Search

Purpose of review Robot-assisted laparoscopic simple prostatectomy (RASP) is being used increasingly for the surgical treatment of benign prostatic obstruction (BPO). Our purpose is to review the main outcomes of RASP for the management of BPO. Recent findings A computerised bibliographic search of Medline was performed for articles that included detailed results of RASP, published over the past 2 years. Although RASP seems to be associated with better perioperative and functional outcomes, this procedure remains expensive when compared to open or endoscopic surgery. However, considering the enhanced safety of RASP compared to open simple prostatectomy and its favourable learning-curve when compared to endoscopic laser enucleation, RASP seems to be a good and effective option in centres with extended robotic expertise. Single-port robotic surgery appeared to be safe and effective in two preliminary studies. Other studies reported interesting and improved results for the preservation of ejaculatory function. Summary Many RASP techniques have been developed, with the common goal of improving the quality of life of patients. Although the cost of RASP is higher than open surgery, the perioperative benefits of the robotic approach make RASP a favourable option in centres with extended robotic expertise.

Purpose of review To present criteria of minimally invasive surgery, which include minimal and hidden incision lines, reduced injury to tissue and application of endoscopic techniques, when feasible; to analyze techniques in rhinoplasty for their minimally invasive character - in light of recent publications; and to discuss the techniques that best meet the criteria of minimally invasive surgery. Recent findings The nose consists of about 60 percent soft tissue and 40 percent skeletal elements. Surgery causes injury to both tissue types through various mechanisms, including mechanical traction, separation, incision, heat, desiccation, and others. Multiple aspects including extent of approach and degree of tissue undermining determine the minimally invasive character of techniques and maneuvers in rhinoplasty. Summary A single incision endonasal approach, the subperichondrial and subperiosteal septal plane, the supraperichondrial plane over the cartilaginous dorsum, the subperiosteal plane over the bony dorsum, limited dorsal undermining with endoscopic visualization when feasible, conventional straight lateral osteotomy or percutaneous curved lateral osteotomy; percutaneous transverse osteotomy; conventional straight paramedian osteotomy; piezo and drill paramedian ostectomy; dorsal uncapping osteotomy; conventional rasp gross dorsal contouring; piezo or drill fine dorsal contouring; (cartilaginous) middle vault 'let down'; and minimal access subperiosteal turbinate bone resection were found to best fulfil the criteria of minimally invasive surgery. A classification system for the degree of minimally invasiveness of rhinoplasty techniques is proposed as a basis for discussion.

INTRODUCTION AND OBJECTIVE:Simple prostatectomy and laser enucleation are surgical treatment options for men with symptomatic benign prostatic hyperplasia (BPH) with large prostates (>80 grams). Th...

INTRODUCTION AND OBJECTIVES:To compare early outcomes of a reconstructive technical modification for robotic-assisted simple prostatectomy (RASP) with those of conventional trigonization approach.METHODS:In a prospective and random model, 20 men who underwent to BPH surgical treatment were allocated in two groups (RASP and TST-RASP). Demographic and preoperative data (including IPSS and Flowmetry scores) were collected.The procedures were carried-out using the Si da Vinci Robotic System (Intuitive Surgical). Through a five-trocars transperitoneal access, we perform a longitudinal incision of the bladder wall and prostate capsule and the removal of prostatic adenoma in both groups. Next, using a three-steps reconstructive technique, a 360 trigonization of the bladder mucosa was proposed in TST-RASP group (Tunnel-Shaped Trigonization) rather than classic trigonization (RASP group). The TST enrolls the advancement of a bladder mucosa flap until the prostatic urethra (first step) followed by a running suture ...

INTRODUCTION AND OBJECTIVES:Robot-assisted simple prostatectomy (RASP) performed with the extraperitoneal (EP) technique (EP-RASP) minimizes the risk of bowel injury, particularly when bowel adhesi...

