1276
LAPAROSCOPY/NEW TECHNOLOGY
Suggested Reading Estrada CR, Datta S, Schneck FX et al: Caliceal diverticula in children: natural history and management. J Urol 2009; 181: 1306. Kim SC, Kuo RL, Tinmouth WW et al: Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single stage approach. J Urol 2005; 173: 1194. Monga M, Smith R, Ferral H et al: Percutaneous ablation of caliceal diverticulum: long-term followup. J Urol 2000; 163: 28.
Re: Predicting an Effective Ureteral Access Sheath Insertion: A Bicenter Prospective Study Y. Mogilevkin, M. Sofer, D. Margel, A. Greenstein and D. Lifshitz Department of Urology, Rabin Medical Center, Petah Tikva, Israel J Endourol 2014; 28: 1414e1417.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.013 available at http://jurology.com/ Editorial Comment: Ureteral access sheaths are now commonly used to facilitate flexible ureteroscopic procedures. These authors identified certain factors that predict the ability to successfully insert a ureteral access sheath. I routinely perform semirigid ureteroscopy with a 7.5Fr instrument before attempting to place an access sheath. If the ureter does not readily accommodate the ureteroscope, I do not attempt to pass an access sheath, and proceed with either flexible ureteroscopy or placement of an internalized stent. I believe that this approach saves dollars and ureters. Dean G. Assimos, MD
Suggested Reading Traxer O and Thomas A: Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013; 189: 580. Kourambas J, Byrne RR and Preminger GM: Does a ureteral access sheath facilitate ureteroscopy? J Urol 2001; 165: 789. Wang HH, Huang L, Routh JC et al: Use of the ureteral access sheath during ureteroscopy in children. J Urol, suppl., 2011; 186: 1728.
Laparoscopy/New Technology Re: Warmed, Humidified Carbon Dioxide Insufflation versus Standard Carbon Dioxide in Laparoscopic Cholecystectomy: A Double-Blinded Randomized Controlled Trial B. Klugsberger, M. Schreiner, A. Rothe, D. Haas, P. Oppelt and A. Shamiyeh 2nd Surgical Department, Academic Teaching Hospital, Ludwig Boltzmann Institute for Operative Laparoscopy, Linz General Hospital, Linz, Austria Surg Endosc 2014; 28: 2656e2660.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.005 available at http://jurology.com/ Editorial Comment: In this well-done randomized study of 148 patients undergoing laparoscopic cholecystectomy the use of warmed humidified CO2 for insufflation decreased postoperative pain on the day of surgery. However, the advantage was small. There was a significant difference in patient reported pain using a visual analogue scale 6 hours postoperatively (0.3 points on a 0 to 10-point scale) but no difference on postoperative day 1. There was no difference in the mean amounts of pain medication used on the day of surgery or postoperative day 1. The authors also observed no difference in the return of bowel function and a 0.2C higher intraoperative core
LAPAROSCOPY/NEW TECHNOLOGY
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temperature with warm humidified gas. I am not sure that these findings are clinically significant enough to justify the added expense of the commercially available technologies. Jeffrey A. Cadeddu, MD
Re: A New Robot for Flexible Ureteroscopy: Development and Early Clinical Results (IDEAL Stage 1-2b) R. Saglam, A. Y. Muslumanoglu, Z. Tokatlı, T. Cas¸kurlu, K. Sarica, A. I_ Tas¸c¸i, B Erkurt, € er, A. S. Kabakci, G. Preminger, O. Traxer and J. J. Rassweiler E Su Departments of Urology, Medicana International Hospital and Ankara University Medical School Hospital, and Department of Bioengineering, Hacettepe University, Ankara and Departments of Urology, Bagcilar Training Hospital, Medeniyet University Hospital, Kartal Training Hospital, Bakırko¨y Training Hospital and Medipol University Medical School Hospital, Istanbul, Turkey, Division of Urologic Surgery, Duke University Medical Center, Durham, North Pierre et Marie Curie, Ho ^ pital Tenon, Paris, France, and Departments of Urology, SLK Kliniken Heilbronn, Carolina, Department of Urology, Universite Heilbronn and University of Heidelberg, Heidelberg, Germany Eur Urol 2014; 66: 1092e1100.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.006 available at http://jurology.com/ Editorial Comment: This study introduces the first commercially available robotic system for endoscopic surgery. The system can accommodate any commercially available ureteroscope that is positioned through a ureteral access sheath. The surgeon sits at a console and can manipulate the scope as well as laser fiber movements remotely. The system was used safely in 81 patients, with an average docking time of less than 1 minute. Of the patients 80% were stone-free at 3 months, with the remaining having “clinically insignificant residual fragments.” Retrospectively the surgeons reported significantly improved ergonomics, with less arm, elbow, wrist and hand stiffness or pain when using the robotic system. We need to see more objective prospective data collection, including possible advantages in decreased radiation exposure. I hope this article does not represent the beginning of another industry driven and unsupported marketing campaign for robotic endoscopic surgery. Jeffrey A. Cadeddu, MD
Suggested Reading Desai MM, Grover R, Aron M et al: Robotic flexible ureteroscopy for renal calculi: initial clinical experience. J Urol 2011; 186: 563.
