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The use of bidirectional barbed suture during robotic assisted radical prostatectomy : impact on the perioperative and functional outcomes
No full textBidirectional barbed self-retaining sutures represent a new advancement in the application of suture
materials used in reconstructive urology. This analysis represents our preliminary effort to examine the
intraoperative, postoperative and intermediate functional outcome of bidirectional sutures during robot
assisted radical prostatectomy (RARP).
Materiali e metodi
Between January 2008 and December 2010, 2168 RARP procedures were performed at our institution by a
single surgeon (VP). In this cohort there were 97 patients in whom a bidirectional-barbed suture (AngiotechQuillTM) was used for bladder neck reconstruction, posterior reconstruction and urethrovesical anastomosis
(Group 1). These 97 patients were then computer-matched using multivariable analysis to those who did
not undergo bidirectional-barbed suture during the procedure (Group 2). Retrospective analysis of the
perioperative and functional outcomes was conducted.
Risultati
There were no differences between the preoperative clinical and demographic variables between the two
matched groups. The anastomosis subjectively evaluated by the surgeon was easier in the group 1 (
Discussione
barbed suture have been recently introduced with the aim of make it easier for the surgeons to perform
sutures, particularly anastomosis. Also in the hands of an experienced and skilled operator, barbed suture
make sutures faster.
Conclusioni
Usage of bidirectional barbed suture during RARP results in easier and quicker urethrovesical anastomosis
and in a lower incidence of radiologic urinary leakage. These preliminary results are encouraging and
provide the impetus to conduct further studies with an increased sample size to more clearly define the
outcomes in the use of Quill bidirectional barbed suture
Continence outcomes robotic assisted radical prostatectomy in suboptimal patients
No full textAim of the study
Large prostate, elderly age, higher BMI, salvage prostatectomy and TURP have been associated with poorer continence outcomes during prostatectomy. We analyze the continence outcomes of robotic assisted prostatectomy in this particular subset of patients.
Materials and methods
From January 2008 through November 2012, 4023 patients underwent RARP by a single surgeon (VP) at our institution.
Retrospective analysis of prospectively collected data from our Institutional Review Board approved registry identified 3362 men who had one year of follow-up. This cohort of patients was stratified into six groups: Group I- age 70 and over (n=451); Group
II-body mass index (BMI) 35 and over (n=197); Group III- prior bladder neck procedures (n=103); Group IV-prostate weight 80 g and over (n=280); and Group V- salvage prostatectomy patients (n=41). Group VI contained patients (n=2447) with none of these risk factors. Continence was defined as the use of no pads at follow-up. Follow-up was completed at 6 weeks, 3-, 6-, 9- and 12-months. Continence outcomes at follow-up were analyzed for all groups. Mean time to continence was compared among the groups using ANOVA and the Tukey-Kramer test to conduct multiple group comparisons.
Results
he continence rate for patients 70 and over was 88.9% (401/451) and the mean time 3.2 ± 4.5 months; BMI 35 and over was 96.5% (190/197) 3.1 ± 4.5 months; prior bladder neck treatment 87.4% (90/103) 3.4 ± 4.7 months; prostate weight 80 g and over 89.3% (250/280) 3.3 ± 4.4 months; and salvage procedures 56.1% (23/41) 6.6 ± 8.3 months (p=0.015). Multiple group comparisons of mean time to continence between each group and the salvage group revealed significant differences (p=0.031).
The time to continence was similar for Groups I, II, III, and IV. The continence rate for Group VI (non-risk patients) was 95.1% (2326/2447) and the mean time to continence was 2.4 ± 3.2 months. A comparison of the mean time to continence for all groups in the study (Groups I-VI) revealed a significance difference (p<0.001).
Discussion
This study has demonstrated that selected risk factors including older age (70 and over), BMI 35 and over, prior bladder neck treatment, prostate weight 80 g and over, and previously having undergone a salvage procedure adversely affect the return of continence following RARP. Patients with these risk factors should be counseled concerning expectations for achieving urinary continence. Patients with none of the risk factors assessed in the present study have an increased probability of achieving continence early on following RARP
Conclusions
Suboptimal patients should be counseled concerning expectations for achieving urinary continence. Patients with none of the risk factors assessed in the present study have an increased probability of achieving continence early on following RAR
PERIOPERATIVE AND ONCOLOGICAL OUTCOMES IN HIGH RISK ELDERLY PATIENTS
Full text linkAim of the study
ontroversy continues to exist concerning the treatment of choice for D’Amico high risk elderly patients.
The purpose of this study is to compare the perioperative and oncologic outcomes of robotic assisted radical
prostatectomy (RARP) in D’Amico high risk, propensity score-matched elderly and younger cohorts.
Materials and methods
From January 2008 through August 2012, 3818 patients underwent RARP at our institution by a single
surgeon (VP). Retrospective analysis of prospectively collected data from our Institutional Review Board
approved registry identified 80 D’Amico high risk patients, 70 years of age and over. A propensity scorematch analysis was conducted using multivariable analysis to compare elderly patients (age 70 and over) to
those under 70. The final two study cohorts – D’Amico high risk elderly patients (n=80) and D’Amico high
risk younger patients (n=80) constituted the clinical material for this comparative study of perioperative and
oncologic outcomes.
Results
Preoperative clinical characteristics were similar for the two matched groups. The operative time,
transfusion rate and intra-operative complications were similar for the two groups.The mean estimated blood
loss was significantly greater in younger patients (156.1 ± 84.2 mLvs 113.6 ± 67.7; p=0.002). No significant
differences were observed in laterality, ease of nerve sparing or surgeon subjectively assessed anastomosis
and pathological outcomes between the groups. No significant differences were found in postoperative
complication rates, overall pain scores, length of stay or duration of indwelling catheterization. At follow-up,
freedom from biochemical recurrence (BCR) in elderly patients was 85.0% vs. 83.8% in younger patients.
The mean time to BCR in elderly patients was 15.0 months (range, 2.3 to 38.8) and 14.5 months (range, 5.2
to 35.1) in younger patients.
Discussion
Conclusions
This study clearly demonstrates that RARP can be performed in D’Amico high risk elderly patients without
increasing perioperative morbidity and with oncologic outcomes comparable to high risk younger patients.
RARP in elderly patients presenting with localized prostate cancer should be considered a viable treatment
alternative based on the individual’s life expectancy
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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