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It is interesting to think that what used to be considered by many (including myself) as one of the “maximally invasive” procedures, can now be performed laparoscopically or robotically. This procedure is described in a study from the USA using the robot, and there is a review of minimally invasive radical cystectomy from the UK. Finally there is a study from Austria on the use of three-dimensional CT in the preoperative assessment of patients undergoing laparoscopic adrenal-sparing surgery. OBJECTIVE To compare the performance of radical cystectomy with ileal conduit diversion by standard methods with that using the assistance of the daVinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA). PATIENTS AND METHODS From November 2003 to August 2005, we performed 30 radical cystectomies with ileal conduit urinary diversions on patients with bladder cancer. Seven patients (one woman) had a cystectomy with the daVinci system and 23 (nine women) had a standard cystectomy. Data were collected prospectively, including estimated blood loss (EBL), transfusion requirement, operative duration, hospital stay and body mass index (BMI), and compared. RESULTS The mean EBL and transfusion requirements for standard and daVinci-assisted cases was 1109 and 479 mL ( P = 0.002) and 2.7 and 1.6 units ( P = 0.14), respectively. Four of seven patients received a transfusion in the robotic group, and 20 of 23 in the standard group ( P = 0.084). The mean operative duration was 638 and 507 min ( P = 0.005) for the daVinci and standard group, respectively, with respective mean hospital stays of 11 and 13 days ( P = 0.52). There was no difference in patient BMI between the groups ( P = 0.22). CONCLUSION The daVinci-assisted cystectomy appears to offer some advantages over standard cystectomy. Larger randomized studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine if atypical small acinar proliferation (ASAP) represents minimally sampled prostate cancer not fully evaluated on a biopsy or a distinct pathological entity, by examining prostates removed at radical cystectomy, as a finding of ASAP of the prostate on needle-core biopsy is closely associated with the detection of cancer on subsequent biopsy. PATIENTS AND METHODS In all, 65 consecutive cystoprostatectomy specimens taken from June 1990 to March 2004 had prostatic material reviewed by one genitourinary pathologist (S.E.M.). The presence of high-grade prostatic intraepithelial neoplasia (HGPIN), ASAP, and adenocarcinoma was recorded. Foci of ASAP found in the absence of cancer were assessed with additional sectioning, high-molecular weight keratin (CK903), and α-methylacyl coenzyme A racemase (AMACR) immunohistochemistry. RESULTS In all, 24 of 65 specimens (37%) had adenocarcinoma. Of the 41 without cancer, 18 (44%) had neither HGPIN nor ASAP, 14 (34%) had HGPIN alone, three (7%) had ASAP alone (four foci), and six had both HGPIN and ASAP (15%). Two foci of ASAP were not present on any further sectioning. The remaining eight foci all lacked CK903 stain, indicating disruption of the basal cell layer. Of these eight, only five were present for the AMACR stain, all of which were positive. Two of these five developed into a lesion considered cancer on further sectioning. CONCLUSION ASAP identified in incidental prostates represented marginally sampled cancer in at least two of 10 foci assessed. The remainder could not be resolved as benign on further evaluation, and remained suspicious for malignancy. [ABSTRACT FROM AUTHOR]