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Melstrom LG, Zhou X, Kaiser A, Chan K, Lau C, Raoof M, Warner SG, Zhumkhawala A, Yuh B, Singh G, Fong Y, Sun V. Feasibility of perioperative remote monitoring of patient-generated health data in complex surgical oncology. J Surg Oncol 2022; 127:192-202. [PMID: 36169200 PMCID: PMC10087541 DOI: 10.1002/jso.27106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The feasibility of remote perioperative telemonitoring of patient-generated physiologic health data and patient-reported outcomes in a high risk complex general and urologic oncology surgery population is evaluated. METHODS Complex general surgical/urologic oncology patients wore a pedometer, completed ePROs (electronic patient-reported outcome surveys) and record their vitals (weight, pulse, pulse oximetry, blood pressure, and temperature) via a telehealth app platform. Feasibility (% adherence) was assessed as the primary outcome measure. RESULTS Twenty-one patients with a median age 58 (32-82) years were included. The readmission rate was 33% and the incidence of ≥Grade 3a morbidity was 24%. Adherence to vital sign and ePRO measurements was 95% before surgery, 91% at discharge, and 82%, 68%, and 64% at postdischarge d2, 7, 14, and 30, respectively. There was significant worsening of mobility, self-care and usual daily activity at postdischarge d2 compared to preoperative baseline (p < 0.05). Median daily preoperative steps taken by patients with <Grade 3a versus ≥Grade 3a postoperative morbidity was 6062 versus 4166 (p < 0.05). Of those interviewed, 87% (13/15) viewed vital sign devices as helpful in recovery. CONCLUSIONS Telemonitoring is feasible in a general surgical and urologic oncology setting. Future studies will ascertain optimal patient selection, duration, and extent of perioperative monitoring.
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Affiliation(s)
- Laleh G Melstrom
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Xiaoke Zhou
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Andreas Kaiser
- Department of Surgery City of Hope, Division of Colorectal Surgery, Duarte, California, USA
| | - Kevin Chan
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Clayton Lau
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Mustafa Raoof
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | | | - Ali Zhumkhawala
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Bertram Yuh
- Department of Surgery City of Hope, Division of Urologic Oncology, Duarte, California, USA
| | - Gagandeep Singh
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA
| | - Virginia Sun
- Department of Surgery City of Hope, Division of Surgical Oncology, Duarte, California, USA.,Department of Population Sciences, City of Hope, Duarte, California, USA
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Shen JK, Jamnagerwalla J, Yuh BE, Bassett MR, Chenam A, Warner JN, Zhumkhawala A, Yamzon JL, Whelan C, Ruel NH, Lau CS, Chan KG. Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy. Ther Adv Urol 2019; 11:1756287219839631. [PMID: 31057669 PMCID: PMC6452578 DOI: 10.1177/1756287219839631] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/04/2019] [Indexed: 01/09/2023] Open
Abstract
Background Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY. Methods A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher's exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance. Results Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs (p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion (p < 0.0001). No complications attributable to the use of SPY were noted. Conclusion Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis.
