MINIMALLY INVASIVE UROLOGIC CANCER SURGERY
MIN IMA LLY I NVAS IVEUROLOGIC CANCER SURGERY2015Where State-of-the-Art Surgery, Patient-Centered Care and World-Class Research Go Hand-In-HandWelcome to the BIDMC Program in Minimally Invasive Urologic Cancer Surgery. We have theprivilege of caring for patients with urologic cancer, and we are devoted to providing personaland compassionate care for each and every patient during a very stressful time. Our teamoffers the full range of treatment options, from non-surgical options, to the most technically advancedsurgery performed by the most experienced robotic surgery team in Massachusetts. This newsletterdescribes the latest developments in our clinical and research efforts, as well as our goals and challengesfor the future. We thank you for allowing us to care for you and your families. By doing so, you join ourteam as well, and we hope to show you how you are helping contribute to the BIDMC difference.THE BIDMC DIFFERENCEThe motto of the BIDMC difference is “HUMAN FIRST.”We aim to live up to the philosophy behind this motto bymaking our care truly patient-centered; the goals, wishes andpreferences of our patients are always our first priority. Wedevelop a deep, personal connection with our patients so thateach one feels that he or she is seen as a unique individual,not just a number.We combine this philosophy with the most robust kidney,prostate and bladder cancer program in New England. Ourmultidisciplinary programs for kidney and prostate cancerwere among the first to be developed in Boston, focusingon patient-centered care, and encouraging non-surgicalapproaches whenever possible. We are also justifiably proudof our robotic surgery team, the most experienced in Boston,having performed over 1500 minimally invasive surgeriesfor genitourinary tumors. This expertise has allowed us todevelop the first minimally invasive urologic fellowship inBoston focusing on robotic surgery.The co-leaders of our team, Drs. Andrew Wagner and PeterChang, specialize in minimally invasive surgical approaches tomalignant urologic conditions, in particular, kidney, prostate,and bladder cancer. Our research interests include evaluatingthe safety of active surveillance for low risk prostate andkidney cancer, evaluating health-related quality of lifefollowing cancer surgery, designing new tools to improve theeducation of patients after their cancer diagnosis, developingablation techniques for small renal tumors, and evaluatingtotally robotic surgery for advanced bladder cancer.In This Issue2 Our Team3 Prostate Cancer8 Kidney Cancer12 Bladder Cancer14 Robotics
Be th Is rae l D e a c o n e s s M ed ical Cen t erOur TeamLeft to right: Peter Renehan, BS; Ostap Dovirak, MD; Catrina Crociani, MPH; Kimberly Taylor,BS; Peter Chang, MD, MPH; Andrew Wagner, MD; Kyle McAnally, BSCatrina is a Clinical Trials Specialist for the Di-Peter Chang, MD, MPHAndrew A. Wagner, MDvision of Urology. She has worked on qualityDr. Peter Chang specializes in minimallyAssistant Professor of Surgery at Harvardinvasive and open approaches to urologicMedical School and Director of Minimallyyears. She reports directly to the principalcancer surgery. He has a particular interestInvasive Urologic Surgery at BIDMC, Dr.in prostate and bladder cancer, and is theWagner specializes in minimally invasiveDirector of the BIDMC Prostate Cancersurgery for urologic cancer, in particularCare Center, a multidisciplinary programkidney, prostate, and bladder tumors.that emphasizes collaboration betweenHe completed a clinical fellowship inurologic oncology, medical oncology,minimally invasive urology and roboticsKimberly Taylor, BSand radiation oncology and providesat the Brady Urological Institute of JohnsKim is a Clinical Research Assistant with acomprehensive care through all stages ofHopkins University. Dr. Wagner hasBS in Biology from Emmanuel College. Shedisease to patients with prostate cancer.performed robotic surgery since 2004 andis currently working on our kidney surgeryis considered one of the country’s mostdatabases and kidney quality of life stud-experienced robotic