Trends in Positioning for Robotic Prostatectomy: Results From a Survey of the Endourological Society.

PURPOSE: most robot-assisted laparoscopic prostatectomies (RALP) are performed with the patient in lithotomy, carrying risks of positioning-related complications. Newer robot models have allowed for supine positioning, potentially avoiding these pitfalls. We gauged the current sentiment on patient positioning among surgeons who perform robot-assisted surgery. METHODS: we surveyed members of the Endourological Society regarding their practice settings and their opinions on positioning for robot-assisted laparoscopic prostatectomy. Summary statistics were reviewed and data were analyzed using chi-square tests and t-tests. RESULTS: our survey had 92 eligible respondents. The majority were fellowship-trained, with 51% trained in robotics and 57% practicing in the U.S. with a mean of 13 years of practice. Most were working in an academic setting (69%) and performing at least 25 robotic prostatectomies yearly. 28 respondents used the Intuitive Surgical Inc. da Vinci® Xi™ exclusively (30%), and nearly two-thirds used it sometimes. Although 54% of respondents considered using supine positioning, less than half of these surgeons used it regularly, while 75% overall preferred lithotomy. A majority attributed this choice to surgical team familiarity with lithotomy positioning. Surgeons in the U.S. and those using the da Vinci® Xi™ were more likely to consider supine positioning. CONCLUSIONS: lithotomy position is the standard for RALP procedures; nonetheless, it poses significant risks that might be avoided with supine positioning. Our survey suggests that, although supine positioning has been considered, it has not gained momentum in practice. Addressing factors of inertia in training practices and one's surgical team might allow for novel and safer approaches.

Ureteroscopic Performance of High Power Super Pulse Thulium Fiber Laser for the Treatment of Urolithiasis: Results of the First Case Series in North America.

OBJECTIVE: To report the first case series of ureterorenoscopy in North America using the High Power Super Pulse Thulium Fiber Laser for the treatment of upper urinary tract stones. METHODS: After Institutional Review Board approval, a multicentric retrospective chart review of patients treated with the High Power Super Pulse Thulium Fiber Laser from October 2019 to March 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. RESULTS: Seventy-six patients were included with a mean age of 60.9 ± 13.3 years. 118 stones were treated including 32 within the ureter, 49 in the lower pole, 37 in mid or upper poles. Dusting technique was commonly used (67.1%) with pulse frequencies up to 2400 Hz. Mean operative time was 59.4 ± 31.5 minutes. Mean laser time and total laser energy were 10.8 ± 14.1 minutes and 12.5 ± 19.1 KJ, respectively. Intraoperative complications were limited to 7 grade 1, 3 grade 2, and 1 grade 3 ureteral injuries and one case of renal collecting system bleeding that was adequately managed with laser coagulation settings (1J-20Hz). CONCLUSION: This initial case series in North America of the High Power Super Pulse Thulium Fiber Laser is promising for the treatment of urolithiasis. Sub-200 µm fibers and dusting settings up to 2400 Hz were utilized successfully. No specific complications related to use of the laser were seen.

Single- versus dual-console robot-assisted radical prostatectomy: impact on intraoperative and postoperative outcomes in a teaching institution.

OBJECTIVE: To compare the outcomes of robotic-assisted laparoscopic prostatectomy (RALP) using a dual versus single-console system in a resident training program using intraoperative, perioperative and postoperative measures. METHODS: Patients with PCa who underwent RALP prior to and after implementing a dual-console system at an academic institution were reviewed from 2006-2012. All surgeries were performed by a single-faculty surgeon well after the learning curve was established. In all cases, chief residents participated in the surgery and performed progressively more portions. Demographic, intraoperative and pathologic parameters were obtained. Continence and erectile function were assessed at 6 and 12 months. Postoperative complications were graded using the Clavien-Dindo classification. Predictors of outcomes on univariate analysis were included in multivariate logistic or linear models. RESULTS: Of 381 patients, 185 and 196 underwent single- or dual-console RALP, respectively. There was a significant decrease in mean operative time using the dual-console system (222 vs. 171 min, p < 0.0001) as well as in the incidence of intraoperative complications (8.65 vs. 1.53%, p < 0.0001) and postoperative complications (14.1 vs. 6.63%, p = 0.03.) Complications of Clavien grade ≥3a occurred more frequently with a single-console system (7 vs. 1%, p = 0.003.) Differences persisted when controlling for potential confounders by multivariate regression. Postoperative measures of continence, erectile function and the rate of biochemical recurrence were similar between cohorts. CONCLUSIONS: When training resident surgeons to perform RALP, a dual-console system may improve intraoperative and perioperative outcomes. The dual-console may represent a safer, more efficient modality for robotic surgical education as compared to a single-console system.

Effect of dissolved carbon dioxide on accumulation of organic acids in liquid hot water pretreated biomass hydrolyzates.

Liquid hot water pretreatment has been proposed as a possible means of improving rates of enzymatic hydrolysis of biomass while maintaining low levels of inhibitory compounds. Supplementation of liquid hot water pretreatment with dissolved carbon dioxide, yielding carbonic acid, has been shown to improve hydrolysis of some biomass substrates compared with the use of water alone. Previous studies on the application of carbonic acid to biomass pretreatment have noted a higher pH of hydrolyzates treated with carbonic acid as compared with the samples prepared with water alone. This study has applied recently developed analytical methods to quantify the concentration of organic acids in liquid hot water pretreated hydrolyzates, prepared with and without the addition of carbonic acid. It was observed that the addition of carbon dioxide to liquid hot water pretreatment significantly changed the accumulated concentrations of most measured compounds. However, the measured differences in product concentrations resulting from addition of carbonic acid did not account for the measured differences in hydrolyzate pH.