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Affiliation(s)
- Jim K Shen
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Juzar Jamnagerwalla
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Bertram E Yuh
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Mitchell R Bassett
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Avinash Chenam
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jonathan N Warner
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Ali Zhumkhawala
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jonathan L Yamzon
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Christopher Whelan
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Nora H Ruel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA
| | - Clayton S Lau
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kevin G Chan
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, 1500 East Duarte Road, MOB L002H, Duarte, CA 91010, USA
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Chenam A, Chu W, Ruel N, Kilday P, Jamnagerwalla J, Lau C, Zhumkhawala A, Chan K, Yamzon J, Yuh B. MP47-12 COMPARISON OF PERIOPERATIVE OUTCOMES, FUNCTIONAL OUTCOMES, AND COMPLICATIONS FOR ROBOT ASSISTED RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN ELDERLY VS. YOUNG PATIENTS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Warner J, Jamnagerwalla J, Yuh B, Chenam A, Kilday P, Zhumkhawala A, Lau C, Chan K. V04-04 THE USE OF COLOR SEGMENTED FLUORESCENCE TO ASSESS URETERAL PERFUSION AT THE TIME OF URINARY DIVERSION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Warner J, Kilday P, Zhumkhawala A. V02-05 COMBINED TRANSURETHRAL ENUCLEATION OF THE PROSTATE AND ROBOT ASSISTED SIMPLE PROSTATECTOMY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chenam A, Yuh B, Zhumkhawala A, Ruel N, Chu W, Lau C, Chan K, Wilson T, Yamzon J. Prospective randomised non-inferiority trial of pelvic drain placement vs no pelvic drain placement after robot-assisted radical prostatectomy. BJU Int 2017; 121:357-364. [DOI: 10.1111/bju.14010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Avinash Chenam
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Bertram Yuh
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Ali Zhumkhawala
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Nora Ruel
- Department of Biostatistics; City of Hope National Medical Center; Duarte CA USA
| | - William Chu
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Clayton Lau
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Kevin Chan
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Timothy Wilson
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
| | - Jonathan Yamzon
- Department of Surgery; Division of Urology and Urologic Oncology; City of Hope National Medical Center; Duarte CA USA
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Chennamsetty A, Zhumkhawala A, Yuh B, Lau C, Chu W, Emtage J, Gellhaus P, Ruel N, Chan K, Yamzon J. PD18-11 PROSPECTIVE RANDOMIZED TRIAL OF PELVIC DRAIN PLACEMENT VERSUS NO PELVIC DRAIN PLACEMENT AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY (RARP). J Urol 2017. [DOI: 10.1016/j.juro.2017.02.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chennamsetty A, Chu W, Emtage J, Gellhaus P, Yamzon J, Lau C, Yuh B, Tong T, Colcher D, Wilson T, Zhumkhawala A. PD10-06 INTRA-OPERATIVE OPTICAL IMAGING UTILIZING ANTI-PSMA (PROSTATE SPECIFIC MEMBRANE ANTIGEN) FLUORESCENT ANTIBODY DURING ROBOT ASSISTED RADICAL PROSTATECTOMY (RARP). J Urol 2017. [DOI: 10.1016/j.juro.2017.02.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mooney R, Schena E, Saccomandi P, Zhumkhawala A, Aboody K, Berlin JM. Gold nanorod-mediated near-infrared laser ablation: in vivo experiments on mice and theoretical analysis at different settings. Int J Hyperthermia 2016; 33:150-159. [DOI: 10.1080/02656736.2016.1230682] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Rachael Mooney
- Department of Neurosciences, Beckman Research Institute at City of Hope, Duarte, CA, United States
| | - Emiliano Schena
- Department of Engineering, Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Paola Saccomandi
- France Institute of Image-Guided Surgery (IHU), Strasbourg, France, Strasbourg Cedex, France
| | - Ali Zhumkhawala
- Department of Urology, Beckman Research Institute at City of Hope, Duarte, CA, United States
| | - Karen Aboody
- Department of Neurosciences, Beckman Research Institute at City of Hope, Duarte, CA, United States
| | - Jacob M. Berlin
- Department of Molecular Medicine, Beckman Research Institute at City of Hope, Duarte, CA, United States