Study design A retrospective study. Objective To analyze the influence of the number of cervical fusion levels on total cervical motion and health-related quality of life (HRQoL) in patients with solid anterior cervical fusions (ACFs). Summary of background data Few studies have analyzed the degree to which cervical range of motion (ROM) and HRQoL are affected by the number of cervical fusion segments. Methods We analyzed a cohort of patients who underwent ACF for degenerative disc disease. To assess the clinical outcomes and HRQoL, preoperative, 1- and 2-year postoperative neck and arm pain, visual-analogue scale, neck disability index, and short form-36 were analyzed. Radiographically, C2-7 and C0-2 ROM, C2-7 sagittal vertical axis (SVA), and Kellgren grade of radiographic adjacent segment pathology (RASP) were evaluated. Results A total of 105 patients (M:F = 46:59, mean age of 51.4 yr) were enrolled. There were 36 patients who underwent single-level ACF (group 1), 41 patients who had a double level ACF (group 2), and 28 patients who underwent ACF involving 3 or more levels (group 3). There was no decrease in C2-7 motion in group 1, a mean 7-degree decrease in group 2, a mean 18-degree decrease in those who underwent a 3-level ACF, and a mean 22-degree decrease after 4-level ACF. The grade of RASP was not influenced by the number of fusion levels. All HRQoL parameters showed no significant correlation between number of fusion levels, cervical ROM, and SVA. Conclusion Single-level ACF showed no decrease in total cervical motion; multilevel ACF decreased cervical motion by a mean of 7.8 degrees per segment of fusion. Progression of RASP showed no correlation with the number of fusion levels. HRQoLs were not influenced by the number of fusion levels, cervical ROM, or SVA after solid ACF. Level of evidence 3.

Study design A systematic review. Objective To critically review and summarize the literature comparing motion preservation devices to fusion in the cervical spine to determine whether the use of these devices decreases the development of radiographical (RASP) or clinical adjacent segment pathology (CASP) compared with fusion. Summary of background data Historically, surgical treatment of symptomatic cervical disc disease presenting as radiculopathy and/or myelopathy with anterior cervical decompression and fusion has yielded excellent results. Controversy remains whether RASP and CASP requiring treatment is due to fusion-altered biomechanics and kinematics versus natural history. Methods We conducted a systematic search in MEDLINE and the Cochrane Collaboration Library for literature published through February 2012 on human randomized control trials or cohort studies published in the English language containing abstracts to answer the following key questions: (1) Is there evidence that total disc replacement (TDR) is associated with a lower risk of RASP or CASP compared with fusion? (2) Is there evidence that other procedures that do not involve arthrodesis or other motion-sparing devices are associated with a lower risk of RASP or CASP compared with fusion? (3)Is one type of motion preservation device or procedure associated with a lower risk of RASP or CASP compared with others? Results The initial literature search yielded 276 citations, of which 73 unique, potentially relevant citations that were evaluated against the inclusion/exclusion criteria set a priori. A total of 14 studies were selected for inclusion. For question 1, RASP was variably reported in studies that compared total disc replacement (TDR) to anterior cervical decompression and fusion (ACDF), and risk differences for reoperation due to CASP ranged from 1.0% to 4.8%, with no statistically significant differences between groups. For question 2, no studies comparing motion preservation devices to ACDF met our inclusion criteria. For question 3, one study comparing motion-sparing devices found the risk of RASP to be similar between groups. Conclusion A paucity of high-quality literature comparing motion-preserving devices or treatment methods to fusion or other motion-preserving techniques or devices (with RASP and/or CASP as an outcome using consistent definitions) exists. Independently funded, blinded long-term follow-up prospective studies would be able to delineate the true effects regarding incidence of RASP and CASP and treatment of CASP. Consensus statement 1. There is no significant difference in development of RASP and CASP after C-TDR versus ACDF at short- to mid-term follow-up. Level of evidence Moderate. Strength of Statement: Strong. Recommendation 1: No recommendation can be made from comparative literature of nonarthroplasty motion preservation device or techniques compared with fusion regarding the risk of RASP or CASP. Level of evidence Insufficient. Strength of Statement: Strong. Recommendation 2: No recommendation can be made from direct comparative literature of various motion preservation devices or techniques regarding the risk of RASP or CASP. Level of evidence Insufficient. Strength of Statement: Strong.

