The stress for surgeons: exploring stress entities with the robotic senhance surgical system.

Robotic surgery is on its way to revolutionizing traditional surgical procedures, offering precise and minimally invasive techniques hypothesized to shorten recovery times and improve patient outcomes. While there have been multiple publications on robotic systems' medical and procedural achievements, more emphasis should be put on the surgeon's experience, especially in comparison with laparoscopic surgery. The present report aims to systematically examine the stress impact on surgeons by comparing the robotic Senhance Surgical System (Asensus Surgical, Durham, North Carolina, U.S.A) to laparoscopic surgery. The well-established "SURG-TLX" survey is used to measure distinct stress entities. The "SURG-TLX" survey is a modified version of the NASA-TLX, validated for surgery by M. Willson. Based on a comprehensive database from six centers encompassing various disciplines and surgical procedures, our analysis indicates significantly reduced "overall stress" levels for robotic (cockpit) compared to laparoscopic surgeons. Exploring the "SURG-TLX" stress dimensions further between methods (robotic vs. laparoscopic) and surgeon position (laparoscopic, (robotic) bedside, or (robotic) cockpit) resulted in significantly more Mental (p.value < 0.015), less Physical Demands (p.value < 0.001) and less Distraction (p.value < 0.009) for robotic surgery, especially regarding the robotic cockpit surgeons. This finding suggests that robotic surgery with the Senhance Surgical System contributes to a favorable stress profile for surgeons, potentially enhancing their overall well-being and performance.

Efficacy, tolerability, and safety of teverelix DP in patients with advanced prostate cancer: A multicenter, open-label, phase 2 trial.

BACKGROUND: Teverelix drug product (DP) is a novel injectable gonadotropin-releasing hormone antagonist. METHODS: An adaptive phase 2, open-label, multicenter trial was conducted in patients with advanced prostate cancer to evaluate the efficacy and safety of a combined subcutaneous (SC) and intramuscular (IM) loading dose regimen of teverelix DP of 120 mg SC + 120 mg IM (Group 1; N = 9) or 180 mg SC + 180 mg IM (Group 2; N = 41) administered at a single visit, followed by 6-weekly SC maintenance doses of 120 mg (Group 1) or 180 mg (Group 2), up to Day 168. The primary endpoint was the proportion of patients achieving castration levels with serum testosterone <0.5 ng/mL at Day 28 with a target castration rate of 90%. Injection sites were inspected by the investigator at every visit and reactions (ISRs) were proactively recorded. RESULTS: The target castration rate was reached in Group 2 (97.5%) but not in Group 1 (62.5%). The castration rates were not maintained to Day 42 (Group 2: 82.5%; Group 1: 50.0%). Suppression of testosterone to castrate levels occurred rapidly (median time: 2 days for both groups). Suppression of testosterone, prostate-specific antigen, follicle-stimulating hormone, and luteinizing hormone was sustained throughout the treatment period, being more prominent with the higher dose. The adverse event (AE) profile was similar between groups. The most common AEs were injection-site induration (n = 40: 80.0%), injection-site erythema (n = 35: 70.0%), and hot flush (n = 21: 42.0%). Most ISRs were Grade 1. CONCLUSION: Overall, the teverelix DP doses were generally well-tolerated but did not adequately maintain castration levels.

Robotic-assisted radical prostatectomy: a multicenter experience with the Senhance Surgical System.

PURPOSE: Robotic-assisted surgery for radical prostatectomy is becoming a standard treatment, and respective implementations are expanding. The Senhance Surgical System is a robotic system with existing but limited data on radical prostatectomy, including a lack of multicenter study experiences. The TRUST study aims to fill this gap and explores observations for radical prostatectomy with the Senhance Surgical System. METHODS: Between August 2019 and November 2022, 375 patients met inclusion criteria from two European sites. Patients' surgical procedure times, data on conversion, malfunction, adverse events, and pain scores were registered and evaluated. Outcomes were calculated for both sides, combined as a total and compared between the initial (1st-150th case) and later (> 150th case) period. RESULTS: The median operating time was 190 min (IQR: 167.5-215.0) and the median docking time was 3 min (IQR: 2.0-5.0). Eighteen cases (4.8%) were converted to standard laparoscopy and two (0.5%) to open. Two perioperative (0.5%) and eleven postoperative adverse events (2.9%) occurred, mostly (83.3%) categorized as mild. Pain scores were reduced from an average of 3.4 (± 1.4) on the postoperative day to 0.9 (± 0.7) at discharge. Compared to our previous data and based on a comparison between our initial and later period, operating time seems to plateau. However, docking time, complication, and conversion rates were successfully reduced. CONCLUSION: We demonstrate progressing safety and efficiency for robotic-assisted radical prostatectomy with the Senhance Surgical System.

