The last 20 years have produced developments in the treatment for patients with non-obstructive azoospermia (NOA) who were once considered to be infertile. The combination of intracytoplasmic sperm injection together with various testicular sperm retrieval techniques, including conventional testicular sperm extraction (TESE), microdissection TESE (micro-TESE) and fine needle aspiration (FNA), have revolutionized treatment for these men. In men with NOA, isolated regions of spermatogenesis within the testis are common. The goal for all types of sperm retrieval procedures is locating the focal region(s) of spermatogenesis, and harvesting the sperm for assisted reproduction. This review article explores the surgical management of men with NOA and describes all techniques that can be used for testicular sperm retrieval. A PubMed search was conducted using the key words: “sperm extraction”, “NOA”, “testicular FNA”, “testicular mapping”, “TESE”, and “testicular biopsy”. All articles were reviewed. Articles were included if they provided data on sperm retrieval rates. The methods for performing sperm retrieval rates and outcomes of the various techniques are outlined. Micro-TESE has a higher sperm retrieval rates with fewer postoperative complications and negative effects on testicular function compared with conventional TESE.
Peri-urethral calcium hydroxylapatite injections can improve urinary QOL scores in patients with initial and recurrent stress urinary incontinence. This short-term retrospective analysis suggests that larger long-term studies focusing on QOL outcomes are needed to evaluate the effect of peri-urethral calcium hydroxylapatite has on incontinence-specific QOL.
Background Robotic surgery presents a challenge to effective teamwork and communication in the operating theatre (OR). Our objective was to evaluate the effect of using a wireless audio headset device on communication, efficiency and patient outcome in robotic surgery. Methods and findings A prospective controlled trial of team members participating in gynecologic and urologic robotic procedures between January and March 2015. In the first phase, all surgeries were performed without headsets (control), followed by the intervention phase where all team members used the wireless headsets. Noise levels were measured during both phases. After each case, all team members evaluated the quality of communication, performance, teamwork and mental load using a validated 14-point questionnaire graded on a 1-10 scale. Higher overall scores indicated better communication and efficiency. Clinical and surgical data of all patients in the study were retrieved, analyzed and correlated with the survey results. The study included 137 procedures, yielding 843 questionnaires with an overall response rate of 89% (843/943). Self-reported communication quality was better in cases where headsets were used (113.0 ± 1.6 vs. 101.4 ± 1.6; p < .001). Use of headsets reduced the percentage of time with a noise level above 70 dB at the console (8.2% ± 0.6 vs. 5.3% ± 0.6, p < .001), but had no significant effect on length of surgery nor postoperative complications. Conclusions The use of wireless headset devices improved quality of communication between team members and reduced the peak noise level in the robotic OR.
19Tsafrir 2 2 20 Abstract 21 Background: Robotic surgery presents a challenge to effective teamwork and 22 communication in the operating theatre (OR). Our objective was to evaluate the effect of 23 using a wireless audio headset device on communication, efficiency and patient outcome in 24 robotic surgery.25 Methods and findings: A prospective controlled trial of team members participating in 26 gynecologic and urologic robotic procedures between January and March 2015. In the first 27 phase, all surgeries were performed without headsets (control), followed by the 28 intervention phase where all team members used the wireless headsets. Noise levels were 29 measured during both phases. After each case, all team members evaluated the quality of 30 communication, performance, teamwork and mental load using a validated 14-point 31 questionnaire graded on a 1-10 scale. Higher overall scores indicated better 32 communication and efficiency. Clinical and surgical data of all patients in the study were 33 retrieved, analyzed and correlated with the survey results. 34The study included 137 procedures, yielding 843 questionnaires with an overall response 35 rate of 89% (843/943). Self-reported communication quality was better in cases where 36 headsets were used (113.0 ± 1.6 vs. 101.4 ± 1.6; p < .001). Use of headsets reduced the 37 percentage of time with a noise level above 70 dB at the console (8.2% ± 0.6 vs. 5.3% ± 0.6, 38 p < .001), but had no significant effect on length of surgery nor postoperative 39 complications. 40 Conclusions: The use of wireless headset devices improved quality of communication 41 between team members and reduced the peak noise level in the robotic OR. 42 Tsafrir 3 3 43 Tsafrir 4 4 44 Introduction45 There is strong evidence in the literature that supports the importance of effective 46 communication and teamwork in regards to patient safety in the operating room (OR) (1, 47 2). Event analysis has found that deficiencies in teamwork and communication contribute 48 to adverse events, thus demonstrating that nontechnical skills are as important as technical 49 surgical skills in preventing adverse patient outcomes (3, 4). 50 Communication is defined as "a process by which information is exchanged between 51 individuals through a common system of symbols, signs, or behavior" (5). Communication 52 in the OR relies heavily on speech, but also encompasses visual and physical cues. Due to 53 the large footprint platform of the robot, team members are physically separated in space, 54 and thus face-to-face interaction during the surgery is severely limited. Unlike the 55 conventional OR setting, robotic surgeons must rely primarily on auditory means of 56 communication, unaided by visual cues (6-8). In addition, studies have shown that 57 increased noise during surgery was associated with a greater risk for postoperative 58 complications (9, 10). The robotic platform possibly lead to increased noise in the OR, 59 which could present a source for errors and impaired safety and efficiency during surgery...
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