Initial consecutive 125 cases of robotic assisted laparoscopic radical prostatectomy performed in Ireland's first robotic radical prostatectomy centre.

BACKGROUND: We examined the patient characteristics, operative proceedings and the outcomes of the initial series of 125 cases of robot-assisted laparoscopic radical prostatectomy (RALRP) in an independent hospital in Ireland, performed by two surgeons using the da Vinci(®) surgical system. MATERIALS AND METHODS: The series data were gathered prospectively in a consecutive series. Focus was given to the outcome trifecta of oncological control, urinary continence and erectile function. We also report on complications reported using the Clavien-Dindo classification. RESULTS: Mean patient age was 58.86 years, with a range between 47 and 71 years. Positive surgical margin rates were 11.3% overall (n = 14); 7.8% (n = 8) in the pT2 group (n = 101) and 30% (n = 6) in the pT3/pT4 (n = 20) group. 93% (n = 125) of patients are continent at 6 months. Biochemical recurrence-free survival was 92.4%. 72% (n = 43) of patients under the age of 65 with normal preoperative erectile function are potent at 1 year post-operatively. No patient in this series required a blood transfusion. Some form of relatively minor complication occurred in 12.8% (n = 16) of cases; there was no mortality rate, and no complication was life-threatening or resulted in single-organ or multiple-organ failure. CONCLUSIONS: With a combination of high-level fellowship training of surgeons, a co-operative and combined approach to cases between surgeons, institutional support, and enthusiasm, encouragement and dedication from ancillary staff and colleagues, we have shown that a programme can be established with excellent levels of safety and efficacy.

Robotic radical prostatectomy in Australia: initial experience.

The purpose of this study is to describe the initial experience of robotic-assisted radical prostatectomy (RARP) in Australia. Since the installation of the daVinci system at the Australian Institute for Robotic Surgery, Epworth Hospital, Melbourne in December 2003, 275 robotic-assisted radical prostatectomies have been performed by two surgeons. A prospective database is compiled for each procedure including patient, operative and outcome details. We report on the initial learning curve, surgical technique and modifications, anaesthetic considerations and surgical results comparative to open radical prostatectomy in a single surgeons experience along with margin positivity rates for the first 200 cases of RARP. RARP is the single most frequent adaptation of robotic-assisted surgery with promising initial results. Increasing availability of this modality will inevitably give rise to further adaptations. We present the initial Australian experience.

Nitric oxide in unilateral ureteral obstruction: effect on regional renal blood flow.

BACKGROUND: Ureteral obstruction (UO) is characterized by reduced blood flow and loss of tissue mass in the involved kidney(s). Vasoactive mediators interact to produce an initial hyperemia, followed by a sustained decrease in renal blood flow in the obstructed kidney. Nitric oxide (NO) has been shown to play a central role in the acute hyperemic response to UO. Its role in the reduced perfusion of prolonged UO is less studied. METHODS: Ureteral obstruction was achieved by ligation of the distal left ureter and maintained for 24 hours. Blood flow was studied in untreated animals and after the administration of the NO synthase (NOS) inhibitor N-mono-methyl L-arginine and the NO donor sodium nitroprusside. Tissue was collected for localization and quantitation of NOS. Serum and renal tissue L-arginine levels were measured in control and UO settings. RESULTS: Blood flow in the obstructed kidney diminished to approximately 50% of control values after 24 hours of UO. NOS blockade led to a further decrease in blood flow. Supplementation with exogenous nitrates restored renal blood flow to levels approaching control values. Serum and tissue L-arginine levels did not change with UO. NOS expression was seen to increase with increasing duration of obstruction, with staining most pronounced in the renal tubules. CONCLUSIONS: NO plays a vasodilatory role even in the hypoperfusion of prolonged UO. The administration of exogenous nitrates has a restorative effect on blood flow, suggesting therapeutic potential in UO.

Alpha-1-antichymotrypsin is an effective inhibitor of pancreatitis-induced lung injury.

BACKGROUND: Pancreatitis-induced adult respiratory distress syndrome (ARDS) may result from an imbalance between leucocyte proteases, produced by infiltrating neutrophils, and endogenous protease inhibitors. OBJECTIVE: The aim of this study was to evaluate the role of recombinant alpha-1-antichymotrypsin (rACT P3-P3'), an endogenous serine protease inhibitor, in ameliorating lung injury associated with pancreatitis. DESIGN: Sprague-Dawley rats were randomly divided into control (saline infusion) and pancreatitis groups, which were treated immediately with saline or rACT P3-P3' (50 mg/kg body weight). METHODS: Myeloperoxidase (MPO) was employed as a monitor of neutrophil traffic in the lung, and wet-dry lung weights as a measure of pulmonary endothelial permeability. Lungs were also evaluated histologically. RESULTS: Caerulein (5 micrograms/kg body weight/h) induced pancreatitis in all animals, with an increase in serum amylase from 1851 +/- 208 IU (control) to 5198 +/- 924 IU (pancreatitis), P < 0.05. Pancreatitis caused a significant increase in MPO activity (7.8 +/- 1.1 units compared with 2.08 +/- 0.5 units in controls, P < 0.001) and wet-dry lung weight ratios (12.8 +/- 3.3 compared with 3.2 +/- 0.1 in controls, P < 0.001), indicating significant pulmonary neutrophil influx and microvascular leakage, respectively. These increases in MPO activity and wet-dry ratios were decreased in the pancreatitis group treated with rACT P3-P3' (MPO 4.68 +/- 0.7 units, wet-dry ratio 4.2 +/- 0.5, P < 0.05 compared with the untreated pancreatitis group). CONCLUSION: These data support the hypothesis that deficient endogenous protease inhibition may be responsible for the neutrophil-mediated lung injury observed in pancreatitis and suggest that there may be a therapeutic role for recombinant protease inhibitors such as alpha-1 antichymotrypsin.