Eye injures from robotic-assisted radical prostatectomy (RARP)
Henry Campbell
Now the interesting thing about this:. One of the sites that I tried with a Google search had an advertisementfor Proton Beam radiation stuck in the middle of the article-- just another form of cheating ??
I think this is important so some precautions are taken but may also a red herring. My wife took off 80% of her
corneal covering with a broom - Dr. said "DUMB" wife said "painful" it healed very quickly. Dr. is no
longer in our loop. Henry
"
Robotic Prostate Surgery
October 16, 2012
TUESDAY, Oct. 16 (HealthDay News) — The number of eye injuries associated with robotic-assisted radical prostatectomy (RARP)— complete removal of the prostate — increased nearly tenfold in the United States between 2000 and 2009, although the risk was still small, a new study finds.
During that time, the incidence rate of eye injuries rose from 0.07 percent to 0.42 percent, according to the review of more than 136,000 such procedures. Most of the injuries involved corneal abrasion, or scratching of the eye surface.
While undergoing robotic-assisted radical prostatectomy,(RARP) patients are positioned head-down and are at risk for facial swelling, arm injuries, as well as corneal or other eye injuries, the researchers explained.
Possible causes of eye injuries during robotic-assisted radical prostatectomy include the long duration of surgery, patient positioning or something associated with the robot itself, said Dr. Ajay Sampat and colleagues at the University of Chicago.
The study was scheduled for presentation Tuesday at the annual meeting of the American Society of Anesthesiologists in Washington, D.C.
Robotic-assisted radical prostatectomy was approved for use in the United States in 2000, and is increasingly used to remove prostate cancer because it is minimally invasive, leading to shorter hospital stays, lower infection rates and less need for pain medications after surgery, the study authors noted in a news release from the society.
The procedure was used in less than 10 percent of prostate cancer surgeries in 2000, and increased to between 50 percent and 80 percent of all such operations in 2008.
“It is important for patients who are considering a robotic operation to discuss these concerns with their health care providers to consider the risks and benefits of all options,” Sampat said in the news release. “And physicians caring for patients undergoing [robotic-assisted radical prostatectomy] should be more watchful of these potential injuries and take the necessary steps to help prevent them.”
Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.
More information
The American Cancer Society has more about prostate cancer surgery.
– Robert Preidt
SOURCE: American Society of Anesthesiologists, news release, Oct. 16, 2012
Last Updated: Oct. 16, 2012
Copyright © 2012 HealthDay. All rights reserved.
| A1173 October 16, 2012 8:00:00 AM - 11:00:00 AM Room Hall C-Area C |
| Perioperative Visual Injury in Radical Prostatectomy: A 10 Year Study From 2000-2009 |
| Ajay Sampat, M.D., David Glick, M.D., Steven Roth, M.D. University of Chicago, Chicago, Illinois, United States |
| Background: Perioperative visual injury (POVI) accompanying non-occular surgeries has been characterized in several different types of operations, but not in prostatectomy. Anecdotal reports suggest the occurence of injuries to the visual system in either open (OP) or robotic assisted radical prostatectomy (RAP), with suspicion that they are more likely in RAP, perhaps due to length of surgery or patient positioning. Our study compares POVI in RAP to that in OP. Many studies have demonstrated the benefit of RAP in reducing the incidence of post-op infection, transfusion requirement, and duration of hospital stay (1). To date, a small single institution study suggested an increase in corneal abrasion in RAP vs. OP (2). Our study used a national database to compare the incidence of POVI in RAP and OP, and to characterize the trend of POVI in prostatectomy over the last 10 years. Methods: Data disks from the Nationwide Inpatient Sample (NIS) were obtained for the years 2000-2009. Patients who underwent radical prostatectomy and had the corresponding ICD9 procedure code (60.5) were abstracted for each year. ICD9 diagnostic codes for common causes of POVI were searched in each database and the incidence rates of each were tabulated for each year (Table 1). For 2009, the robot-assisted modifier code (17.42) was used to identify RAP cases, which were examined separately from the OP cases. Of note, the 17.42 code was not used prior to 2009. Incidence of POVI was compared to a control group, laparoscopic cholecystectomy. Results: A total of 136,711 cases of radical prostatectomy were in the NIS over the 10 year period from 2000-2009. Of these cases, the overall incidence of POVI was 0.22%, and that of corneal abrasions was 0.15% (Table 2). There was an overall increasing trend in the total rate of POVI and of corneal abrasion during the 10-year period when compared with the control (Figure 1). In 2009, of the 15,614 radical prostatectomies, 39.7% were OP, while 60.3% were RAP. Rates of occular injury were significantly increased in the robotic group vs. the open approach group for both total POVI (OR=2.924, 95% CI 1.561-5.475, p=0.0004), as well as for corneal abrasion (OR=2.792, 95% CI 1.349-5.777, p=0.004). Conclusion: Rates of POVI, and of corneal abrasion in particular, have increased nearly 10-fold over the span from 2000-2009. This corresponds to the time period where the robotic approach became the predominant method of performing radical prostatectomies (3). The data from 2009 showed a higher rate of POVI, specifically of corneal abrasion, when the robotic approach is used compared to the open approach. Clinicians should be vigilant and methods should be developed to lower the incidence of these eye injuries. 1) JAMA. Oct 14;302(14):1557-64, 2009. 2) J Robotic Surg. 1:119-123, 2007. 3) Eur Urol. Apr;61(4):803-9, 2012. |
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