Virtual Bladder Tumor Transurethral Resection: An Objective Evaluation Tool to Overcome Learning Curves with and without Photodynamic Diagnostics

2011 ◽  
Vol 87 (2) ◽  
pp. 138-142 ◽  
Author(s):  
Stephan Kruck ◽  
Jens Bedke ◽  
Jörg Hennenlotter ◽  
Bastian Amend ◽  
Axel Merseburger ◽  
...  
Keyword(s):  
Transurethral Resection ◽  
Bladder Tumor ◽  
Objective Evaluation ◽  
Learning Curves ◽  
Evaluation Tool ◽  
Photodynamic Diagnostics

Deciding When to Omit Repeat Transurethral Resection of Superficial Bladder Cancer: Do Photodynamic Diagnostics help?

2020 ◽  
Vol 6 (4) ◽  
pp. 489-496
Author(s):  
Eva Sailer ◽  
Frens-Steffen Krause ◽  
Volkmar Tauber ◽  
Wolfgang Schimetta ◽  
Sebastian Alfred Graf
Keyword(s):  
Transurethral Resection ◽  
Tumor Size ◽  
Bladder Tumor ◽  
Superficial Bladder Cancer ◽  
Residual Tumor ◽  
Current Evidence ◽  
Short Term ◽  
Repeat Resection ◽  
Photodynamic Diagnostics ◽  
Initial Resection

BACKGROUND: Repeat transurethral resection of bladder tumor is recommended when certain risk constellations are present on initial resection. Current evidence is conflicting, leading to dissenting recommendations in multinational guidelines around the world. Photodynamic diagnostics (PDD) is a tool which has been shown to increase diagnostic accuracy, but evidence is still lacking if this may permit omission of repeat resections in certain cases. OBJECTIVE: To evaluate whether the use of photodynamic diagnostics has an impact on resection quality and residual tumor rate, and to explore which parameters may have an impact on the necessity of repeat transurethral resections. METHODS: We retrospectively evaluated 373 patients in the timeframe of ten years, in whom a repeat transurethral resection of bladder tumor has been performed following initial resection at our department. About half of those resections were performed using photodynamic diagnostics. RESULTS: When PDD was used, more tumor mass was revealed and resected, but the shown trend toward a lower residual tumor rate was non-significant. Muscularis was shown more often on PDD resections. While being a rare occurrence, upstaging on repeat resection happened significantly less often after initial PDD use. Furthermore, tumor size and multifocality significantly influenced residual tumor rate in Ta high-grade stage. CONCLUSIONS: PDD use may lead to a more accurate initial staging but this may not have an impact on short-term residual tumor rate. Tumor size and multifocality should be granted more weight in the decision-making process as when to perform a repeat resection.

A New Objective Evaluation Tool for Grading Cataract Density Using PENTACAM®

2008 ◽  
Vol 225 (S 1) ◽  
Author(s):  
S Hara ◽  
MJ Sanchez ◽  
D Vucic ◽  
GU Auffarth
Keyword(s):  
Objective Evaluation ◽  
Evaluation Tool

Comparison of Endoscopic Versus Percutaneous Approach (Blind) to Control the Obturator Jerk in Patients Undergoing Transurethral Resection of Bladder Tumors Under Spinal Anesthesia

2020 ◽  
Vol 21 (2) ◽  
pp. 120-126
Author(s):  
Alamgir Md ◽  
Karim Km Monwarul ◽  
Nandy SP ◽  
Md Monwar Ul Haque ◽  
Sakhawat Mahmud Khan
Keyword(s):  
Statistical Analysis ◽  
Spinal Anesthesia ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Complete Resection ◽  
Satisfaction Level ◽  
Bladder Tumors ◽  
Percutaneous Approach ◽  
Group A ◽  
Group B