Robotic-assisted radical prostatectomy with the Senhance® robotic platform: single center experience.

OBJECTIVE: To describe our institution's initial experience with robot-assisted radical prostatectomy (RARP) using the Senhance® robotic system. PATIENTS AND METHODS: A prospective analysis of 127 robot-assisted radical prostatectomies was performed. Patient demographics, preoperative and intraoperative parameters, histopathological examination results, intraoperative and early postoperative complications were obtained and analyzed. RESULTS: The median patient age was 61.0 ± 6.36 (from 37 to 73) years, with a mean body mass index of 26.2 ± 3.79 kg/m2. Of 127 patients, 16.5% (n = 21) underwent a pelvic lymph node dissection, 29.1% (n = 37) underwent one sided or bilateral nerve sparing. Post-operative extracapsular invasion (≥ pT3) was found in 15% (n = 19) of the cases and a Gleason score ≥ 7 in 74.8% of all patients. Our median operative time was 180 ± 41.98 min [interquartile range (IQR) 150-215], and median blood loss was 250 ± 236 (IQR 175-430) ml. Of 127 patients, 33.9% (n = 43) had positive margins, of them 28.7% in pT2 and 57.9% in pT3. Fifteen patients (11.8%) experienced complications, of them only three had Clavien-Dindo ≥ 3. Operation time decreased by about 60 min and estimated blood loss decreased by about 200 ml from the initial experience of each surgeon. CONCLUSIONS: Robotic prostatectomy using a Senhance® robotic system is feasible, and warrants further study to determine whether it can improve patient outcomes.

[Review and results of our first ureteroscopy experience at the Klaipeda Hospital]. / Pirmuju ureterorenoskopiju Klaipedos ligonineje apzvalga ir rezultatai.

OBJECTIVE: To estimate an experience of our first ureteroscopic procedures. MATERIAL AND METHODS: The data of 65 patients, who underwent ureteroscopy in Klaipeda Hospital during period 2000 August - 2002 February were analyzed. The indications were: obstructive ureteral stones after not successful extracorporeal lithotripsy, rigid ureteral stones, radionegative ureteral stones and ureteral strictures. The procedures were performed mostly in general, less in spinal anesthesia. The operations were completed on average within 120 minutes. The whole procedure was performed in double visual and radiologic correction. In 42.3 percent of cases there was performed only lithextraction, in other 42.3 percent of cases pneumatic lithotripsy and lithextraction, the remainder underwent for fixing with Dormia basket, pneumatic lithtripsy and lithextraction. RESULTS: There were 65 ureteroscopies performed, of them 59 cases for the reason of ureterolithiasis. The overall success rate for ureterolithiasis was 92.3 percent. Two cases were transformed in open operation. All patients received postoperative stenting, which lasted from 3-4 days to several weeks. The required hospitalization after ureteroscopy was on average 4.7 days. No serious operative and postoperative complications were noticed. CONCLUSIONS: Ureteroscopy -minimally invasive, effective and comparatively safe method of treatment for complicated ureterolithiasis. This may be second - line treatment of ureteral stones after extracorporeal lithotripsy and even the choice of first line of treatment in some cases. An experience of surgeon is very definitive.

[Results of the treatment of kidney and ureteral stones by the method of extracorpored shock wave lithotripsy at the Klaipeda Hospital]. / Inkstu ir slapimtakiu akmenu gydymo ekstrakorporines litotripsijos metodu rezultatai Klaipedos ligonineje.

OBJECTIVE: review the cases, which are cured by extracorpored shock wave lithotripsy using the device of third generation "Lithostar Multiline" (Germany). There are data of 603 patients treated by extracorpored shock wave lithotripsy. Almost a thousand (979) renal stones' fragmentations were performed for 271 (45%) patients. The analysis had showed: a full success in 225 (83%) patients, partial in 28 (12.4%) ones and there wasn't any fragmentation in 18 (6.6%) of cases. Extracorpored wave lithotripsy of ureteral stones was performed in 364 (60.4%) cases. Full success was in 319 (87.6%) cases; partial fragmentation in 25 (6.9%) cases and there wasn't any effect in 24 (8%) cases.