Examinando por Autor "Haber, Georges-Pascal"

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    Perioperative outcomes of robotic and laparoscopic simple prostatectomy: A european-American multi-institutional analysis
    (Elsevier B.V., 2015) Autorino, Riccardo; Zargar, Homayoun; Mariano, Mirandolino B.; Sanchez-Salas, Rafael; Sotelo, René J.; Chlosta, Piotr L.; Castillo, Octavio; Matei, Deliu V.; Celia, Antonio; Koc, Gokhan; Vora, Anup; Aron, Monish; Parsons, J. Kellogg; Pini, Giovannalberto; Jensen, James; Sutherland, Douglas; Cathelineau, Xavier; Bragayrac, Luciano A.; Varkarakis, Ioannis M.; Amparore, Daniele; Ferro, Matteo; Gallo, Gaetano; Volpe, Alessandro; Vuruskan, Hakan; Bandi, Gaurav; Hwang, Jonathan; Nething, Josh; Muruve, Nic; Chopra, Sameer; Patel, Nishant D.; Derweesh, Ithaar; Weeks, David Champ; Spier, Ryan; Kowalczyk, Keith; Lynch, John; Harbin, Andrew; Verghese, Mohan; Samavedi, Srinivas; Molina, Wilson R.; Dias, Emanuel; Ahallal, Youness; Laydner, Humberto; Cherullo, Edward; De Cobelli, Ottavio; Thiel, David D.; Lagerkvist, Mikael; Haber, Georges-Pascal; Kaouk, Jihad; Kim, Fernando J.; Lima, Estevao; Patel, Vipul; White, Wesley; Mottrie, Alexander; Porpiglia, Francesco
    Background: Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique. Objective: To report a large multi-institutional series of minimally invasive SP (MISP). Design, setting, and participants: Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis. Intervention: Laparoscopic or robotic SP. Outcome measurements and statistical analysis: Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score [removed]15 ml/s, and no perioperative complications. Results and limitations: Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6%) and 843 laparoscopic (63.4%) SP cases. Median overall prostate volume was 100 ml (range: 89-128). Median estimated blood loss was 200 ml (range: 150-300). An intraoperative transfusion was required in 3.5% of cases, an intraoperative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 d (range: 3-5). On pathology, prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p = 0.136; odds ratio [OR]: 1.6; 95% confidence interval [CI], 0.8-2.9), whereas operative time (p = 0.01; OR: 0.9; 95% CI, 0.9-1.0) and estimated blood loss ( p = 0.03; OR: 0.9; 95% CI, 0.9-1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis. Conclusions: This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications. Patient summary: Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy. © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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    Robot-assisted partial prostatectomy for anterior prostate cancer: a step-by-step guide
    (Blackwell Publishing Ltd, 2017-06) Villers, Arnauld; Flamand, Vincent; Arquímedes, Rodríguez-Carlin; Puech, Philippe; Haber, Georges-Pascal; Desai, Mihir M.; Crouzet, Sebastien; Ouzzane, Adil; Gill, Inderbir S.
    Objective: To describe a step-by-step guide to robot-assisted anterior partial prostatectomy (RA-APP) for isolated magnetic resonance imaging (MRI)-detected anterior prostate cancer (APC). Patients and Methods: After Institutional Review Board approval, over an 8-year period (2008–2015), 17 consenting patients were enrolled in a prospective, single-arm, single-centre, Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery (IDEAL) phase 2a study. The inclusion criteria comprised pre-urethral, low–intermediate risk APC diagnosed by MRI and targeted biopsies. Patient position and port placement were identical to the transperitoneal RA radical prostatectomy procedure. Three steps of dissection were identified in the following order: (i) retrograde apical, after dorsal venous plexus division, transition zone (TZ) enucleation, and distal peripheral zone (PZ) sectioning; (ii) antegrade, at the bladder neck (BN) after anterior BN sectioning, TZ enucleation up to the verumontanum; and (iii) lateral dissections, including anterolateral PZ sectioning without incision of the endopelvic fascia. We report the incidence of perioperative complications. The RA completion of prostatectomy in four cases with cancer recurrence was performed at 0.3, 2.5, 2 and 2 years, respectively. Results: The RA-APP comprised en bloc excision of the anterior part of the prostate comprising of the anterior fibromuscular stroma, BN, prostate adenoma (TZ and median lobe) along with the proximal prostate urethra, PZ apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. The posterolateral parts of the PZ and distal (sub-montanal) urethra and peri-prostatic tissues were preserved intact. The bladder opening was sutured to the anterior sphincteric urethra wall and PZ lateral edges. The technique was feasible in all cases with no conversion to an open procedure. Perioperative complications were only Clavien–Dindo grade II. RA completion of prostatectomy was feasible in the four cases with cancer recurrence. Conclusion: PZ prostate-sparing RA-APP for isolated APC is feasible and safe, and represents an option for highly selected men with APCs as an alternative to other focal ablative therapy. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd