Accessibility to surgical robot technology and prostate-cancer patient behavior for prostatectomy

Two conflicting guidelines on prostate specific antigen screening in Japan

Japanese urologists need to listen seriously to the opinions of public health physicians and it is necessary to properly inform people of prostate specific antigen screening.

Surgical Tolerability and Frailty in Elderly Patients Undergoing Robot-Assisted Radical Prostatectomy: A Narrative Review

Simple Summary

Life expectancy in Western countries and East Asian countries has incremented over the past decades, resulting in a rapidly aging world, while in general, radical prostatectomy (RP) is not recommended in elderly men aged ≥75 years. Together with the evolving technique of robotic surgeries, surgical indications for RP should be reconsidered in ‘elderly’ and ‘frail’ men, since this procedure has now become one of the safest and most effective cancer treatments for prostate cancer. One important element to determine surgical indications is surgical tolerability. However, evidence is scarce regarding the surgical tolerability in elderly men undergoing robot-assisted radical prostatectomy (RARP). In this review, we focused on the surgical tolerability in ‘elderly’ and/or ‘frail’ men undergoing RARP, with the intent to provide up-to-date information on this matter and to support the decision making of therapeutic options in this spectrum of patients.

Abstract

Robot-assisted radical prostatectomy (RARP) has now become the gold standard treatment for localized prostate cancer. There are multiple elements in decision making for the treatment of prostate cancer. One of the important elements is life expectancy, which the current guidelines recommend as an indicator for choosing treatment options. However, determination of life expectancy can be complicated and difficult in some cases. In addition, surgical tolerability is also an important issue. Since frailty may be a major concern, it may be logical to use geriatric assessment tools to discriminate ‘surgically fit’ patients from unfit patients. Landmark studies show two valid models such as the phenotype model and the cumulative deficit model that allow for the diagnosis of frailty. Many studies have also developed geriatric screening tools such as VES-13 and G8. These tools may have the potential to directly sort out unfit patients for surgery preoperatively.

Impact of surgical wait times during summer months on the oncological outcomes following robotic-assisted radical prostatectomy: 10 years' experience from a large Canadian academic center

PURPOSE

Most Canadian hospitals face significant reductions in operating room access during the summer. We sought to assess the impact of longer wait times on the oncological outcomes of localized prostate cancer patients following robotic-assisted radical prostatectomy (RARP).

METHODS

We conducted a retrospective review of a prospectively maintained RARP database in two high-volume academic centers, between 2010 and 2019. Assessed outcomes included the difference between post-biopsy UCSF-CAPRA and post-surgical CAPRA-S scores, Gleason score upgrade and biochemical recurrence rates (BCR). Multivariable regression analyses (MVA) were used to evaluate the effect of wait times.

RESULTS

A total of 1057 men were included for analysis. Consistent over a 10 year period, summer months had the lowest surgical volumes despite above average booking volumes. The lowest surgical volume occurred during the month of July (7.1 cases on average), which was 35% less than the cohort average. The longest average wait times occurred for patients booked in June (93 ± 69 days, p < 0.001). On MVA, patients booked in June had significantly more chance of having an increase in CAPRA score [HR (95% CI) 1.64 (1.02-2.63); p = 0.04] and in CAPRA risk group [HR (95% CI) 1.82 (1.04-3.19); p = 0.03]. Cohort analysis showed fair correlation between CAPRA-score difference and wait time (Pearson correlation: r =  - 0.062; p = 0.044).

CONCLUSION

Our cohort results demonstrate that conventional RARP wait times are significantly and consistently prolonged during summer months over the past 10 years, with worse post-RARP oncological outcomes in terms of CAPRA scores. Other compensatory mechanisms to sustain consistent yearly operative output should be considered.

