Future Directions in Prostate Brachytherapy Integrating Biologic Based Imaging Information into Treatment Planning

Reports from investigators at the University of California San Francisco have indicated that magnetic resonance spectroscopy (MRS) may provide reliable information regarding the ability to more precisely localize malignant zones within the prostate gland 40 . MRS takes advantage of the significantly higher choline levels and significantly lower citrate levels in regions of cancer compared to regions of benign prostatic hypertrophy and normal prostatic epithelium. Detection was especially...

Development of a Telesurgical Robotic System

In 1994, a group at the Imperial College in London investigated a robotic system to assist the urologist with intraoperative percutaneous renal access 7 . They employed a passive, encoded, 5 degrees of freedom (DOF) manipulator equipped with electromagnetic brakes mounted on the operating table. The access needle was manually positioned as prescribed by a computer that triangulated the calyx location from multiple C-arm images 8 . In vitro experiments evaluating system performance demonstrated...

Urinary Tolerance

In general, almost all patients after prostate brachytherapy develop acute urinary symptoms such as urinary frequency, urinary urgency, and occasional urge incontinence. Depending upon the isotope used, these symptoms often peak at one to three months after the procedure and subsequently gradually decline over the ensuing three to six months. Most patients significantly benefit from the use of an alpha-blocker, which ameliorates such symptoms in 60 to 70 of patients. Grimm et al. 25 summarized...

Telesurgery Remote Monitoring and Assistance During Laparoscopy

Bhayani, and Louis R. Kavoussi Summary. Laparoscopic surgery is the most commonly practiced and accepted form of minimally invasive surgery. Laparoscopic surgery in urology has, in many instances, become the standard of care. However, laparoscopy is associated with a steep learning curve because of its complexity and difficulty.This learning curve causes long operative times and potentially increases operative complications. Interestingly, to date there are no formal...

Results

Seventy-one patients were treated in one HIFU session, 13 patients in two sessions, and 1 patient in three sessions, for a total of 100 procedures in 85 patients (1.2 sessions per patient). The reasons for repeat HIFU treatments were as follows six patients were retreated because of short on (2sec) or long off (8 to 12 sec) intervals four patients were retreated for residual tumor two patients were hemilaterally treated on the right or left lobe of the prostate two patients needed a repeat...

Indications and Contraindications for Permanent Prostate Implantation

The ideal candidates for permanent interstitial implantation are those with favorable-risk prognostic features who have a high likelihood of organ-confined disease. This group includes those with prostate-specific antigen (PSA) levels < 10ng ml and with Gleason scores < 7. Although not essential for staging, pre-treatment magnetic resonance imaging (MRI) of the prostate with endorectal coil may be helpful in the assessment of the integrity of the prostatic capsule as well as the geometry of...

Materials and Methods HIFU Equipment

For this study, we used a modified second- and third-generation device called the Sonablate 200 and 500 (Focus Surgery, Indianapolis, IN, USA) in 35 and 50 patients, respectively. A treatment module includes the ultrasound power generator, multiple transrectal probes of different focal depths, the probe positioning system, and a cooling system (Fig. 1). The transrectal HIFU probes use proprietary transducer technology with low-energy ultrasound (4 MHz) for imaging of the prostate and for the...

Merging of Endourology and Oncology Endourooncology

Lee, and Arthur D. Smith Summary. There is a growing need to bring together endourological approaches and sound oncological principles to achieve minimally invasive cancer control in urologic malignancies. Reduced treatment morbidity and quality-of-life issues are becoming more valued by both patients and physicians. In this chapter, we present an overview of the most recent advances in endoscopic, laparoscopic, and energy-based ablation techniques for the treatment...

Robot Assisted Da Vinci Urologic Surgery An Emerging Frontier

Robotic urologic surgery is an interesting and new development in the field of urology that has tremendous possibilities for progress in the future. Reports from various centers worldwide of complex urologic procedures in humans performed with robotic assistance have documented their safety, efficacy, efficiency, and feasibility. This review attempts to define the incorporation of robotics into laparoscopic urologic surgery and also reflects on our experience with over 900 cases of...

HIFU Procedure

All patients were anesthetized by epidural or spinal anesthesia and were placed in the lithotomy position. A condom was placed over the probe, degassed water was used to inflate the condom, which was covered with ultrasound gel for close coupling of the ultrasound probe to the rectal wall, and the probe was inserted manually into the rectum. The probe was fixed in position by an articulating arm attached to the operating table. After selection of the treatment region of the prostate from the...

Complications Safety and Oncological Efficacy

Potential risks include urine extravasation, urinary obstruction, hemorrhage, thrombosis and hematomas, abscess, and dysfunction of the kidney and the tissue through which the waves pass. Up to now, none of these has been reported in association with the procedure. As described above, skin burns are common side effects 21 . They occur because of absorption of ultrasound energy at the interface between two materials that have different attenuation properties....

Problems in Telesurgery

Transferring speed, image quality, and the amount of transferable data may be considered technical problems. On the other hand, the protection of personal information and privacy and malpractice liability are considered legal problems. Table 3. Telementoring trials in Johns Hopkins University Table 3. Telementoring trials in Johns Hopkins University Conventional telephones and modems, Ethernet, ISDN, ADSL, and ATM are currently used for the transmission of information. ISDN is the most popular,...

RF Ablation

All ablation procedures were performed under intravenous sedation with 100 mg of phentanyl citrate and local anesthesia with 1 lidocaine. Internally cooled electrodes with impedance-controlled pulse current from a 200 W generator Radionics, Burlington, MA, USA were used for ablation Fig. 1 . All tumors were treated with a single 1- or 2-cm active tip needle electrode. We usually started with RF energy of 20 W and then gradually increased the energy by 10W every 2min. When the impedance of the...

Robotic Surgery Assisted by the ZEUS System

Aesop Robotic Surgical System

Urology has continuously embraced novel technologies, such as shockwave lithotripsy, lasers, and laparoscopy, that reduce patient morbidity yet maintain an excellent standard of care. To potentially increase the clinical applicability of laparoscopy, robots that enhance operative performance have recently been introduced for a variety of laparoscopic procedures, such as laparoscopic radical prostatectomy, pyeloplasty, and nephrectomy. Although the introduction of robotics has generated...