cancer surgeons.ies, the PASS and MEAL prostate cancerDr. Chang is also a promising researchinvestigator. He was recognized as one of theof life/outcome research studies for over 10investigators (Drs. Chang and Wagner) andprovides guidance on all related study activities including day-to-day troubleshooting,regulatory affairs, study finances, and hiring/training of junior personnel.active surveillance studies, the robotic vsnation’s top 10 young Urologic InvestigatorsDr. Wagner is the director of the BIDMCin 2014, and served as a Urology CareMinimally Invasive Urologic FellowshipFoundation Research Scholar from 2012-Program, the first such academic fellowship2014. He currently is the first recipientin New England. Dr. Wagner has also beenKyle McAnally, BSof the Martin and Diane Trust Careerthe course director for the New EnglandKyle is a Clinical Research Assistant withDevelopment Chair in Surgery at BIDMC.Robotics Teaching Course since 2012. Thisa BS in Geography from the University ofcourse allows surgeons and residents fromNorth Alabama. He is currently working onaround the country to come to BIDMC tothe Mazzone and P3P prostate cancer edu-learn from world-renowned faculty aboutcation trials, the robotic vs open prostateadvanced robotic surgery techniques.cancer quality of life study, and the PASSDr. Chang is a world expert in qualityof life assessment in prostate cancer,and is committed to bringing cuttingedge research findings to patients in2Catrina Crociani, MPHopen prostate cancer quality of life studyand the bladder cancer database.and MEAL prostate cancer active surveil-the clinic. He developed the ExpandedDr. Wagner has published over 50Prostate Cancer Index Composite for Clinicalmanuscripts and book chapters onPractice (EPIC-CP) questionnaire, which isurologic surgery. His research interestsPeter Renehan, BSused to measure prostate cancer patients’include evaluating the safety of activePeter is a Harvard medical student with aquality of life in the clinical setting. He issurveillance for low risk prostate cancerresearch interest in surgical cost effective-also interested in prostate cancer patientand kidney cancer, evaluating quality ofness. He is studying the return to workeducation, and leads BIDMC’s effort inlife after urologic cancer surgery (roboticpatterns of our patients and gatheringhelping patients learn about their cancerprostatectomy, laparoscopic nephrectomy,data that will allow him to evaluate thediagnoses and communicate their personalrobotic partial nephrectomy and roboticoverall societal financial impact frompreferences to the doctor so that patient-cystectomy), and developing ablationcancer care.centered treatment decisions can be made.techniques for small renal tumors.lance studies.
Mi ni mal l y I nvasi ve Urologic Cancer SurgeryProstate CancerPhilosophyProstate cancer care at BIDMC featuresremarkably integrated clinical andresearch programs with a commonthread: patient-centered care. Ourphilosophy is that every patient withprostate cancer has different prioritiesfor his care, has a right to communicatethose wishes to doctors clearly, andhas the right to have the best qualityof-life possible. While our team hasextraordinary surgical expertise, it isactually our efforts before and aftertreatment that set us apart from otherinstitutions.Surgical and Clinical Excellence in Prostate Cancer CareWe pride ourselves in being the mosthighly trained and most experiencedrobotic surgery program in the NewEngland area. Every component of ourteam, from our surgeons, Drs. Wagnerand Chang, our nurse practioners Jodiand Analesa to our operating roomnurses and technologists, to our preoperative and recovery room staff,has been working together since ourrobotic surgery program started hereat BIDMC in 2008. This combinedexperience allows us to offer a level ofcare that is unparalleled in this area.How do we know? We track everyoutcome that occurs and constantlylook for ways to make our surgerysafer and better.Our clinical excellence in prostatecancer goes far beyond our surgicalexcellence. We offer the most moderntools for diagnosis, including MRIguided prostate biopsy, and urine/blood tests that may guide a patienttowards or away from biopsy. After apatient finds out he has prostate cancer,we offer multidisciplinary care at theBIDMC Prostate Cancer Care Center,led by Dr. Chang, where patients canreceive comprehensive care from thesurgeon, radiation oncologist, andmedical oncologist in a single session.For patients with lower-grade cancer,we are committed to encouragingactive surveillance in order to preservequality of life for as long as possible.For patients whose tumor biology orbehavior is unclear, we offer genomictests to better understand the genesthat make these tumors more or lessaggressive. Lastly, no matter whattreatment a patient chooses, we believehe has a right to have the best qualityof life possible.ROBOTIC PROSTATECTOMY AT BIDMC IS EXTRAORDINARILY SAFE11.2%Major2.6%Total 13.8%MinorAverageHospital Stay1.3d aysComplicationsComplicationsComplication RateCONVERSIONTO OPEN SURGERY0%High RiskCancer DeathPatients RateINFECTION RATE 3.2% 43% 0%BloodTRANSFUSIONS0.2%PROSTATE3
Be th Is rae l D e a c o n e s s M ed ical Cen t erQuality of Lifeand Prostate CancerWhen a patient first hears that he has prostate cancer and begins to learn more about the disease, he will find out that, because of theprostate’s function and anatomical location, his urinary, sexual, bowel, and hormonal systems may be injured during cancer treatment.This raises questions, such as, “Will I still be able to have sex after treatment?”, and “If I have urine leakage after surgery, how longwill it last?” BIDMC has long been a national leader in prostate cancer quality of life research, and we are proud of how we bring thisexpertise to the clinical setting so that every patient can expect to have his quality of life concerns addressed.Prostate Cancer Surgery Database: Outcomes and TransparencyOur commitment to using patient-reported data to measurequality of life has allowed us to build a clinical databaseof patients who have undergone prostate cancer surgeryat BIDMC. The information in this database assists usin analyzing our performance as surgeons, and helps uscounsel patients about their expected outcomes based onour own experiences with previous patients. For example,we can tell patients that based on our last 400 operations,about 70% of those patients are no longer using anyprotective pads for urinary leakage six months after surgeryand 92% are using either zero or one pad per day (see table).Our techniques and outcomes after robotic prostatectomyhave been accepted and/or presented at several scientificmeetings.4Use of protective urinary pads after robotic prostatectomyat BIDMC, as reported using the EPIC-CP questionnaire in thelast 400 patients6 monthsafter surgery2 yearsafter surgeryDo not need anyurinary pads70%79%Use 1 or fewerurinary pads92%95%We track every outcome that occurs andconstantly look for ways to make oursurgery safer and better.
Minimally Invasive Urologic Cancer SurgeryChoosing No Treatment:Active Surveillance for Prostate CancerNot all prostate cancers are the same.Some tend to be very slow-growingand will never metastasize (spread toother organs) or cause problems. Thesecancers may not need to be treated.Indeed, BIDMC has been a nationalleader in an approach called activesurveillance, one in which a patient withsuch a tumor is carefully monitoredthrough regular rectal exams, PSAmeasurements, and most importantly,repeat prostate biopsies, to determinewhether the tumor is getting worse orstaying the same. The rationale behindsuch active surveillance is that, for everyyear, month, or day that a patient candelay getting his prostate removed, hecan preserve his current quality-of-life.Unfortunately, despite its proven safety,many doctors across the nation are notcomfortable with this approach, and areover-treating low-grade prostate cancer.At BIDMC, we not onlyregularly offer activesurveillance, but we alsooffer participation inexciting national clinicaltrials for patients onactive surveillance that arechanging our understandingof these tumors.Men’s Eating and Living Study (MEAL)Prostate Active Surveillance Study (PASS)“What can I do to help slow down my cancer? Does what I eat affectThe PASS study is the largest multi-center study in the U.S.the growth of my cancer?” These are common questions from ourdedicated to prostate cancer active surveillance, with over 1200patients, and ones that we do not have good answers to, as yet.patients enrolled to date, and over 120 patients from BIDMC.The MEAL study aims to investigate how diet may (or may not)This study aims to identify substances (called biomarkers) inaffect prostate cancer progression in men on active surveillancethe blood and urine that may predict whether a man on activefor their cancer. It is a national study run out of the Universitysurveillance will progress (and require treatment) or continue toof California - San Diego, and we have recently started accruingmeet the criteria for active surveillance. BIDMC is proud to be a toppatients. Patients are randomly chosen to receive either a strictcontributor to the PASS study, and we are the only institution thatphone-based dietary intervention or other information regardingoffers participation in the study in the Northeast. Once again, beingdiet using paper or web format. Being on the study does noton the study does not change clinical care, nor will it immediatelychange our clinical care of patients. It is an opportunity for patientsbenefit the participants. However, it is an important opportunity toto contribute to our understanding of this disease and how we maycontribute to science, and one of the unique aspects of receivinginfluence its course.care at an academic center of excellence such as BIDMC.PROSTATE5
Be th Is rae l D e a c o n e s s M ed ical Cen t erAccurate and ConsistentQuality of LifeMeasurement: EPIC-CPResearch has shown that doctorstend to overestimate their ownoutcomes and underestimate patients’symptoms after prostate cancertreatment. In order to limit this bias,and to give patients their own voice tocommunicate their problems clearly,Dr. Chang created the EPIC for ClinicalPractice (EPIC-CP) questionnaire,which is now used worldwide byorganizations such as the MovemberFoundation and the AmericanUrological Association (Chang P et al,J Urol Sep 2011).Our team is committed to using EPICCP to evaluate quality of life for everypatient, on every visit.Bringing our quality oflife research expertiseto the clinic allowsus to tell a prostatecancer patient, givenhis age, PSA level,and pre-surgerysexual function, hisapproximate chancesof recovering sexualfunction after surgery.(Chipman et al, J Urol Mar 2014)Prostate Cancer Treatment Decision-MakingThe treatment decisions associated with certain cancers can be fairlystraightforward. However, prostate cancer is more complicated. A patient mostoften has multiple potential treatment choices, each of which affects cancer controland quality of life differently and may have lifelong consequences. At BIDMC, weaim to achieve a shared decision-making approach and almost all of our prostatecancer patients are offered participation in an exciting research study that may aidin this shared decision-making.Personalized Patient Profile-Prostate (P3P) Randomized TrialPatients seen at BIDMC areoffered participation in theP3P randomized trial, anNIH-funded study that testswhether an individualized webbased program may improvethe patient-doctor interactionand decrease the confusionthat can occur during apatient’s treatment decision.This program finds out what’smost important to the patientUsing EPIC-CP also allows us toidentify a patient who may not berecovering more slowly than othersand may require intervention. Mostimportantly, however, it allows ourpatients to tell us how they are doingin an objective, consistent way.(e.g. sexual function, cancercontrol, bowel function), andwho he wants to be involvedin the treatment decision andhow much. Based on theseresponses, the P3P uses videosto advise the patient on howto talk to his doctor about these concerns. BIDMC is the only site in New Englandparticipating in this national study, and is the highest accruing site in the nation,reflecting our dedication to helping patients make the best decision possible.6
Minimally Invasive Urologic Cancer SurgeryLeading the Way in Understanding Quality of LifeChanges after Prostate Cancer Treatment:The PROST-QA and RP2 studiesDr. Chang is the Co-Overall Principal Investigator and Dr. Wagner is a CoInvestigator for the NIH-funded multi-center PROST-QA and RP2 studies. Thesestudies aim to describe clearly how different prostate cancer treatments impactquality of life and patient satisfaction, and their results have been published inthe New England Journal of Medicine and the Journal of the American MedicalAssociation. They are arguably the most important prostate cancer quality-oflife studies ever performed, and BIDMC continues to play a critical role in theircontinued success, serving as the main DataCoordinating Center. Dr. Chang has recentlycompleted an in-depth analysis of the urinaryeffects of prostate cancer treatment, whichhas been presented at several nationalscientific meetings and is pendingsubmission for publication. Themulti-center RP2 study evaluatespatients after either robotic oropen surgery and will allowus to compare how open androbotic prostatectomy affectpatients’ quality of life. We arecurrently analyzing this data andeagerly await these results.Future Goalsand Directions Expand our clinical researchprogram to include ALL prostatecancer patients in BIDMC — amultidisciplinary effort. Analyze results of the PROST-QARP2 study — addressing the questionof how robotic and open surgerycompare in regards to quality of lifeoutcomes. Implement electronic EPIC-CPthroughout BIDMC. Evaluate the relationshipbetween pelvic floor strengthand post-prostatectomy urinaryincontinence. Assess how use of EPIC-CPaffects practitioner workflow andpatient satisfaction.Select Prostate Cancer Bibliography (2010-Present)Alemozaffar M, Narayan R, Minnillo B,Matthes K, San Francisco I, Nguyen H,Wagner AA. A novel high fidelity robotassisted radical prostatectomy simulator. JEndourol part B, Videourology, Dec 2010Chang P, Szymanski KM, Dunn RL, ChipmanJJ, Litwin MS, Nguyen PL, Sweeney CJ,Cook R, Wagner AA, Dewolf WC, BubleyGJ, Funches R, Aronovitz JA, Wei JT, SandaMG. Expanded prostate cancer indexcomposite for clinical practice: developmentand validation of a practical health relatedquality of life instrument for use in theroutine clinical care of patients with prostatecancer. J Urol 2011; 186: 865-72Wagner AA, Sanda MG. Retropubic androbotic-assisted radical prostatectomy. In.Baker RJ and Fischer JE, editors. Mastery ofSurgery. 6th edition, Lippincott Williams &Wilkins. 2012Chipman JJ, Sanda MG, Dunn RL, Wei JT,Litwin MS, Crociani CM, Regan MM, ChangP; PROST-QA consortium. Measuring andpredicting prostate cancer related quality oflife changes using the Expanded ProstateCancer Index Composite for Clinical Practice(EPIC-CP).Alemozaffar M, Percy AA, Narayan R,Minnillo BB, Steinberg P, Haleblian G,Gautam S, Matthes K, Wagner AA.Validation of a novel, tissue based simulatorfor robot assisted radical prostatectomy. JEndourol 2014, 28: 995Carneiro A, Sasse AD, Wagner AA,Peixoto G, Kataguiri A, Neto AS, BiancoBA, Chang P, Pompeo AC, Tobias-MachadoM. Cardiovascular events associated withandrogen deprivation therapy in patientswith prostate cancer: a systematic reviewand meta-analysis. World J Urol. 2014 Nov12 [Epub ahead of print].Chang P, Carneiro A, Dovirak O, Taylor K,Crociani C, McAnally K, Percy A, Sanda M,Wagner AA. Real-world use of EPIC forClinical Practice (EPIC-CP) to assess patientreported prostate cancer quality of life in theclinical setting. American Urologic AssociationAnnual Meeting, New Orleans 2015Skolarus TA, Dunn RL, Sanda MG, Chang P,Greenfield TK, Litwin MS, Wei JT, and thePROST-QA Consortium. Minimally importantdifference for the Expanded Prostate CancerIndex Composite Short Form. Urology. 2015Jan; 85(1):101-6.Chen RC, Chang P, Vetter RJ, Lukka H,Stokes WA, Sanda MG, Watkins-BrunerD, Reeve BB, Sandler HM. Recommendedpatient-reported core set of symptoms tomeasure in prostate cancer treatment trials.Journal of the National Cancer Institute.2014 Jul 8 106(7).Gay H, Michalski J, Hamstra D, Wei JT, DunRL, Klein E, Sandler HM, Saigal C, LitwinM, Kuban D, Hembroff L, Chang P, SandaMG, PROSTQA Consortium. Neoadjuvantandrogen deprivation therapy (NADT)leads to immediate impairment of vitality/hormonal and sexual quality of life: Resultsof a multi-center, prospective study. Urology.2013 Dec; 82(6): 1363-8.PROSTATE7
Kidney CancerPhilosophyKidney cancer patients at BIDMC are caredAdvanced Multidisciplinary Kidney Cancer CareAs Dana Farber/Harvard Cancer Center’s (DF/HCC) lead site for kidney cancer,BIDMC has the largest team of specialists with a specific clinical and academicinterest in kidney cancer in New England, and one of the only multidisciplinarykidney cancer clinics in the northeast. This includes surgeons, medical oncologists,radiologists, pathologists, radiation oncologists, social workers, nurse specialists,and psychiatrists. Patients with advanced disease see not just one doctor but ateam of kidney cancer specialists. In weekly meetings, our team collaborates todiscuss challenging cases to determine the best treatment options. This integratedapproach to evaluation and treatment enhances patient care.As DF/HCCs lead kidney site, we have received Kidney Cancer SPORE funding:this is the largest NCI-sponsored multi-center grant for kidney cancer in thecountry. Our team continues to make novel treatment and research breakthroughsin kidney cancer, advancing the field in Boston and around the world. Very fewplaces, if any, have such a high concentration of kidney experts, providing youwith the widest and most updated array of treatment options.Robotic Partial NephrectomyOur team has themost experience with robotic partial nephrectomyin Massachusetts. We have pioneered novel approaches to this surgery,allowing for safe removal of tumors while sparing damage to the normal kidneyand preserving kidney function. For the last five years, we have used an “earlyunclamping technique.” This procedure allows the tumor to be removed whiledrastically reducing the amount of time blood flow to the kidney is stopped. Ourresults demonstrate complication rates and “ischemia time” among the best ofall published series. We also published our novel approach to upper pole tumors,known as the “transposition technique.” This allows safer access to difficult-toreach tumors while allowing the surgeon excellent visualization of the tumor andkidney blood vessels.for by New England’s best multidisciplinaryteam of kidney cancer specialists. Weprovide the most technologically advancedsurgical and medical care for our patients,and at the same time make each patientpart of the team through open lines ofcommunication and education. As webelieve well-informed patients live longerhealthier lives, we encourage our patientsto learn about and become involved intheir care whenever possible.BIDMC urologic oncology surgeons areacknowledged as New England’s leadersin robotic and laparoscopic surgery forkidney cancer. We perform 100 to 150kidney cancer surgeries annually, and90% of our surgery, evenfor complicated cases, isminimally invasive. Because wesee a large volume of advanced kidneycancers from around the country andbeyond, we are especially skilled atremoving smaller tumors robotically(robotic partial nephrectomy) and largetumors laparoscopically — even verylarge tumors that are starting to invadesurrounding structures (laparoscopicradical nephrectomy).ROBOTIC PARTIAL NEPHRECTOMY AT BIDMC BY THE NUMBERSAverage WarmISCHEMIAT I M E14.7minutes8UrineL eak0%AverageHospital Stay2.5d aysPositiveMargins3% AverageOperative Time193minutes16.6%Major1.4%Total 18.0%MinorComplicationsComplicationsComplication RateBloodTRANSFUSIONS3.7%
