherapy procedure for insertion of radioactive seeds to treat prostate cancer. The specification and design of a robotic system is provided, which can position a series of needles and radioactive pellets in accordance with a pre-operative plan. The needles can be withdrawn automatically, leaving the seeds in position.A separate motorised system is used to position a trans-rectal ultrasound (U/S) probe, which can be used to continually monitor the seed placement. The robot program can be updated intra-operatively if the U/S image shows this to be necessary. The demonstrator system has been demonstrated in-vitro using a variety of gel and animal tissue phantoms. The resulting robot performance shows this to be a viable approach.