Objective: The aim of the study was to compare the endoscopic versus percutaneous approach (blind) to control the obturator jerk in patients undergoing transurethral resection of bladder tumors under spinal anesthesia. Materials and methods: A prospective observational study was performed in Department of Urology, Chittagong Medical College, Chittagong and some Private Hospitals (Ltd.) in Chittagong city during the period from January 2016 to June 2016. Total 100 patients were grouped into two, on alternate basis. Fifty(50) patients in group- A conducted with endoscopic infiltration with 20ml of injection 2% lignocaine at the bladder tumor base and another 50 patients in group-B, conducted with blind percutaneous technique with same drug and volume ( 20ml inj.2% lignocaine) to control obturator jerk. Severity of obturator jerk in both procedure, percentage of complete resection, ONB procedure related time, ONB procedure related complications and surgeon’s satisfaction level were recorded and compared between two approaches. Chi-square analysis was performed to compare the ease of approach and outcome of the two techniques. A value of P<0.05 was considered statistically significant. Results: The mean age of the patients were 59.44+7.681. In group-A, 50 patients were given inj. 2% lignocaine endoscopically at the bladder tumor base to control obturator jerk. Twenty five patients (50%) had no jerk, 20 patients(40%) developed mild jerk and 5 patients (10%) developed moderate jerk and no patients developed severe jerk. Second attempt was taken in moderate jerk patients (5 patients) and succeeded in 3(6%) patients. So, in this group, complete resection of bladder tumor was possible in 96%. In group B, complete resection of bladder tumor was possible in 84%. Statistical analysis was done and result is significant in case of endoscopic procedure to control obturator jerk(p<0.05). ONB Procedure related time was <20 mins. in 32(64%) patients in group-A and 45 (90%) patients in group- B. 20 mins. or more time was required for 18 (36%) patients in group-A and 5 (10%) patients in group-B. Statistical analysis was done and result is significant in percutaneous (blind) technique (p<0.05). ONB procedure related complications in group-A and Group –B were noted. Statistical analysis was done and result is insignificant (p>0.05). Surgeons satisfaction level were recorded on the basis of obturator jerk block and complete resection and which was statistically significant in favour of endoscopy group (p<0.05). Conclusion: It is concluded that endoscopic injection of 2% lignocaine into the bladder tumor base is better in case of jerk elimination and complete resection than blind percutaneous approach. Though, ONB procedure related time was significantly less in percutaneous group. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.120-126

scholarly journals Objective Evaluation of Drivability in Passenger Cars with Dual-Clutch Transmission: A Case Study of Static Gearshift Condition

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Wei Zhou ◽  
Xuexun Guo ◽  
Xiaofei Pei ◽  
Chengcai Zhang ◽  
Jun Yan ◽  
...  
Keyword(s):  
Fuzzy Ahp ◽  
Subjective Evaluation ◽  
Objective Evaluation ◽  
Dual Clutch Transmission ◽  
Evaluation Tool ◽  
Passenger Cars ◽  
Denoising Method ◽  
Fuzzy Matrix ◽  
Predictability Score

This paper is aimed at the problem that the subjective drivability evaluation by experienced test drivers is limited in time efficiency and is of high cost and poor repeatability. In this article, an intelligent drivability objective evaluation tool (I-DOET) for passenger cars with dual-clutch transmission (DCT) is developed and verified by real vehicle testing. First, the signal denoising method and its key parameters, which are suitable for drivability evaluation, are selected based on analytic hierarchy process (AHP) and technique for order preference by similarity to ideal solution (TOPSIS). Besides, combined with the uncertainty characteristics of subjective judgment, a mathematical model of the objective drivability evaluation FARODE (fuzzy AHP-RS based on objective drivability evaluation) is proposed by using the fuzzy comprehensive assessment (FCA) method. The AHP and rough set (RS) method are used to calculate the subjective and objective weights of the drivability evaluation, respectively, and the proportion of subjective and objective weights is determined by the principle of minimum relative information entropy. The fuzzy matrix is built by membership function of the evaluation indexes. Finally, the static gearshift condition focused on by the subjective evaluation experts is taken as a case study. The predictability score is obtained by combining the drivability quantization lever vector, comprehensive weight, and fuzzy matrix. The experimental results indicate that the proposed method is applicable for objective drivability evaluation in passenger cars with DCT.

En bloc transurethral resection of bladder tumor: A review of the literature

2021 ◽  
pp. 205141582199373
Author(s):  
Jonathan Kopel ◽  
Pranav Sharma
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Clinical Stage ◽  
Surgical Techniques ◽  
Cancer Recurrence ◽  
En Bloc ◽  
Level Of Evidence ◽  
Alternative Technologies ◽  
Bladder Cancer Recurrence

Bladder cancer remains one of the most common malignancies of the genitourinary tract. Transurethral resection of the bladder tumor (TURBT) via cystoscopy with examination under anesthesia remains the primary method for determining the diagnosis and clinical stage of bladder cancer. Given the substantial cost of treatment and risk of bladder cancer recurrence after TURBT, novel approaches to transurethral resection, such as the en bloc technique, have been developed in an attempt to address these limitations. In this review, we examined the postoperative and oncological outcomes of en bloc TURBT compared to traditional resection techniques. Further prospective clinical studies, however, are still necessary to determine whether these alternative technologies or surgical techniques may improve treatment in bladder cancer patients. Level of evidence: Not applicable.