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Zhumkhawala A, Tirughana-Sambandan R, Mooney R, Berlin J, Aboody K, Yamzon J. MP61-03 NEURAL STEM CELLS AND GOLD NANOPARTICLES AS NOVEL TREATMENT FOR PROSTATE CANCER – EARLY IN VITRO STUDIES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhumkhawala A, Kozinn S, Chan K, Lau C, Ruel N, Yamzon J, Yuh B, Kawachi M, Wilson T. MP67-18 A DECADE OF ROBOTIC CYSTECTOMY: SURGICAL CHARACTERISTICS AND ONCOLOGIC OUTCOMES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zhumkhawala A, Tirughana-Sambandan R, Mooney R, Berlin J, Aboody K, Yamzon J. MP49-17 NEURAL STEM CELLS AND GOLD NANOPARTICLES AS NOVEL TREATMENT FOR BLADDER CANCER – EARLY IN VITRO STUDIES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chan KG, Guru K, Wiklund P, Catto J, Yuh B, Novara G, Murphy DG, Al-Tartir T, Collins JW, Zhumkhawala A, Wilson TG. Robot-assisted radical cystectomy and urinary diversion: technical recommendations from the Pasadena Consensus Panel. Eur Urol 2015; 67:423-31. [PMID: 25595099 DOI: 10.1016/j.eururo.2014.12.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The technique of robot-assisted radical cystectomy (RARC) has evolved significantly since its inception >10 yr ago. Several high-volume centers have reported standardized techniques with refinements and subsequent outcomes. OBJECTIVE To review all existing literature on RARC and urinary diversion techniques and summarize key points that may affect oncologic, surgical, and functional outcomes. DESIGN, SETTING, AND PARTICIPANTS The Pasadena Consensus Panel on RARC and urinary reconstruction convened May 3-4, 2014, to review the existing peer-reviewed literature and create recommendations for best practice. The panel consisted of experts in open radical cystectomy and RARC. No commercial support was received. SURGICAL PROCEDURE The consensus panel extensively reviewed the surgical technique of RARC in men and women, extended pelvic lymph node dissection, extracorporeal urinary diversion, and intracorporeal urinary diversion. Critical aspects of the technique are described. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Preoperative, operative, and postoperative parameters from the largest and most contemporary RARC series, stratified by urinary diversion technique, are presented. RESULTS AND LIMITATIONS Preoperative, operative, and postoperative measures of RARC technique adhere closely to the standards established in open surgery. CONCLUSIONS Refinement of techniques for RARC and urinary diversion over the past 10 yr has made it safe, reproducible, and oncologically sound. PATIENT SUMMARY We summarize the critical aspects of surgical techniques reviewed at the Pasadena international consensus meeting on RARC and urinary reconstruction. Preoperative, operative, and postoperative measures of RARC technique adhere closely to the standards established in open surgery.
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Mooney R, Schena E, Zhumkhawala A, Aboody KS, Berlin JM. Internal temperature increase during photothermal tumour ablation in mice using gold nanorods. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:2563-2566. [PMID: 26736815 DOI: 10.1109/embc.2015.7318915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Laser ablation (LA) is gaining large acceptance in the treatment of tumor. One of the main risks of this treatment is damaging the healthy tissue around the tumor. Among the solutions proposed to improve the selectivity of the LA and to localize heating to tumor tissue, the use of gold nanoparticles is one of the most promising. The aim of this work is threefold: i) to measure the temperature increase within the tumor during plasmonic photothermal therapy using gold nanorods; ii) to investigate the influence of nanorods concentration and laser settings on both the intra-tumoral temperature and the tumor surface temperature; iii) and to establish the nanorods concentrations able to cause tumor resorption at a defined laser settings. Two sets of trials were performed: i) 16 mice were divided in four groups with different treatment time (i.e., 5 min, 2 min, 1 min, and 30s), with constant gold nanorods amount (i.e., 12.5 μg) and laser power (i.e., 3 W·cm(-2)); ii) 16 mice were divided in four groups treated with different amount of gold nanorods (i.e., control, 12.5 μg, 25 μg, 50 μg) for 5 min at 2 W·cm(-2). Results show significant differences between internal and surface temperatures. We also demonstrate that this temperature difference increases with nanoparticle concentrations, decreases with laser power, and is not influenced by treatment time. This information is critical to improve the theoretical models that will guide future study designs in sensitive orthotopic tumor models.
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Rieder J, Tovar S, Johnston E, Zhumkhawala A, Tran V, Londono D, Patel H, Aboseif S. 1778 WHY PATIENTS STOP TAKING ANTICHOLINERGIC MEDICATIONS FOR OVERACTIVE BLADDER: CREATION AND RESULTS OF A VALIDATED QUESTIONNAIRE. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Navai N, Zhao LC, Okotie O, Han J, Zhumkhawala A, Patil M, Nadler RB, Smith ND. 699: Comparison of Surgical Outcomes between Pure and Hand-Assisted Laparoscopic Radical Nephrectomy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Navai N, Zhao LC, Zhumkhawala A, Patil M, Loeb S, Pazona JF, Lesani OA, Nadler RB, Smith ND. 581: Management of Renal Tumors Smaller than 7CM. J Urol 2007. [DOI: 10.1016/s0022-5347(18)30821-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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