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author:("Azhar, red A.")
1.  Avoiding and managing vascular injury during robotic-assisted radical prostatectomy 
There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented.
PMCID: PMC4294799  PMID: 25642293
robotic prostatectomy; prostate cancer; vascular injury
2.  Robotic nephron-sparing surgery for renal tumors: Current status 
There have been a number of advances in robotic partial nephrectomy (RPN) for renal masses. We reviewed these advances with emphasis on the evolution of technique and outcomes as well as the expanding indications for RPN. Literature in the English language was reviewed using the National Library of Medicine database. Relevant articles were extracted, and their citations were utilized to broaden our search. The identified articles were reviewed and summarized with a focus on novel developments. RPN is an evolving procedure and is an emerging viable alternative to laparoscopic partial nephrectomy and open partial nephrectomy with favorable outcomes. The contemporary techniques used for RPN demonstrate excellent perioperative outcomes. The short-term oncologic outcomes are comparable to those of laparoscopic and open surgical approaches. Further studies are needed to assess long-term oncologic control.
PMCID: PMC4120214  PMID: 25097313
Outcomes; partial nephrectomy; renal cell carcinoma; robotic surgery
3.  Robotic radical cystectomy and intracorporeal urinary diversion: The USC technique 
Radical cystectomy is the gold-standard treatment for muscle-invasive and refractory nonmuscle-invasive bladder cancer. We describe our technique for robotic radical cystectomy (RRC) and intracorporeal urinary diversion (ICUD), that replicates open surgical principles, and present our preliminary results.
Materials and Methods:
Specific descriptions for preoperative planning, surgical technique, and postoperative care are provided. Demographics, perioperative and 30-day complications data were collected prospectively and retrospectively analyzed. Learning curve trends were analyzed individually for ileal conduits (IC) and neobladders (NB). SAS® Software Version 9.3 was used for statistical analyses with statistical significance set at P < 0.05.
Between July 2010 and September 2013, RRC and lymph node dissection with ICUD were performed in 103 consecutive patients (orthotopic NB=46, IC 57). All procedures were completed robotically replicating the open surgical principles. The learning curve trends showed a significant reduction in hospital stay for both IC (11 vs. 6-day, P < 0.01) and orthotopic NB (13 vs. 7.5-day, P < 0.01) when comparing the first third of the cohort with the rest of the group. Overall median (range) operative time and estimated blood loss was 7 h (4.8-13) and 200 mL (50-1200), respectively. Within 30-day postoperatively, complications occurred in 61 (59%) patients, with the majority being low grade (n = 43), and no patient died. Median (range) nodes yield was 36 (0-106) and 4 (3.9%) specimens had positive surgical margins.
Robotic radical cystectomy with totally ICUD is safe and feasible. It can be performed using the established open surgical principles with encouraging perioperative outcomes.
PMCID: PMC4120218  PMID: 25097317
Bladder cancer; intracorporeal urinary diversion; robot-assisted radical cystectomy; robotic; urinary diversion
4.  Construct validity of the LapSim virtual reality laparoscopic simulator within a urology residency program 
We assessed the construct validity of the LapSim laparoscopic surgical simulator in a urology residency training program.
In total, 15 residents participated in the study between July 2007 and July 2008. The subjects were tested six times at one-month intervals on three skill tasks (lifting and grasping, cutting and clip application) using the LapSim laparoscopic simulator. The testing sessions were divided into the first three sessions (seminar 1), and the subsequent three sessions (seminar 2). We evaluated the following parameters: total time, path length, angular path length, tissue damage, maximum damage and stretch damage. The subjects were divided into junior (PGY 1,2) and senior resident groups (PGY 3,4,5). The Wilcoxon Signed-Rank test for paired samples was used to compare the performances of the juniors and seniors during seminar 1 to their performance in seminar 2 to determine whether there was improvement over time. The Wilcoxon Rank-Sum test for independent samples was used to compare the performance of the juniors to that of the seniors for seminar 1, seminar 2 and the combination of both seminars to determine whether the more experienced senior residents performed better than the less experienced juniors.
No significant performance improvement between testing sessions could be demonstrated. Similarly, there was no significant difference in performance between junior and senior residents.
Construct validity could not be demonstrated for the total time, path length, angular path length and tissue handling parameters of the LapSim laparoscopic surgical simulator when examined within the context of a urology residency program.
PMCID: PMC3433540  PMID: 23093534
5.  Percutaneous Holmium Laser Fulguration of Calyceal Diverticula 
Case Reports in Urology  2012;2012:716786.
Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution which may be associated with the absorption of hypotonic fluids with its inherent electrolyte disturbances. Case Report. In this paper, we present for the first time percutaneous holmium laser fulguration of calyceal diverticula in 2 patients using normal saline. Their immediate postoperative sodium was unchanged and their follow-up imaging showed absence of stones. Both patients remain asymptomatic at 30 months post-operatively. Conclusion. This demonstrates that holmium laser is a safe alternative method to fulgurate the calyceal diverticulum after clearing the stone percutaneously.
PMCID: PMC3352233  PMID: 22606636

Results 1-5 (5)