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Technical notes Integrated image navigation system using head-mounted display in “RoboSurgeon” endoscopic radical prostatectomy
摘要： The safety and efficacy of minimally invasive surgery relies on visual information. We aimed to develop an integrated image navigation system (RoboSurgeon System) that combines head-mounted displays (HMDs) with multiple image modalities, and assessed its feasibility in 5 prostate cancer patients who underwent gasless single-port endoscopic radical prostatectomy. A robotically manipulated transrectal ultrasound (TRUS) system was used. In all cases, preoperative magnetic resonance (MR) images and intraoperative real-time images of an endoscope, TRUS, and HMD-mounted camera were integrated and displayed synchronously on each HMD in a four-split screen mode during the entire process. The TRUS helped identify the boundary with the adjacent structures endoscopically in reference to MR images. There were no negative incidents in intraoperative or postoperative courses. Integrated image navigation using HMDs as individualized monitors is feasible in the natural ergonomic position and may be beneficial to identify correct dissection planes. The efficacy of the RoboSurgeon System deserves further evaluation.
关键词： image navigation,prostate cancer,head-mounted display,minimally invasive surgery,transrectal ultrasound,radical prostatectomy
更新于2025-09-23 15:22:29
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Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience
摘要： Bleeding is the most common complication of transurethral resection of the prostate and simple open prostatectomy, especially in men on antiplatelet/anticoagulant therapy. The present study aimed to evaluate the safety and effectiveness of thulium laser vapoenucleation of the prostate (ThuVEP) for benign prostatic hyperplasia in patients on chronic antithrombotic medications. Between January 2015 and December 2019, 88 men underwent the procedure under antithrombotic agents in our center. The mean age was 74.7 ± 6.1 years. Median prostate volume was 66.5 mL. Patients on oral anticoagulants were bridged to low-molecular-weight heparin (n = 35). Aspirin (n = 39), clopidogrel (n = 10), and ticlopidine (n = 4) were maintained. Of the patients, 69.3% had an American Society of Anesthesiologists score ≥ 3. Blood loss at 24 h was comparable in all groups. Median catheterization length and postoperative stays were 2 and 3 days respectively. Acute cardiovascular events occurred in 2 patients (2.3%). Of the patients, 4 required prolonged bladder irrigation, 2 required blood transfusions, 1 required a cystoscopy for bleeding control, and 1 required a suprapubic cystostomy for blood clot evacuation. No patients died within 30 days of being discharged. Late complications occurred in 3 (3.8%) patients (1 optical urethrotomy and 1 bladder neck incision for stenosis; 1 acute myocardial infarction). All follow-up visits (1, 6, and 12-month) showed a significant improvement in all urinary parameters compared to baseline. ThuVEP appears to be a feasible surgical option in high-risk patients on antithrombotic regimens, with acceptable postoperative morbidity, good functional outcome, and low incidence of medium-term reoperation rate.