STUDY DESIGN: A systematic review. OBJECTIVE: To provide a detailed description of the methods undertaken in the systematic search and analytical summary of adjacent segment pathology (ASP) issues and to describe the process used to develop consensus statements and clinical recommendations regarding factors associated with the prevention and treatment of ASP. SUMMARY OF BACKGROUND DATA: We present methods used in conducting the systematic, evidence-based reviews and development of expert panel consensus statements and clinical recommendations on the classification, natural history, risk factors, and treatment of radiographical and clinical ASP. Our intent is that clinicians will combine the information from these reviews with an understanding of their own capacities and experience to better manage patients at risk of ASP and consider future research for the prevention and treatment of ASP. METHODS: A systematic search and critical review of the English-language literature was undertaken for articles published on the classification, risk, risk factors, and treatment of radiographical and clinical ASP. Articles were screened for relevance using a priori criteria, and relevant articles were critically reviewed. Whether an article was included for review depended on whether the study question was descriptive, one of therapy, or one of prognosis. The strength of evidence for the overall body of literature in each topic area was determined by 2 independent reviewers considering risk of bias, consistency, directness, and precision of results using a modification of the Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria. Disagreements were resolved by consensus. Findings from articles meeting inclusion criteria were summarized. From these summaries, consensus statements or clinical recommendations were formulated among subject experts through a modified Delphi process using the GRADE approach. RESULTS: A total of 3382 articles were identified and screened on 14 topics relating to the classification, risks, risk factors, and treatment of radiographical and clinical ASP. Of these, 127 met our predetermined inclusion criteria and were used to answer specific clinical questions within each topic. Lack of precision in the terminology related to adjacent segment disease and critical evaluation of definitions used across included articles led to a consensus to use ASP and suggest it as a standard. No validated comprehensive classification system for ASP currently exists. The expert panel developed a consensus definition of radiographical and clinical ASP (RASP and CASP). Some of the highlights from the analyses included the annual, 5- and 10-year risks of developing cervical and lumbar ASP after surgery, several important risk factors associated with the development of cervical and lumbar ASP, and the possibility that some motion sparing procedures may be associated with a lower risk of ASP compared with fusion despite kinematic studies demonstrating similar adjacent segment mobility following these procedures. Other highlights included a high risk of proximal junctional kyphosis (PJK) following long fusions for deformity correction, postsurgical malalignment as a potential risk factor for RASP and the paucity of studies on treatment of cervical and lumbar ASP. CONCLUSION: Systematic reviews were undertaken to understand the classification, risks, risk factors, and treatment of RASP and CASP and to provide consensus statements and clinical recommendations. This article reports the methods used in the reviews.

Study design Systematic review. Objective To systematically review the literature related to distal adjacent segment pathology (ASP) after long thoracolumbar fusions for deformity including frequency, risk factors, frequency differences between adolescents and adults, surgical approach for revision, and revision complications. Summary of background data Spinal deformity surgery complications include ASP. Although ASP at the rostral end of instrumented fusions has been well described, substantially less has been documented about distal ASP. Methods A systematic search was conducted in Medline and the Cochrane Collaboration Library for articles published between January 1, 1983, and March 15, 2012. We included all articles that described distal ASP after long thoracolumbar fusion for deformity. Radiographical ASP (RASP) was defined as evidence of ASP based on imaging, and clinical ASP (CASP) was defined as symptomatic ASP. Results Seven retrospective cohort studies met inclusion criteria. Distal CASP developed in 17.7% at 2- 6-year follow-up and 19.8% at 9-year follow-up, whereas reoperation due to CASP was reported in 15.6% at 2 to 6 years and 14.4% at 9 years. Distal RASP was more frequent (44.7%-65.5%). Preoperative sagittal imbalance was associated with increased risk of distal ASP. There was increased risk of CASP in patients with higher postoperative fractional curve and increased risk of RASP in younger patients and those with preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5-S1 disc space narrowing. No studies meeting inclusion criteria compared distal ASP in adults and adolescents or defined the best approach or complications for distal ASP revision. Conclusion Low-quality evidence suggests a cumulative rate of 18% to 20% for CASP and 45% to 65% for RASP after long thoracolumbar fusion for spinal deformity during 9-year follow-up. Low-quality evidence suggests an association between preoperative sagittal imbalance and distal ASP, with greater risk of distal ASP in patients with sagittal imbalance. Low-quality evidence suggests increased risk of CASP in patients with higher postoperative fractional curve and increased risk of RASP in younger patients and those with preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5-S1 disc space narrowing. Consensus statement 1. The risk of developing new symptoms secondary to distal adjacent segment pathology following long thoracolumbar fusion for deformity is approximately 18–20% during a period of 9 years follow up, and most of these patients will require revision surgery. Strength of Statement: Weak. 2. The risk of developing distal adjacent segment pathology may be higher in those with preoperative sagittal imbalance, preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5–S1 disc space narrowing. Strength of Statement: Weak.