LAPAROSCOPY/NEW TECHNOLOGY
Suggested Reading Estrada CR, Datta S, Schneck FX et al: Caliceal diverticula in children: natural history and management. J Urol 2009; 181: 1306. Kim SC, Kuo RL, Tinmouth WW et al: Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single stage approach. J Urol 2005; 173: 1194. Monga M, Smith R, Ferral H et al: Percutaneous ablation of caliceal diverticulum: long-term followup. J Urol 2000; 163: 28.
Re: Predicting an Effective Ureteral Access Sheath Insertion: A Bicenter Prospective Study Y. Mogilevkin, M. Sofer, D. Margel, A. Greenstein and D. Lifshitz Department of Urology, Rabin Medical Center, Petah Tikva, Israel J Endourol 2014; 28: 1414e1417.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.013 available at http://jurology.com/ Editorial Comment: Ureteral access sheaths are now commonly used to facilitate flexible ureteroscopic procedures. These authors identified certain factors that predict the ability to successfully insert a ureteral access sheath. I routinely perform semirigid ureteroscopy with a 7.5Fr instrument before attempting to place an access sheath. If the ureter does not readily accommodate the ureteroscope, I do not attempt to pass an access sheath, and proceed with either flexible ureteroscopy or placement of an internalized stent. I believe that this approach saves dollars and ureters. Dean G. Assimos, MD
Suggested Reading Traxer O and Thomas A: Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013; 189: 580. Kourambas J, Byrne RR and Preminger GM: Does a ureteral access sheath facilitate ureteroscopy? J Urol 2001; 165: 789. Wang HH, Huang L, Routh JC et al: Use of the ureteral access sheath during ureteroscopy in children. J Urol, suppl., 2011; 186: 1728.
Laparoscopy/New Technology Re: Warmed, Humidified Carbon Dioxide Insufflation versus Standard Carbon Dioxide in Laparoscopic Cholecystectomy: A Double-Blinded Randomized Controlled Trial B. Klugsberger, M. Schreiner, A. Rothe, D. Haas, P. Oppelt and A. Shamiyeh 2nd Surgical Department, Academic Teaching Hospital, Ludwig Boltzmann Institute for Operative Laparoscopy, Linz General Hospital, Linz, Austria Surg Endosc 2014; 28: 2656e2660.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.005 available at http://jurology.com/ Editorial Comment: In this well-done randomized study of 148 patients undergoing laparoscopic cholecystectomy the use of warmed humidified CO2 for insufflation decreased postoperative pain on the day of surgery. However, the advantage was small. There was a significant difference in patient reported pain using a visual analogue scale 6 hours postoperatively (0.3 points on a 0 to 10-point scale) but no difference on postoperative day 1. There was no difference in the mean amounts of pain medication used on the day of surgery or postoperative day 1. The authors also observed no difference in the return of bowel function and a 0.2C higher intraoperative core
LAPAROSCOPY/NEW TECHNOLOGY
1277
temperature with warm humidified gas. I am not sure that these findings are clinically significant enough to justify the added expense of the commercially available technologies. Jeffrey A. Cadeddu, MD
Re: A New Robot for Flexible Ureteroscopy: Development and Early Clinical Results (IDEAL Stage 1-2b) R. Saglam, A. Y. Muslumanoglu, Z. Tokatlı, T. Cas¸kurlu, K. Sarica, A. I_ Tas¸c¸i, B Erkurt, € er, A. S. Kabakci, G. Preminger, O. Traxer and J. J. Rassweiler E Su Departments of Urology, Medicana International Hospital and Ankara University Medical School Hospital, and Department of Bioengineering, Hacettepe University, Ankara and Departments of Urology, Bagcilar Training Hospital, Medeniyet University Hospital, Kartal Training Hospital, Bakırko¨y Training Hospital and Medipol University Medical School Hospital, Istanbul, Turkey, Division of Urologic Surgery, Duke University Medical Center, Durham, North Pierre et Marie Curie, Ho ^ pital Tenon, Paris, France, and Departments of Urology, SLK Kliniken Heilbronn, Carolina, Department of Urology, Universite Heilbronn and University of Heidelberg, Heidelberg, Germany Eur Urol 2014; 66: 1092e1100.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.006 available at http://jurology.com/ Editorial Comment: This study introduces the first commercially available robotic system for endoscopic surgery. The system can accommodate any commercially available ureteroscope that is positioned through a ureteral access sheath. The surgeon sits at a console and can manipulate the scope as well as laser fiber movements remotely. The system was used safely in 81 patients, with an average docking time of less than 1 minute. Of the patients 80% were stone-free at 3 months, with the remaining having “clinically insignificant residual fragments.” Retrospectively the surgeons reported significantly improved ergonomics, with less arm, elbow, wrist and hand stiffness or pain when using the robotic system. We need to see more objective prospective data collection, including possible advantages in decreased radiation exposure. I hope this article does not represent the beginning of another industry driven and unsupported marketing campaign for robotic endoscopic surgery. Jeffrey A. Cadeddu, MD
Suggested Reading Desai MM, Grover R, Aron M et al: Robotic flexible ureteroscopy for renal calculi: initial clinical experience. J Urol 2011; 186: 563.
