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Hampson A, Sharaf A, Tamhankar A, Lane T, Adshead J, Vasdev N. Post-operative outcomes following robotic assisted laparoscopic radical prostatectomy in patients between the ages of 65 and 69 and between the ages of 70 and 75 years. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02259-5] [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: 11/06/2022] Open
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Nayak A, Piedad J, Wagh Y, Nathan P, Sharma A, Pullar B, Hanbury D, Adshead J. A comparison of cytoreductive and non-cytoreductive management strategies for nephron-sparing approaches to tumours in solitary kidneys. Ann R Coll Surg Engl 2022; 104:548-552. [PMID: 34860125 PMCID: PMC9246560 DOI: 10.1308/rcsann.2021.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tumours in a solitary kidney pose challenges in management. Metastatic tumours and those in difficult locations complicate treatment further. The advent of immunotherapy has shed new light on the management of such tumours. We present a series of three cases treated with nephron-sparing surgery following neoadjuvant immunotherapy and compare the outcomes with patients who underwent robotic partial nephrectomy in a solitary kidney. METHODS We present the outcomes of three patients with solitary kidney tumours who underwent delayed nephron-sparing surgery following good response to immunotherapy. All patients had solitary kidney following a previous nephrectomy, two of which were nonmetastatic but, due to size/location, not amenable to primary treatment; the third patient had metastatic disease and responded to immunotherapy. Two patients underwent robotic partial nephrectomy and one opted for cryotherapy. We compared the preoperative, intraoperative and postoperative parameters of the two patients who underwent robotic cytoreductive partial with patients who underwent robotic partial nephrectomy in a solitary kidney. RESULTS Out of 231 partial nephrectomy patients in our centre, 2 underwent cytoreductive partial nephrectomy and 5 underwent solitary partial nephrectomy. There was no statistically significant difference in the patient demographics in the two groups. Patients in both groups had comparable operative time, warm ischaemia time, blood loss and length of stay. Two of the five patients in the non-cytoreductive robotic partial nephrectomy had Clavien Dindo 1 complications compared with one patient in the robotic cytoreductive partial nephrectomy group. This was not statically significant. CONCLUSION Neoadjuvant immunotherapy can play a valuable role in shrinking renal tumours in solitary kidneys to facilitate robotic partial nephrectomies. There were no significant differences in the intra- and postoperative parameters in patients who underwent cytoreductive partial nephrectomy when compared with patients undergoing robotic solitary partial nephrectomy.
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Solà Marqués C, Abascal Junquera J, Cecchini Rosell L, Juanpere Rodero N, Sabadell Garcia A, Galian Buruaga C, Corcoy Bidasolo M, Walz J, Hadaschik B, Adshead J, Everaerts W, Goffin K, Grootendorst M, Oldfield F, Mestre Fusco A, Vidal-Sicart S, Fumado L. Interim results from a multicentre clinical trial evaluating a drop-in gamma probe for sentinel lymph node dissection in prostate cancer. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)01211-8] [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] Open
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Noël J, Spencer N, Lodia S, Karim S, Taneja S, Moghanchizadeh D, Nayak A, Tamhankar A, Swamy R, Agarwal S, Narula A, Lane T, Adshead J, Vasdev N. Neurovascular Structure-Adjacent Frozen-section Examination (NeuroSAFE) Robotic Radical Prostatectomy: Functional outcomes from the first 500 consecutive cases. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01467-6] [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: 11/28/2022]
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Vasdev N, Tamhankar A, Adshead J, Catto J, Kelly J, Thurairaja R. Radical cystectomy (open, laparoscopic and robotic) in 12625 patients in England: National trends and peri-operative outcomes from Hospital Episode Statistics data. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34147-1] [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: 10/23/2022] Open
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Tamhankar A, Spencer N, Hampson A, Noel J, El-Taji O, Arianayagam R, McNicholas T, Boustead G, Lane T, Adshead J, Vasdev N. Real-time assessment of learning curve for robot-assisted laparoscopic prostatectomy. Ann R Coll Surg Engl 2020; 102:717-725. [PMID: 32538121 DOI: 10.1308/rcsann.2020.0139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The learning curves analysed to date for robot-assisted laparoscopic prostatectomy are based on arbitrary cut-offs of the total cases. METHODS We analysed a large dataset of robot-assisted laparoscopic prostatectomies from a single centre between 2008 and 2019 for assessment of the learning curve for perioperative outcomes with respect to time and individual cases. RESULTS A total of 1,406 patients were evaluated, with mean operative time 198.08 minutes and mean console time 161.05 minutes. A plot of operative time and console time showed an initial decline followed by a near-constant phase. The inflection points were detected at 1,398 days (308th case) for operative time and 1,470 days (324th case) for console time, with a declining trend of 8.83 minutes and 7.07 minutes, respectively, per quarter-year (p<0.001). Mean estimated blood loss showed a 70.04% reduction between the start (214.76ml) and end (64.35ml) (p<0.001). The complication rate did not vary with respect to time (p=0.188) or the number of procedures (p=0.354). There was insufficient evidence to claim that the number of operations (p=0.326), D'Amico classification (p=0.114 for intermediate versus low; p=0.158 for high versus low) or time (p=0.114) was associated with the odds of positive surgical margins. CONCLUSIONS It takes about 300 cases and nearly 4 years to standardise operative and console times, with a requirement of around 80 cases per annum for a single surgical team in the initial years to optimise the outcomes of robot-assisted laparoscopic prostatectomy.
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Affiliation(s)
| | | | - A Hampson
- East and North Hertfordshire NHS Trust, UK
| | - J Noel
- East and North Hertfordshire NHS Trust, UK
| | - O El-Taji
- East and North Hertfordshire NHS Trust, UK
| | | | | | - G Boustead
- East and North Hertfordshire NHS Trust, UK
| | - T Lane
- East and North Hertfordshire NHS Trust, UK
| | - J Adshead
- East and North Hertfordshire NHS Trust, UK
| | - N Vasdev
- East and North Hertfordshire NHS Trust, UK.,University of Hertfordshire, UK
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Mirmilstein G, Noel J, Gbolahan O, Vasdev N, Lane T, Adshead J. The Lister AirSeal® port closure technique - Initial patient outcomes. Ann R Coll Surg Engl 2019; 101:606-608. [PMID: 31672035 DOI: 10.1308/rcsann.2019.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The 12-mm AirSeal® port is widely used in robotically assisted laparoscopic prostatectomy due to its ability to maintain stable pneumoperitoneal pressures and smoke evacuation. However, it creates a potential risk of port site hernia. We have traditionally used EndoClose™ to perform full thickness closure of this port, but noted that patients experienced increased pain related to this procedure, which sometimes persisted for several months. Using the Da Vinci Si we performed peritoneal closure with 2-0 vicryl by switching the fourth arm to the right master controller. The external oblique sheath was closed outside with 1 Ethibond. MATERIALS AND METHODS We performed this closure in 20 consecutive patients (group 1). Postoperative day 1, 2 and post-discharge telephone consultation pain scores (1-10) were recorded and compared with the previous 20 consecutive patients who had the EndoClose closure (group 2). RESULTS We recorded an instructional video to enable reproduction of the new technique. The mean length of stay was 1.5 days for patients in group 1 and 1.9 days for those in group 2 (P = 0.04). There was no difference in operating time or average day 1 pain scores. Post-discharge follow-up call revealed 1 of 20 patients who had AirSeal port site pain in group 1 and 5 of 17 in group 2 (P = 0.04). Pain scores also tended to be higher for group 2. CONCLUSIONS Our preliminary analysis of this novel technique to close the AirSeal port in two separate layers improves postoperative pain related to this port site.
