LAPAROSCOPY/NEW TECHNOLOGY
129
within the first year. This finding is a concern, as adaptation of surveillance and preservation of acceptable clinical outcomes from surveillance will require consensus in the proper methodology for practice. Samir S. Taneja, MD
Suggested Reading Filson CP, Schroeck FR, Ye Z et al: Variation in use of active surveillance among men undergoing expectant treatment for early stage prostate cancer. J Urol 2014; 192: 75. Loeb S, Berglund A and Stattin P: Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer. J Urol 2013; 190: 1742.
Laparoscopy/New Technology Re: Lateral Temperature Spread of Monopolar, Bipolar and Ultrasonic Instruments for Robot-Assisted Laparoscopic Surgery L. J. Hefermehl, R. A. Largo, T. Hermanns, C. Poyet, T. Sulser and D. Eberli Division of Urology, University Hospital Zurich, Zurich, Switzerland BJU Int 2014; 114: 245e252.
Abstract available at http://jurology.com/ Editorial Comment: This is a valuable well-done study that independently assesses the lateral thermal changes associated with activation of the various energy based robotic instruments. Of course, these findings are particularly relevant to robotic prostatectomy. I cannot review all of the data presented in that each instrument was tested in various activation scenarios. Suffice it to say that when activated for 1 second at 30 watts (the most common clinical settings), the robotic scissors performed the worst, with the temperature increasing above 45C as far as 2.6 mm from the instrument tip. The Maryland bipolar instrument had a 1.5 mm spread, and the HarmonicÒ scalpel had the lowest spread at 1.1 mm. When it comes to possible application near the neurovascular bundles, the automatic robotic PKSÔ and LigaSureÔ instruments probably should be avoided as well, given that they perform no better than hot shears, with lateral temperature increases above 45C of 2.5 and 2.8 mm, respectively. Interestinglydand a good clinical pearldthe tissue temperature increase associated with each instrument can be mitigated by placing a second instrument alongside the energy device and touching the tissue to act as a heat sink. The thermal spread decreased by 0.5 to 1.0 mm for the instruments tested using this maneuver. Jeffrey A. Cadeddu, MD
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Testicular Cancer Incidence to Rise by 25% in Europe? Model-Based Predictions in 40 Countries Using Population-Based Registry Data ranger, A. Flechon, C. Le Cornet, J. Lortet-Tieulent, D. Forman, R. Be € B. Fervers, J. Schuz and F. Bray Cancer Sections of Environment and Radiation, and Cancer Information, International Agency for Research on Cancer, and Unite on Be rard, Lyon and Universite Claude Bernard Lyon 1, et Environnement and Centre de Lutte Contre le Cancer, Centre Le Villeurbanne, France
129
within the first year. This finding is a concern, as adaptation of surveillance and preservation of acceptable clinical outcomes from surveillance will require consensus in the proper methodology for practice. Samir S. Taneja, MD
Suggested Reading Filson CP, Schroeck FR, Ye Z et al: Variation in use of active surveillance among men undergoing expectant treatment for early stage prostate cancer. J Urol 2014; 192: 75. Loeb S, Berglund A and Stattin P: Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer. J Urol 2013; 190: 1742.
Laparoscopy/New Technology Re: Lateral Temperature Spread of Monopolar, Bipolar and Ultrasonic Instruments for Robot-Assisted Laparoscopic Surgery L. J. Hefermehl, R. A. Largo, T. Hermanns, C. Poyet, T. Sulser and D. Eberli Division of Urology, University Hospital Zurich, Zurich, Switzerland BJU Int 2014; 114: 245e252.
Abstract available at http://jurology.com/ Editorial Comment: This is a valuable well-done study that independently assesses the lateral thermal changes associated with activation of the various energy based robotic instruments. Of course, these findings are particularly relevant to robotic prostatectomy. I cannot review all of the data presented in that each instrument was tested in various activation scenarios. Suffice it to say that when activated for 1 second at 30 watts (the most common clinical settings), the robotic scissors performed the worst, with the temperature increasing above 45C as far as 2.6 mm from the instrument tip. The Maryland bipolar instrument had a 1.5 mm spread, and the HarmonicÒ scalpel had the lowest spread at 1.1 mm. When it comes to possible application near the neurovascular bundles, the automatic robotic PKSÔ and LigaSureÔ instruments probably should be avoided as well, given that they perform no better than hot shears, with lateral temperature increases above 45C of 2.5 and 2.8 mm, respectively. Interestinglydand a good clinical pearldthe tissue temperature increase associated with each instrument can be mitigated by placing a second instrument alongside the energy device and touching the tissue to act as a heat sink. The thermal spread decreased by 0.5 to 1.0 mm for the instruments tested using this maneuver. Jeffrey A. Cadeddu, MD
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Testicular Cancer Incidence to Rise by 25% in Europe? Model-Based Predictions in 40 Countries Using Population-Based Registry Data ranger, A. Flechon, C. Le Cornet, J. Lortet-Tieulent, D. Forman, R. Be € B. Fervers, J. Schuz and F. Bray Cancer Sections of Environment and Radiation, and Cancer Information, International Agency for Research on Cancer, and Unite on Be rard, Lyon and Universite Claude Bernard Lyon 1, et Environnement and Centre de Lutte Contre le Cancer, Centre Le Villeurbanne, France