Minimally Invasive Urologic Cancer SurgeryKidney Cancer Surgery ResearchWith a large clinical volume of kidney cancer surgeriescomes a responsibility to gain knowledge for futuregenerations of patients and clinicians. Our researchinterests cover important areas such as developingnovel surgical techniques, to finding non-surgicaltreatments using state-of-the-art technology,evaluating quality of life after surgery, and identifyingways to improve cost effectiveness of cancer care.Read on for more information on our studies.Small Kidney Masses:Choosing No SurgeryWhen PossibleIn 2012, we joined up with thekidney cancer team from JohnsHopkins University to evaluate thesafety of “surveillance” of smallkidney masses. This project, named“DISSRM” (Delayed Intervention andSurveillance for Small Renal Masses),has blossomed into a full-fledgedcollaboration, and is helping to changethe way urologists approach thetreatment of small kidney masses forselect patients.Together, we are followingover 400 patients with smallkidney masses and only ahandful have eventuallyrequired surgery. We are alsohelping to design a scoring systemto allow other doctors to determinewhen surveillance or surgery is moreappropriate. We presented multipleabstracts describing our work at the2014 American Urologic Associationannual meeting in Orlando, andhave recently published our results inEuropean Urology, 2015.Developing New Robotic Kidney Surgery TechniquesOur team has been performing roboticpartial nephrectomy longer thanany other team in Boston and wecontinue to pave the way. Wehavedeveloped even safer methodsto remove kidney tumorswhile limiting ischemia timethat can damage kidneysduring surgery. We have partneredwith a multi-center group in Franceto share results using our “earlyunclamping technique,” in a first ofits kind video manuscript. Also, avideo describing our robotic kidneytransposition technique won first prizeat the World Congress of Endourologyin Istanbul, Turkey in 2012.This picture demonstrates transpositionof the kidney during robotic partialnephrectomy. The kidney is transposedallowing for safer resection of hard-toaccess upper pole tumors. Cost Effectiveness StudiesThere is still considerable controversy regarding the increased expense of robotics in surgery.Although we published on this topic in 2013, comparing the hospital costs of open,laparoscopic, and robotic partial nephrectomy, the overall financial impact of these surgerieshas never been quantified and our team is currently evaluating several different ways todo this. This year we designed and carried out a pilot study to evaluate the societal impactof kidney cancer surgery. Our results showed the typical patient societal costs after kidneysurgery were approximately 10,000 and even higher in certain patient populations. We arevery excited about this project and recently had our work accepted for presentation at boththe American Society of Clinical Oncology Meeting in Orlando (Feb. 2015) and the AmericanUrologic Association Meeting in New Orleans (May 2015). Future funding could help us studythe overall financial impact of minimally invasive surgery on health care in the United States.KIDNEY9
Be th Is rae l D e a c o n e s s M ed ical Cen t erQuality of Life After Kidney Surgery: What is the Best Approach?Recovery From Laproscopic Radical Nephrectomy (RN)and Robotic Partial Nephrectomy (PN)100Quality of LifeThrough seed funding from the Kidney Cancer Association,and generous philanthropic support from BIDMC patients,we have developed a multi-center project to prospectivelyevaluate the quality of life in patients following kidneysurgery. In particular, we are interested in objectivelycomparing recovery between different types of surgery,such as partial and radical nephrectomy. Also we areevaluating the differences in recovery between open androbotic surgery. Pilot data from this work was published inthe journal Urology. More recent updates were presentedin October 2014 at the New England Sectional meetingof the American Urologic Association annual meeting inNewport, Rhode Island and will be presented in 2015 atthe American Association of Urology National Meeting inNew Orleans. Through continued philanthropic support,we are now enrolling patients into our study from MaineMedical Hospital in Portland, Maine, making this one ofthe largest multi-center projects in the country specificallydesigned to study recovery after kidney cancer surgery. Thiscombined database will allow us to answer questions aboutkidney failure