Single Instillation of Hypertonic Saline Immediately Following Transurethral Resection of Bladder Tumor for Recurrence Prevention –A Phase I Study

2021 ◽  
pp. 1-6
Author(s):  
Jonathan Modai ◽  
Alexey Kovalyonok ◽  
Avigdor Scherz ◽  
Dina Preise ◽  
Yuval Avda ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hypertonic Saline ◽  
Serum Sodium ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
Osmotic Dehydration ◽  
Control Group ◽  
Plasma Sodium ◽  
Pelvic Cavity ◽  
Blue Discoloration

BACKGROUND: Urologic guidelines recommend perioperative instillation of chemotherapy after transurethral resection of bladder tumor (TURBT) to decrease tumor recurrence, yet implementation of this recommendation is partial due to associated morbidity. Hypertonic saline destroys cells by osmotic dehydration and might present a safer alternative. OBJECTIVE: To evaluate the safety of 3% hypertonic saline (Hypersal) intravesical instillation following TURBT in rats and in humans. METHODS: In 8 rats whose bladders were electrically injured, intravesical blue-dyed Hypersal was administered. We measured serum sodium levels before and after instillation and pathologically evaluated their pelvic cavity for signs of inflammation or blue discoloration. Twenty-four patients were recruited to the human trial (NIH-NCT04147182), 15 comprised the interventional and 10 the control group (one patient crossed over). Hypersal was given postoperatively. Serum sodium was measured before, 1 hour and 12–24 hours after instillation. Adverse effects were documented and compared between the groups. RESULTS: In rats, average sodium levels were 140.0 mEq/L and 140.3 mEq/L before and following instillation, respectively. Necropsy revealed no signs of inflammation or blue discoloration. In humans the average plasma sodium levels were 138.6 mEq∖L, 138.8 mEq∖L and 137.7 mEq∖L before, 1 hour and 12–24 hours after instillation, respectively. During the postoperative follow-up there was one case of fever. A month after the surgery, dysuria was reported by 5 patients while urgency and hematuria were reported by one patient each. The most severe adverse events were grade 2 on the Clavien-Dindo scale. Adverse events were similar in the control group. CONCLUSIONS: Hypersal instillation is safe and tolerable immediately after TURBT.

Time Interval from Transurethral Resection of Bladder Tumor to BCG Induction Does Not Impact Therapeutic Response

2021 ◽  
Author(s):  
Patrick J. Hensley ◽  
Kelly K. Bree ◽  
Nathan Brooks ◽  
Justin Matulay ◽  
Roger Li ◽  
...  
Keyword(s):  
Transurethral Resection ◽  
Bladder Tumor ◽  
Therapeutic Response ◽  
Time Interval

RELATIONSHIP BETWEEN SURGEON'S PHYSIOLOGICAL AND KINEMATIC PARAMETERS AND THE QUALITY OF SURGICAL PERFORMANCE AND WORKLOAD IN LAPAROSCOPIC TRAINING

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
J A Sánchez-Margallo ◽  
J Castillo Rabazo ◽  
D Durán Rey ◽  
I López-Agudelo ◽  
M R González-Portillo ◽  
...  
Keyword(s):  
Heart Rate ◽  
Objective Evaluation ◽  
Laparoscopic Training ◽  
Evaluation Tool ◽  
Surgical Performance ◽  
Hand Motion ◽  
Task Load ◽  
Tissue Manipulation ◽  
Level Of Experience

Abstract INTRODUCTION This study presents the first steps and results towards the development of a system for predicting the quality of surgical performance and workload in laparoscopic training. MATERIAL AND METHODS Surgeons wore a smartwatch which recorded their heart rate and hand motion during each laparoscopic procedure. Data was then correlated with both the Surgery Task Load Index (SURG-TLX) subjective questionnaire and the Global Operational Assessment of Laparoscopic Skills (GOALS) objective evaluation tool. Statistical analysis was conducted in order to study the relationship between parameters and to compare the results according to the surgeons’ level of experience. RESULTS Nine laparoscopic surgeons participated in this study, five gynecologists and four digestive surgeons. Gynecological surgeons showed a positive correlation between their level of experience, heart rate, hand motion, and GOALS score, except for bimanual dexterity. The reduction in the variability of hand accelerations led to improved tissue handling. Digestive surgeons showed a negative correlation between their level of experience and the reported temporal demand and complexity of the procedure. Novice digestive surgeons reported increased workload during surgery, mainly in mental, physical, and temporal workload. In both surgical specialties, it was observed that reduction in surgical workload was associated with improved GOALS score. CONCLUSIONS Preliminary results showed that bimanual dexterity is independent of the experience of gynecological surgeons. During laparoscopic surgical procedures, reduced variability in hand accelerations leads to better tissue manipulation. In addition, in gynecological and upper gastrointestinal procedures, reduced surgical workload is associated with improved surgical performance.

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