Background: Suction during robotic surgery has traditionally been performed by a bedside assistant. Adequately skilled assistants are not always available. We assessed a purpose-designed robotic surgeon-controlled suction catheter for efficiency and safety by comparing with historic cases of suction controlled by a dedicated bedside assistant using standard rigid laparoscopic suction. Methods: Beginning in February 2019, the remotely operated suction irrigation (ROSI) device was used in all robotic prostatectomy procedures, which is a flexible suction catheter manipulated by the surgeon such that a bedside assistant is never required for suction. The initial 300 consecutive cases performed with ROSI were compared with the 300 immediately previous procedures using bedside assistant suction (BAS). Results: There were no statistically significant differences between groups in age, body mass index, American Anesthesiologist Association score, prostate specific antigen, or pathologic stage. Lymph node dissection was performed in all 600 patients. All 300 ROSI cases were completed without requiring switching to BAS. Estimated blood loss (102.7 vs 120.2 mL, p = 0.001) and operative time (156.1 vs 149.3 minutes, p < 0.001) were slightly lower in the ROSI group. There was no statistical difference in the 90-day complication rate (Clavien ‡III) between groups, with both having 3% of patients readmitted or seen in the emergency department within 90 days of surgery. Conclusion: Surgeon-controlled suction allowed more surgeon autonomy without a negative impact on efficiency or safety issues requiring ''bailout'' suctioning by the bedside assistant whether urgent or otherwise. Robotic surgeons without access to skilled bedside assistants should consider suctioning for themselves not unlike the norm for many laparoscopic surgeons.
rectal hydrogel spacer placement and from distinct steps of the procedure, as well as willingness to repeat the procedure if medically indicated. Pain score was quantified using a validated VAP scale out of 10. For hydrogel placement, the perineal skin and space of interest were anesthetized with a 50:50 mixture of bupivacaine and lidocaine. The rectal hydrogel spacer was injected via transperineal approach under transrectal ultrasound guidance with an 18g needle in a single skin access site. Descriptive statistics were calculated on the data.RESULTS: A total of 34 men completed the survey after hydrogel placement. The majority of these patients underwent prior transrectal biopsy (31/34) for diagnosis of their prostate cancer. Overall, patients reported an average pain score of 4.9 out of 10. Of all the steps in the hydrogel spacer placement processdincluding positioning, probe insertion, local anesthetic placement, and hydrogel placementdpatients reported local anesthetic placement as the most painful portion of the procedure with average pain score of 4.0 out of 10 (Figure 1). Of the 28 men who responded to all questions on the survey, 71.4% would definitely repeat the procedure again if medically indicated, while 28.5% would either probably or possibly repeat the procedure.CONCLUSIONS: Men tolerated rectal hydrogel spacer placement under local anesthetic well with average pain score of 4.9. The most painful portion of the procedure was instillation of the local anesthetic, yet it was overall well tolerated. Ultimately, nearly three out of four men would definitely undergo this effective, well-tolerated, inoffice procedure again if medically indicated.
Background: Enlarged median lobes (ML) can be technically challenging, particularly during bladder-neck dissection, and may affect urinary functional outcomes of robotic radical prostatectomy (RARP). If known, the impact of potentially larger bladder necks on continence and chronic obstruction on postoperative urinary symptoms might aid patient counseling. We assessed the impact of intraoperatively identified median lobes (ML) on urinary function.Methods: We reviewed our prospective RP database from 2013 to 2020. AUA symptoms scores (AUA-SS) were assessed preoperatively and at 1, 3, and 6 months.We compared patients with and without ML (NoML). Bladder-neck sparing was routine to avoid reconstruction.Results: Of 663 patients who completed AUA-SS questionnaires at all time points, 202 (30%) had ML. There were no significant differences in demographics, PSA, or clinical stage. Only two patients in ML and one in NoML group required bladder-neck reconstruction (1.2% and 0.2%). There was no immediate or long-term difference in continence rates between groups. Baseline mean AUA-SS was higher in ML patients and showed more improvement postoperatively (−5.5 vs. −3.6, p < .05) with greatest improvement in ML patients with severe preoperative symptoms (−15.1). There was no difference in AUA-SS between groups by 6 months. Conclusions:The presence of enlarged ML does not increase the risk of incontinence after RARP and it appears that ML patients have greater improvements in postsurgical urinary functions. Preoperative diagnosis of ML and lower urinary tract symptoms assessment could be helpful in counseling patients undergoing RARP regarding their expected postoperative urinary outcomes.
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