INTRODUCTION AND OBJECTIVES: Robotic-assisted simple prostatectomy (RASP) has been demonstrated to be an acceptable alternative to open simple prostatectomy (OSP) for the treatment of high-volume symptomatic BPH. We performed a matched analysis comparing clinical and perioperative outcomes following RASP and OSP at our institution. METHODS: We identified 15 consecutive patients who underwent RASP between 2013 and 2014. They were 1:1 matched to patients from our OSP database based on preoperative prostate size ( 10 cc) by CT or ultrasound imaging, age ( 10 years), BMI ( 5), and ASA score ( 1). Perioperative and clinical data were examined. Analyses for comparison and statistical significance were performed using the paired two-tailed student’s t-test. RESULTS: Patients in the OSP group were found to be of comparable age (74.1 and 68.8, p 1⁄4 0.11), BMI (26.3 and 28.5, p 1⁄4 0.16), and ASA score (2.6 and 2.6, p 1⁄4 1.0) to the RASP group. OSP prostate size was 158.6 cc (156.1 cc in RASP group). The mean volume of tissue resected was similar between the OSP and RASP groups (112.6 cc and 104.7 cc respectively, p 1⁄4 0.42). Length of stay was significantly shorter in the RASP group (2.4 vs 6 days, p

A new nasal rasp has been developed from tungsten-carbide steel and is available in eight different cutting grits. One-hundred rhinoplasties were completed using a single tungsten-carbide steel rasp without evidence of dulling or loss of cutting effectiveness. Both a conventional stainless steel Fomon rasp and the diamond-tip tungsten-carbide steel rasp were wear tested on an accelerator for comparison. The testing involving the conventional stainless steel rasp was discontinued after the removal of 20 mm of bone. At this time, there was severe loading of the instrument with bony debris and there was an apparently complete lack of cutting ability. The test involving the diamond-tip tungsten-carbide steel rasp was electively discontinued after the removal of 300 mm of bone, at which time there was no evidence of either debris loading or diminished cutting effectiveness. The scanning electron microscope photographs of the two instruments support our conclusions regarding the clinical and laboratory studies.

A new rasp for rhinoplasty is presented. It can be dismantled and has a renewable blade that looks like the one you find in a plane. The main advantage of this rasp is that it rasps the cartilaginous septum as well as the bony part of the hump.

Direct anterior approach to the hip joint utilizing a curved transverse skin incision and splitting the tensor fascia muscle longitudinally provides an effective exposure for carrying out primary total hip arthroplasty. Excellent visualization of the acetabulum is afforded by this direct approach. Modified femoral rasps of varying lengths are employed to rasp the femur with the leg in external rotation. Trochanteric osteotomy was carried out on only three occasions in a series of 104 procedures performed on 85 patients during a three-year period. The duration of operation averaged 65 minutes. Average blood replacement was 1.9 units in unilateral hips and 3.5 units in patients operated upon sequentially. Mean postoperative stay was 12.8 days following unilateral and 22.3 days following bilateral surgery. Four patients experienced perioperative complications. The anterior approach provides a safe and effective approach to total hip arthroplasty with limited morbidity.