rates after surgery, compare recovery andquality of life after open, robotic and percutaneous surgeryPartial Nephrectomy80Radical Nephrectomy604020Baseline2weeks48weeks weeks126weeks months1yearfor kidney tumors, and evaluate cost effectiveness of differentapproaches to kidney tumors.Above, we show a figure comparing the quality of liferecovery of laparoscopic radical nephrectomy to roboticpartial nephrectomy. We found that although most patientsreturn to baseline by 4 weeks, many patients require longerthan this for certain areas of quality of life.Cyberknife Radio-SurgeryFor Kidney TumorsBIDMC is investigating innovative nonsurgical treatments for smaller kidneytumors. CyberKnife is the newesttechnology to treat tumors withoutanesthesia or surgery. This approachoffers superior targeting accuracy, sendingpencil-thin beams of radiation into thetumor, while sparing the normal kidneyand surrounding organs. BIDMC wasthe first center in New England to treatkidney tumors using the CyberKniferobotic stereotactic radiosurgery system.Our experience with this technology nowexceeds 50 patients, but is still only offere
Jul 08, 2014 · Andrew A. Wagner, MD Assistant Professor of Surgery at Harvard Medical School and Director of Minimally Invasive Urologic Surgery at BIDMC, Dr. Wagner specializes in minimally invasive surgery for urologic cancer, in particular kidney, prostate, and bladder tumors. He completed a clinical fellowship in minimally invasive urology and robotics
Follow-up after treatment for non-muscle-invasive bladder cancer Low-risk non-muscle-invasive bladder cancer Discharge to primary care people who have hadlow-risknon-muscle-invasive bladder cancer and who have no recurrence of the bladder cancer within 12months. Intermediate-risk non-muscle-invasive bladder cancer
urologic or pelvic surgery, there is an anticipated prolonged duration of surgery, patient is anticipated to receive large volume infusions of fluid or diuretics, or the patient requires monitoring 3.3.1 If used, the Foley catheter should be removed within 24 hours except if the patient underwent rectal or urologic surgery
Key words: Minimally invasive treatment, micromachining, MEMS, catheter, endoscope Introduction Medical tools for use in the human body, such as catheters and endoscopic tools, need to be thin or small. With the progress of minimally invasive diagnostics and treatment techniques and the increasing number of their applications, these
Rhinological and Otological Society, Inc. Minimally Invasive Transfrontal Sinus Approach to Resection of Large Tumors of the Subfrontal Skull Base Yadranko Ducic, MD, FRCS(C); Caetano Coimbra, MD Objectives/Hypothesis: To review our favorable experience with a minimally invasive transfrontal sinus approach to tumors of the subfrontal region.
Robotic Surgery: Prostate Cancer and Other Urologic Applications Champ Weeks, MD, FACS Director of Robotic Surgery Memorial Hospital at Gulfport www.drchampweeks.com. Topics of Discussion Role of laparoscopy in Urology
General Urology Isuru Jayaratna, MD General Urology, Urologic Oncology Steven A. Kaplan, MD Men’s Health, Benign Prostate Disease Reza Mehrazin, MD Urologic Oncology, Robotic Surgery Jay A. Motola, MD Male and Female Urology Craig F. Nobert, MD Urologic Oncology, General Urology Sovrin M. Shah, MD, FPMRS
Page 6 of 6 Adam Hittelman, MD, PhD, with co-authors Marianne Casilla-Lennon, MD, and Jose Murillo Netto, MD, recently submitted a book chapter, "New Robotic Systems, Minimally Invasive and Robotic-Assisted Surgery in Pediatric Urology." The Smilow Cancer Hospital Prostate and Urologic Cancers Program is expected to launch a multidisciplinary clinic at the Smilow Cancer Hospital Care Center in .
1 Advanced Engineering Mathematics C. Ray Wylie, Louis C. Barrett McGraw-Hill Book Co 6th Edition, 1995 2 Introductory Methods of Numerical Analysis S. S. Sastry Prentice Hall of India 4th Edition 2010 3 Higher Engineering Mathematics B.V. Ramana McGraw-Hill 11 th Edition,2010 4 A Text Book of Engineering Mathematics N. P. Bali and Manish Goyal Laxmi Publications 2014 5 Advanced Engineering .