Human motion recognition based on limit learning machine

With the development of technology, human motion capture data have been widely used in the fields of human–computer interaction, interactive entertainment, education, and medical treatment. As a problem in the field of computer vision, human motion recognition has become a key technology in somatosensory games, security protection, and multimedia information retrieval. Therefore, it is important to improve the recognition rate of human motion. Based on the above background, the purpose of this article is human motion recognition based on extreme learning machine. Based on the existing action feature descriptors, this article makes improvements to features and classifiers and performs experiments on the Microsoft model specific register (MSR)-Action3D data set and the Bonn University high density metal (HDM05) motion capture data set. Based on displacement covariance descriptor and direction histogram descriptor, this article described both combine to produce a new combination; the description can statically reflect the joint position relevant information and at the same time, the change information dynamically reflects the joint position, uses the extreme learning machine for classification, and gets better recognition result. The experimental results show that the combined descriptor and extreme learning machine recognition rate on these two data sets is significantly improved by about 3% compared with the existing methods.

WITHDRAWN: The Role of Intercostal Nerve Block Combined with Puncture Surgery Robot Controlled by Fuzzy Proportion Integral Differential Algorithm under the Guidance of MRI Image in the Treatment of Lung Cancer

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US/MRI Guided Robotic System for the Interventional Treatment of Prostate

Needle-based percutaneous prostate interventions include biopsy and brachytherapy and the former is the gold standard for the diagnosis of prostate cancer and the latter is often used in the treatment of prostate cancer. This paper introduces a novel robotic assistant system for prostate intervention and the system architecture and workflow are described, which is significant for the design of similar systems. In order to offer higher precision and better real-time performance, a Ultrasound (US)/Magnetic Resonance Imaging (MRI) fusion method is proposed to guide the procedures in this study. Moreover, image registration is a key step and a hot issue in image fusion, especially in multimodal image fusion. In this work, we adopt a novel registration method based on active demons and optic flow for prostate image fusion. To verify the availability of the system, we evaluate our approach of the US/MRI image fusion by using data acquired from six patients, and root mean square error (RMSE) for anatomical landmarks is 3.15[Formula: see text]mm. In order to verify the accuracy and validity of the system developed in this paper, a system experimental platform was built and used for bionic tissue puncture of prostate under the guidance of MR and Transrectal Ultrasound (TRUS) fusion images. The experimental results show that the deviations of the final actual needle points of the three target points on the bionic tissue model measured in the laboratory environment are less than 2.5[Formula: see text]mm.

Safe surgery in the elderly: A review of outcomes following robotic proctectomy from the Nationwide Inpatient Sample in a cross-sectional study

Background

As our nation's population ages, operating on older and sicker patients occurs more frequently. Robotic operations have been thought to bridge the gap between a laparoscopic and an open approach, especially in more complex cases like proctectomy.

Methods

Our objective was to evaluate the use and outcomes of robotic proctectomy compared to open and laparoscopic approaches for rectal cancer in the elderly. A retrospective cross-sectional cohort study utilizing the Nationwide Inpatient Sample (NIS; 2006-2013) was performed. All cases were restricted to age 70 years old or greater.

Results

We identified 6740 admissions for rectal cancer including: 5879 open, 666 laparoscopic, and 195 robotic procedures. The median age was 77 years old. The incidence of a robotic proctectomy increased by 39%, while the open approach declined by 6% over the time period studied. Median (interquartile range) length of stay was shorter for robotic procedures at 4.3 (3-7) days, compared to laparoscopic 5.8 (4-8) and open at 6.7 (5-10) days (p < 0.01), while median total hospital charges were greater in the robotic group compared to laparoscopic and open cases ($64,743 vs. $55,813 vs. $50,355, respectively, p < 0.01). There was no significant difference in the risk of total complications between the different approaches following multivariate analysis.

Conclusion

Robotic proctectomy was associated with a shorter LOS, and this may act as a surrogate marker for an overall improvement in adverse events. These results demonstrate that a robotic approach is a safe and feasible option, and should not be discounted solely based on age or comorbidities.

Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer

BACKGROUND

Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP).

METHODS

We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment.

RESULTS

Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791).

CONCLUSIONS

Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.