JOURNAL OF ENDOUROLOGY Volume 29, Number 8, August 2015 ª Mary Ann Liebert, Inc. P. 867 DOI: 10.1089/end.2015.0214
Editorial Comment for Silay et al. Pasquale Casale, MD
T
he authors should be congratulated on their work. Robotic or pure laparoscopic ureteral reimplantation is a procedure taken for granted as being a simple approach to correcting vesicoureteral reflux (VUR). This misconception flows from the fact that VUR is so widespread that the experience with minimally invasive surgery in this disease entity must be large just because of sheer numbers. Robotic extravesical or intravesical reimplantation is quite challenging. Having performed both approaches, I believe the intravesical is much more difficult because of the many issues regarding bladder access and stability, as well as the working environment. The outcomes across the U.S. might be considered unacceptable, and vary even among outstanding surgeons with great minimally invasive experience as reported by Grimsby and associates.1 There are reports, however, with helpful techniques showing outstanding results in the short and long term.2,3 What this proves to me is that we have become irresponsible with the dissemination of knowledge, which hinders our progress for one common goal we all have—the delivery of the best possible care for children. How we rectify this dilemma is a challenge in the era where productivity with decreased reimbursement adds barriers to taking the time to ensure excellent outcomes and techniques become ubiquitous. Instead of reinventing the wheel in each region or each institution, it behooves us to join
together, share our knowledge, be critical of our own and each other’s techniques, swallow our pride, and strive to be better. We need to stop working in silos. How do we do it? I’m open to suggestions, but it seems we have no choice when outcomes vary so widely for such a common problem. References
1. Grimsby GM, Dwyer ME, Jacobs MA, et al. Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation. J Urol 2015;193(suppl 5):1791–1795. 2. Kasturi S, Sehgal SS, Christman MS, et al. Prospective longterm analysis of nerve-sparing extravesical robotic-assisted laparoscopic ureteral reimplantation. Urology 2012;79:680–683. 3. Silay MS, Baek M, Koh CJ. Robot-assisted laparoscopic extravesical ureteral reimplantation in children: Top-down suturing technique without stent placement. J Endourol. 2015 Mar 11. Epub ahead of print.
Columbia University Hospital, New York, New York.
867
Address correspondence to: Pasquale Casale, MD Columbia University Hospital 3959 Broadway, 11th floor New York, NY 10032 E-mail: [email protected]
Editorial Comment for Silay et al. Pasquale Casale, MD
T
he authors should be congratulated on their work. Robotic or pure laparoscopic ureteral reimplantation is a procedure taken for granted as being a simple approach to correcting vesicoureteral reflux (VUR). This misconception flows from the fact that VUR is so widespread that the experience with minimally invasive surgery in this disease entity must be large just because of sheer numbers. Robotic extravesical or intravesical reimplantation is quite challenging. Having performed both approaches, I believe the intravesical is much more difficult because of the many issues regarding bladder access and stability, as well as the working environment. The outcomes across the U.S. might be considered unacceptable, and vary even among outstanding surgeons with great minimally invasive experience as reported by Grimsby and associates.1 There are reports, however, with helpful techniques showing outstanding results in the short and long term.2,3 What this proves to me is that we have become irresponsible with the dissemination of knowledge, which hinders our progress for one common goal we all have—the delivery of the best possible care for children. How we rectify this dilemma is a challenge in the era where productivity with decreased reimbursement adds barriers to taking the time to ensure excellent outcomes and techniques become ubiquitous. Instead of reinventing the wheel in each region or each institution, it behooves us to join
together, share our knowledge, be critical of our own and each other’s techniques, swallow our pride, and strive to be better. We need to stop working in silos. How do we do it? I’m open to suggestions, but it seems we have no choice when outcomes vary so widely for such a common problem. References
1. Grimsby GM, Dwyer ME, Jacobs MA, et al. Multi-institutional review of outcomes of robot-assisted laparoscopic extravesical ureteral reimplantation. J Urol 2015;193(suppl 5):1791–1795. 2. Kasturi S, Sehgal SS, Christman MS, et al. Prospective longterm analysis of nerve-sparing extravesical robotic-assisted laparoscopic ureteral reimplantation. Urology 2012;79:680–683. 3. Silay MS, Baek M, Koh CJ. Robot-assisted laparoscopic extravesical ureteral reimplantation in children: Top-down suturing technique without stent placement. J Endourol. 2015 Mar 11. Epub ahead of print.
Columbia University Hospital, New York, New York.
867
Address correspondence to: Pasquale Casale, MD Columbia University Hospital 3959 Broadway, 11th floor New York, NY 10032 E-mail: [email protected]