关键词： aging,postoperative complications,intraoperative complications,prostatectomy,laser therapy,platelet aggregation inhibitors,ThuVEP,benign prostatic hyperplasia,anticoagulants
更新于2025-09-23 15:19:57
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Randomized Trial Comparing Bipolar Transurethral Vaporization of the Prostate versus GreenLight Laser (XPS-180Watt) Photoselective Vaporization of the Prostate for Treatment of small to moderate Benign Prostatic Obstruction: Two-years Outcome
摘要： To test the non-inferiority of Bipolar (B.TUVP) compared to Greenlight laser (GL.PVP) vaporization of the prostate in reduction of BPH-related LUTS in randomized trial. Methods: Eligible patients with 30-80ml prostate were randomly allocated to GL.PVP/XPS? (58) and B.TUVP (61). Non-inferiority of symptoms score (IPSS) at 24 months was evaluated. All perioperative parameters were recorded and compared. Urinary (IPSS, Q.max and PVR) and sexual (IIEF-15) outcome measures were evaluated at 1, 4, 12 and 24 months. Need for retreatment and complications, change of PSA and health-resources related cost of both procedures were depicted and compared. Results: Baseline and perioperative parameters were comparable between the two groups. At 1, 4, 12 and 24 months; 117, 116, 99 and 96 patients were evaluable respectively. Regarding urinary outcome measures, there was no significant difference between both groups. Mean IPSS at one and two years was (7.1±3, 7.9±2.9) following GL.PVP and (6.3±3.1, 7.2±2.8) following B.TUVP (P=0.8, 0.31) respectively. At 24 months the mean difference in the IPSS was 0.7 (95%CI ?0.6-2.3, P=0.6). Median postoperative PSA reduction was 64.7% (25-99) and 65.9% (50-99) following GL.PVP and was 32.1% (28.6-89.7) and 39.3% (68.8- 90.5) following B.TUVP P= 0.006 and 0.005 at 1 and 2 years respectively. After 2 years, retreatment for recurrent BOO was reported in 8 (13.8%) and 10 (16.4%) following GL.PVP and B.TUVP groups respectively (P=0.8). The mean estimated cost per B.TUVP procedure was significantly lower than per GL.PVP procedure after 24 months (P=0.01) Conclusions: In terms of symptoms control, B.TUVP was not inferior to GL.PVP at 2 years. Durability of the outcome needs to be tracked. The cost issue of GL.PVP is a critical concern compared to B.TUVP.
关键词： BPH,prostatectomy,Greenlight,Laser,Bipolar,Prostate,vaporization
更新于2025-09-19 17:13:59
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Robot assisted radical prostatectomy in patients with a history of Holmium laser enucleation of the prostate: The Indiana University Experience
摘要： Introduction: We sought to update our experience of oncologic and functional outcomes of robot-assisted radical prostatectomy (RARP) for prostate cancer in patients with history of holmium laser enucleation of the prostate (HoLEP). Methods: 27 patients with previous HoLEP who underwent RARP were matched 1:1 to RARP patients with no history of transurethral surgery. Demographic, operative, oncologic, continence, and erectile function outcomes were analyzed. Results: Median time between HoLEP and RARP was 31 months with a mean PSA doubling time of 4.28 ng/mL/yr. Operative times were significantly longer with higher bladder neck reconstruction rates and similarly low complication rates. Biochemical recurrence was relatively low (7%) in HoLEP group, identical to the comparative group. Continence at last follow up was not statistically significant between groups although time to continence favored the non-HoLEP cohort. Erectile function recovery was generally poor in the post HoLEP cohort (11%) although bilateral nerve sparing was rarely performed (11%). Compared to our initial experience, there were significant improvements in time to continence (16 vs 36 weeks). No T2 post-HoLEP RARP since 2010 has had a positive surgical margin. Conclusions: Post HoLEP prostatectomy remains feasible with similar perioperative and oncologic outcomes compared with matched cohorts. Functional recovery remains slowed yet may continue to improve with technical familiarity.
关键词： prostatectomy,robotic surgery,HoLEP
更新于2025-09-12 10:27:22
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Standardization of 532 nm Laser Terminology for Surgery in Benign Prostatic Hyperplasia (BPH): A Systematic Review
摘要： Introduction: The use of GreenLight? laser technology to remove the prostatic transitional zone (TZ) transurethrally has grown considerably in recent years, and with it an increase in the number of terms that are used to describe similar techniques. Varying terminology complicates literature analysis and publication, which can cause confusion when performing reviews of the literature. It has become necessary to simplify and standardize terminology used to describe transurethral prostate debulking procedures using the 532 nm laser in order to simplify communication on these techniques. Materials and Methods: We conducted a search on September 17th, 2019 in the following databases: Ovid MEDLINE?; Ovid EMBASE; and PubMed. Results: Of the 1115 unique records found in our database search, a total of 27 articles were selected for inclusion. Of the 16 search terms used, we found that 4 terms could be used to describe the fundamental technique associated with each search term. These terms include “vaporization”, “vaporesection”, “vapoenucleation”, and “enucleation”. Conclusions: Standardizing terminology leads to an efficient consolidation of terms based on the above outcomes. This will streamline the literature search process for future publications and facilitate comparison of varying techniques.
