AUA News - December 2012 - (Page 1)
December 2012 Volume 17, Issue 12 Inside T H I S I S S U E Feature Articles Bringing MRI into the Urologist’s Office ....... 9 Impact of Diet and Nutrition on Prostate Cancer ................................................... 11 Changes in Urine Parameters due to Desert Environment .......................................... 13 Tissue Damage from Lithotripsy ................ 17 As Nature Made Them ............................... 21 Massachusetts Health Care ....................... 23 Image Guided Oncologic Surgery in Urology Dr. Osamu Ukimura Dr. Masahiko Nakamoto Los Angeles, California Dr. Inderbir S. Gill* Feature Columns AUA/SUFU Guideline on Adult Urodynamics 22 Fall Board of Directors’ Meeting ................ 28 Office of Education Year in Review ............ 26 Have You Read? ............................25 Managing Your Practice ...............30 Calendar of Events........................32 During preoperative surgical planning and intraoperative decision making, surgeons have traditionally relied on high resolution, 2-dimensional radiological images, such as computerized tomography (CT), magnetic resonance (MR) imaging (MRI) or ultrasound (US). Using these images, the surgeon requires expert mental imagination to know precisely where to cut and what to preserve during surgical exposure of the target. As oncologic surgery increasingly becomes minimally invasive in nature, novel radiological and molecular based imaging modalities are being developed to enable real-time 3-dimensional (3D) surgical navigation in an organ and tissue specific manner. We focus on novel imaging approach due to increased surgical space. Improved dexterity allows for more precise handling of the renal hilar vessels, avoiding unnecessary traction, as reported previously about our laparoscopic experience.4 After Gerota’s fascia is incised, the ureters are identified. The upper moiety ureter is separated from the technologies for surgical targeting of critical anatomical structures that are ordinarily invisible to the surgical view.1-3 Our team has developed prototypical 3D navigation software designed specifically for minimally invasive urological oncologic surgery. The process includes 1) image acquisition from thin sliced CT scans to retrieve 3D volume data of the surgical field, 2) segmentation of the region of interest (ROI) and 3) 3D volume rendered reconstruction.4 To illustrate our approach in a practical manner we provide 2 specific example cases, 1 each for kidney and prostate cancer surgery. Example 1: Kidney Cancer Surgery During partial nephrectomy preoperative CT of the kidney is performed t Continued on page 6 The Role of Robotics in the Management of Renal Duplication Anomalies Dr. Mohan S. Gundeti Chicago, Illinois lower moiety, transected at the lower pole and then passed posterior to the renal hilum cranially (retrograde technique). This maneuver helps identify the vasculature to the upper moiety, which is then clipped. The diseased moiety is transected t Continued on page 7 American Urological Association 1000 Corporate Boulevard Linthicum, Maryland 21090 NON-PROFIT ORG. U.S. POSTAGE PERMIT NO. 797 RICHMOND, VA PAID Robotic technology is slowly being embraced by pediatric urologists. The 6 degrees of freedom/dexterity and magnification have helped bridge the gap between open and laparoscopic surgery.1 Pyeloplasty followed by ureteral reimplantation is currently a commonly performed procedure but this has been extended to complex reconstructions, such as cystoplasty and appendicovesicostomy, at select centers.2, 3 Complete duplication anomaly has various associated abnormalities, eg variable function in each moiety, ureterocele, vesicoureteral reflux and ureteropelvic junction (UPJ). In select children during the treatment course surgical intervention may be necessary. We describe the role of robotic technology in performing various procedures for this congenital anomaly. Robotic Assisted Laparoscopic Procedures Heminephrectomy: When there is no function in 1 moiety with hydronephrosis, associated ureterocele or reflux, we choose to remove the nonfunctioning moiety to avoid potential future lower tract surgery with its associated morbidity. On most occasions this is the upper moiety with or without an obstructing ureterocele. Port placement is similar to that for pyeloplasty (fig. 1). The transperitoneal approach is better than the retroperitoneal
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