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Background Large prostate size, median lobes, and prior benign prostatic hyperplasia (BPH) surgery may pose technical challenges during robot-assisted laparoscopic prostatectomy (RALP). Objective To describe technical modifications to overcome BPH sequelae and associated outcomes. Design, settings, and participants A retrospective study of prospective data on 951 RALP procedures performed from September 2005 to November 2010 was conducted. Outcomes were analyzed by prostate weight, prior BPH surgical intervention ( n =59), and median lobes >1cm ( n =42). Surgical procedure RALP. Measurements Estimated blood loss (EBL), blood transfusions, operative time, positive surgical margin (PSM), and urinary and sexual function were measured. Results and limitations In unadjusted analysis, men with larger prostates and median lobes experienced higher EBL (213.5 vs 176.5ml; p p =0.002), and larger prostates were associated with more transfusions (4 vs 1; p =0.037). Operative times were longer for men with larger prostates (164.2 vs 149.1min; p =0.002), median lobes (185.8 vs 155.0min; p =0.004), and prior BPH surgical interventions (170.2 vs 155.4min; p =0.004). Men with prior BPH interventions experienced more prostate base PSM (5.1% vs 1.2%; p =0.018) but similar overall PSM. In adjusted analyses, the presence of median lobes increased both EBL ( p =0.006) and operative times ( p p =0.014). However, prostate size did not affect EBL, PSM, or recovery of urinary or sexual function. Conclusions Although BPH characteristics prolonged RALP procedure times and increased EBL, prostate size did not affect PSM or urinary and sexual function.

In this paper we describe the principles that have guided our design and the experience we have gained building multi-wire proportional chambers detectors for the ultra-cold neutron (UCN) source at the Los Alamos Neutron Science Center (LANSCE). Simple robust detectors with 50 cm2 of active area have been designed. These have been used both in ion chamber and proportional mode for the detection of UCN.

We describe the feasibility of partial arterial clamping (PAC) during robot-assisted partial nephrectomy (RAPN).We undertook a retrospective study of five patients who underwent PAC vs 17 who underwent complete hilar clamping (CHC). Estimated blood loss (EBL), transfusion rate, operative/console time, warm ischemia time (WIT), pathology, and postoperative glomerular filtration rate (GFR) were compared.PAC patients were older (P=0.002) and more likely to have had previous abdominal surgeries (P=0.032). PAC vs CHC was associated with higher median EBL (350 mL vs 75 mL, P=0.026), although there were no differences in blood transfusions (P=0.250). PAC was associated with shorter WIT (14 min vs 21 min, P=0.023). Positive margin rate and GFR change were similar.PAC offers a simple and reproducible technique that limits WIT during RAPN. PAC was not associated with more transfusions or positive margins. Further study is warranted to determine the utility of PAC with larger tumor size as well as the long-term benefits on renal function.

Apical dissection and control of the dorsal vein complex (DVC) affects blood loss, apical positive margins, and urinary control during robot-assisted laparoscopic radical prostatectomy (RALP).To describe technique and outcomes for athermal DVC division followed by selective suture ligation (DVC-SSL) compared with DVC suture ligation followed by athermal division (SL-DVC).Retrospective study of prospectively collected data from February 2008 to July 2010 for 303 SL-DVC and 240 DVC-SSL procedures.RALP with comparison of DVC-SSL prior to anastomosis versus early SL-DVC prior to bladder-neck dissection.Blood loss, transfusions, operative time, apical and overall positive margins, urine leaks, catheterization duration, and urinary control at 5 and 12 mo evaluated using 1) the Expanded Prostate Cancer Index (EPIC) urinary function scale and 2) continence defined as zero pads per day.Men who underwent DVC-SSL versus SL-DVC were older (mean: 59.9 vs 57.8 yr, p0.001), and relatively fewer white men underwent DVC-SSL versus SL-DVC (87.5% vs 96.7%, p0.001). Operative times were also shorter for DVC-SSL versus SL-DVC (mean: 132 vs 147 min, p0.001). Men undergoing DVC-SSL versus SL-DVC experienced greater blood loss (mean: 184.3 vs 175.6 ml, p=0.033), and one DVC-SSL versus zero SL-DVC were transfused (p=0.442). Overall (12.2% vs 12.0%, p=1.0) and apical (1.3% vs 2.7%, p=0.361) positive surgical margins were similar for DVC-SSL versus SL-DVC. Although 5-mo postoperative urinary function (mean: 72.9 vs 55.4, p0.001) and continence (61.4% vs 39.6%, p0.001) were better for DVC-SSL versus SL-DVC, 12-mo urinary outcomes were similar. In adjusted analyses, DVC-SSL versus SL-DVC was associated with shorter operative times (parameter estimate [PE]±standard error [SE]: 16.84±2.56, p0.001), and better 5-mo urinary function (PE±SE: 19.93±3.09, p0.001) and continence (odds ratio 3.39, 95% confidence interval 2.07-5.57, p0.001).DVC-SSL versus SL-DVC improves early urinary control and shortens operative times due to fewer instrument changes with late versus early DVC control.