关键词： vapoenucleation,enucleation,532 nm laser,vaporesection,prostate,terminology,benign prostatic hyperplasia,laser prostatectomy,vaporization,GreenLight laser
更新于2025-09-12 10:27:22
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Dependence of laser-induced tissue ablation on optical fiber movements for laser prostatectomy
摘要： Purpose The aim of the current study was to identify the efficient fiber movements for 532-nm laser prostatectomy. Materials and methods 532-nm Lithium triborate (LBO) laser light was tested on 120 kidney tissues at three different translational speeds (TS 1, 2, and 4 mm/s) and four different rotational speeds (RS 0.5, 1.0, 1.6, and 2.1 rad/s). The applied power was 120 W at a 2-mm working distance and 60° sweeping angle. Ablation rate and dimensions of resulting ablation craters were measured. Results Slower TSs and RSs created deeper and wider ablation craters with thinner coagulation, leading to more efficient ablation performance. Maximal ablation rate was achieved at a TS of 2 mm/s and RSs of 0.5 and 1.0 rad/s. An RS of 0.5 rad/s accompanied surface carbonization for all the TSs. Irrespective of TS, ablation rate became saturated at faster RSs than 1.0 rad/s. Faster TSs or RSs reduced tissue ablation, but increased thermal coagulation due to a shorter interaction time. Conclusions Optimal ablation efficiency occurred at a TS of 2 mm/s and a RS of 1.0 rad/s with a thin coagulation of around 1.0 mm and no or minimal carbonization. Further studies will validate the current findings with prostate tissue and high-power levels for laser prostatectomy.
关键词： Rotational speed,Laser prostatectomy,Translational speed,Ablation,Coagulation
更新于2025-09-11 14:15:04
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Greenlight laser enucleation of the prostate
摘要： Symptomatic benign prostatic hyperplasia increases greatly in men beginning in the sixth decade of life. The American Urological Association (AUA) and European Association of Urology (EAU) recommend surgical intervention in patients who fail medical therapy [1,2]. The surgical approach is dependent on patient anatomy, patient and surgeon preference, medical comorbidities, as well as surgeon experience and prostate size. Transurethral prostatectomy is historically prostate size-dependent because of irrigant absorption (dilutional hyponatremia) and procedure time [photovaporization of the prostate (PVP)]. Incomplete resection of large adenoma can fail to improve patient symptoms.
关键词： Greenlight laser enucleation of the prostate,surgical intervention,benign prostatic hyperplasia,transurethral prostatectomy
更新于2025-09-11 14:15:04
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Imaging as a Personalized Biomarker for Prostate Cancer Risk Stratification
摘要： Biomarkers provide objective data to guide clinicians in disease management. Prostate-specific antigen serves as a biomarker for screening of prostate cancer but has come under scrutiny for detection of clinically indolent disease. Multiple imaging techniques demonstrate promising results for diagnosing, staging, and determining definitive management of prostate cancer. One such modality, multiparametric magnetic resonance imaging (mpMRI), detects more clinically significant disease while missing lower volume and clinically insignificant disease. It also provides valuable information regarding tumor characteristics such as location and extraprostatic extension to guide surgical planning. Information from mpMRI may also help patients avoid unnecessary biopsies in the future. It can also be incorporated into targeted biopsies as well as following patients on active surveillance. Other novel techniques have also been developed to detect metastatic disease with advantages over traditional computer tomography and magnetic resonance imaging, which primarily rely on defined size criteria. These new techniques take advantage of underlying biological changes in prostate cancer tissue to identify metastatic disease. The purpose of this review is to present literature on imaging as a personalized biomarker for prostate cancer risk stratification.
关键词： magnetic resonance imaging (MRI),cancer staging,active surveillance,radical prostatectomy,Gleason score,radiation therapy
更新于2025-09-09 09:28:46