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- Collins, J.W., et al.
(författare)
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Assessing intra-operative ergonomics and workload in robotic surgery using inertia measuring unit sensors and validated questionnaires
- 2016
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Ingår i: European urology. Supplement. - : Elsevier BV. - 1569-9056 .- 1878-1500. ; 15:7, s. 247-247
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION & OBJECTIVES: Robotic approaches have revolutionized radical prostatectomy surgery. The 3D vision and 10 fold magnification provide surgeons improved anatomical vision and more precise instrument control compared to open or laparoscopic techniques. However, the potential benefits of robotic techniques may have trade-offs in increased mental and physical demands for the surgeons. The assisting surgeon, also has the added workload of maintaining working postures that do not impede the robotic arms. This study implemented an innovative motion tracking tool along with validated workload questionnaires to assess the ergonomics and workload for both assisting and console surgeons during robotic surgery. MATERIAL & METHODS: Ten individual surgeons (6 console surgeons and 4 assistant surgeons) performed 15 robotic prostatectomy cases while wearing inertia measurement units (IMUs) to track neck, shoulder, and torso motion during each case. Postoperatively, participants completed a validated workload questionnaire (NASA-TLX). Analysis of variance was performed on all response variables that do not violate the assumption of normality to identify the impact of surgeon role (Console vs Assistant). RESULTS: Twenty-six questionnaires were completed from 13 assisting and 13 console surgeons over the 15 cases. Selfreported mental demand was 41% higher for surgeons at the console than assisting (p<0.05), but physical demand was not statistically different. Post-operative pain was reported highest for the right shoulder and neck and this was more frequently seen in the console surgeons. On IMU readings, the assisting surgeon experienced high neck flexion (>10 degrees) duration over 42% of the procedure compared to only 24% in the console surgeon. In general, surgeons posture on the console was primarily static resulting in fewer movements compared to assisting surgeons. Table 1 summarizes posture movements and durations of static postures. CONCLUSIONS: Postures were more ergonomic during console tasks than assisting by the operating table. However, the console constrains postures leading to static postural loads that have been associated with musculoskeletal symptoms for the neck, torso and shoulders.
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- Ljungberg, Borje
(författare)
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Nephron-Sparing Surgery Strategy : The Current Standard for the Treatment of Localised Renal Cell Carcinoma
- 2011
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Ingår i: European urology. Supplement. - : Elsevier BV. - 1569-9056 .- 1878-1500. ; 10:3, s. E49-E51
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Tidskriftsartikel (refereegranskat)abstract
- Context: In the past few years, there has been a trend towards nephron-sparing surgery (NSS) strategies in renal cell carcinoma (RCC). The previous standard treatment-radical nephrectomy (RN)-has been abandoned, because a number of studies have shown similar oncologic outcomes after NSS for localised RCCs at least up to 7 cm. RN is recommended only in patients with locally advanced tumour growth; those who have an unfavourable tumour location; or for other clinical reasons, such as general health. Objective: The major advantage of NSS is the preservation of renal function. Evidence acquisition: Medical literature was retrieved from PubMed. Evidence synthesis: Already, one-fourth of patients in the current RCC population having tumours <4 cm in size have significantly impaired renal function diagnostic for stage 3 chronic kidney disease. Patients who have and those at risk for impaired renal function of the contralateral kidney have a higher risk for cardiovascular events and decreased overall mortality after RN. Conclusions: In general, NSS is currently advocated for patients with pT1 RCCs whenever technically feasible. This recommendation is based on the evidence that preserving kidney function in the long term results in reduced frequency of cardiovascular events and decreased overall mortality than after RN. Compared with RN, NSS has slightly higher complication rates but is a safe technique offering similar oncologic results. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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- Russo, Andrea, et al.
(författare)
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Silodosin From Bench to Bedside: Selectivity, Safety, and Sustained Efficacy
- 2011
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Ingår i: European urology. Supplement. - : Elsevier. - 1569-9056 .- 1878-1500. ; 10:6, s. 445-450
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Tidskriftsartikel (refereegranskat)abstract
- Context: Silodosin is the alpha(1)-adrenoceptor (AR) antagonist with the highest selectivity for the alpha(1A)-AR subtype that is available for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). How do preclinical findings translate into clinical effect? less thanbrgreater than less thanbrgreater thanObjective: Analyse information on the preclinical selectivity profile of silodosin in relation to clinical efficacy and safety. less thanbrgreater than less thanbrgreater thanEvidence acquisition: A Medline search for published articles on silodosin in preclinical and clinical studies was conducted. Information was also acquired from documents published by the European Medicines Agency. less thanbrgreater than less thanbrgreater thanEvidence synthesis: Silodosin exhibits high selectivity for the alpha(1A) subtype of the adrenoceptor, and it also displays selectivity for the lower urinary tract and prostate versus vascular functions as assessed in studies of isolated tissues, animal models, and patients. Silodosin causes symptom relief within days and is superior to placebo and noninferior to tamsulosin in reducing symptoms in patients with BPH. The effects of silodosin were sustained for 40-52 wk in open-label extension studies of 1170 patients. The safety and tolerability of silodosin are excellent. Silodosin more frequently causes abnormal ejaculation than placebo or tamsulosin, although only a minority of the patients discontinues treatment due to this adverse event. less thanbrgreater than less thanbrgreater thanConclusions: Both preclinical and clinical studies support the contention that silodosin has high uroselectivity and a positive cardiovascular safety profile, likely related to its selectivity for the alpha(1A)-AR subtype. Silodosin has a rapid onset of action and a sustained efficacy on LUTS due to BPH.
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