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Affiliation(s)
- G Mirmilstein
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - J Noel
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - O Gbolahan
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - N Vasdev
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - T Lane
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - J Adshead
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
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Shah T, Undre S, Adshead J. UP-02.223 Effect of a Suspension Suture in Addition to a Total Anatomical Reconstruction in Robot-Assisted Laparoscopic Prostatectomy: Does It Help Early Continence? Urology 2011. [DOI: 10.1016/j.urology.2011.07.1041] [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: 11/27/2022]
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Patel H, Sandhu SS, Adshead J, Norman A, Huddart R, Horwich A, Christmas T. 928: Bone Metastases from Testicular Tumours: Management and Outcomes. J Urol 2004. [DOI: 10.1016/s0022-5347(18)38177-1] [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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Adshead J, Khoubehi B, Wood J, Rustin G. Testicular implants and patient satisfaction: a questionnaire-based study of men after orchidectomy for testicular cancer. BJU Int 2001; 88:559-62. [PMID: 11678751 DOI: 10.1046/j.1464-4096.2001.02392.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the satisfaction of men with their testicular implants after undergoing orchidectomy for testicular cancer, and to determine their reasons for accepting or declining a prosthesis. PATIENTS AND METHODS In all, 424 men who had undergone radical orchidectomy and were part of the testicular cancer follow-up programme were sent an anonymous questionnaire comprising 10 questions covering two main areas. First, the reasons for accepting or declining an implant and second (if they received an implant) their satisfaction with the size, position, feel, shape and overall comfort; 234 men (55%) responded. RESULTS About a third (71 men) accepted an implant, a third declined and a third were not offered the choice. Of the men who replied 91% felt that it was extremely important to be offered an implant at the time of surgery. Of the 71 who received an implant, 19 (27%) were dissatisfied and felt that they had an average or poor cosmetic result. The reasons for this dissatisfaction are presented and discussed. CONCLUSIONS All men undergoing orchidectomy should be offered a testicular implant, irrespective of age. Sample implants in all sizes should be available in the outpatient department. This will give men realistic expectations and allow them to choose a suitable size of implant. The dimensions of the available implants should be improved to create a more elliptical prosthesis, to avoid dissatisfaction with the shape. Adequate fixation to the base of the scrotum is important to avoid the 'high riding' implant.
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Affiliation(s)
- J Adshead
- Department of Urology, Watford NHS Trust, Linda Jackson Centre and Department of Medical Oncology, Mount Vernon Hospital, Middlesex, UK
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Abstract
In a double-blind, crossover study, we determined whether microencapusulated pancreatic enzymes reduce postprandial symptoms experienced by healthy volunteers after ingestion of a high calorie, high fat meal. At 7 AM, 18 subjects ingested 185 g of cookies (1196 calories and 72 g of fat) with three pancrelipase capsules or a placebo. The severity of gastrointestinal symptoms and flatus passages were recorded for 15-17 hr, and end-alveolar samples were obtained hourly for 10 hr. Ingestion of pancreatic supplements was associated with a significant (P = 0.049) reduction in bloating over the entire recording period, and with significant reductions in bloating, gas, and fullness during the dinner to bedtime period. Pancreatic supplements had no significant effect on breath H2 or CH4 concentration. The finding that pancreatic supplements reduce postprandial symptoms in healthy subjects suggests that these supplements also might be beneficial in irritable bowel syndrome.
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Affiliation(s)
- F Suarez
- Minneapolis Veterans Affairs Medical Center, Minnesota 55417, USA
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Suarez FL, Adshead J, Furne JK, Levitt MD. Lactose maldigestion is not an impediment to the intake of 1500 mg calcium daily as dairy products. Am J Clin Nutr 1998; 68:1118-22. [PMID: 9808231 DOI: 10.1093/ajcn/68.5.1118] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A National Institutes of Health consensus conference concluded that a daily calcium intake of 1500 mg reduces the severity of osteoporosis. Because dairy products are the main natural source of dietary calcium, a diet providing 1500 mg Ca must contain large quantities of dairy products. However, it is widely believed that the lactose content of these products will not be tolerated by persons with lactose maldigestion (approximately 30% of the adult US population). OBJECTIVE We evaluated the symptoms of lactose maldigestion and digestion when the diet was supplemented with dairy products providing 1300 mg Ca/d. DESIGN Sixty-two women (31 with lactose maldigestion and 31 without) were studied in a double-blind, randomized protocol. Symptoms were compared during 1-wk periods when the diet was supplemented with 480 mL (2 cups) milk, 56 g cheese, and 240 mL yogurt provided as conventional products (34 g lactose/d) or as lactose-hydrolyzed products (2 g lactose/d). RESULTS Women who digested lactose reported no significant difference in symptoms between the 2 treatment periods. Women with lactose maldigestion reported significantly increased flatus frequency and subjective impression of rectal gas during the period of high lactose intake; however, bloating, abdominal pain, diarrhea, and the global perception of overall symptom severity were not significantly different between the 2 treatment periods. CONCLUSION The symptoms resulting from lactose maldigestion are not a major impediment to the ingestion of a dairy-rich diet supplying approximately 1500 mg Ca/d.
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Affiliation(s)
- F L Suarez
- Minneapolis Veterans Affairs Medical Center, MN 55417, USA
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