Baylor College of Medicine Archives

Alternative Access Approaches for Less-invasive Nephron-sparing Surgery

Posted by Richard E. Link, MD, PhD | Jan 2025

Richard E. Link, MD, PhD, explores advances in robotic kidney surgery, focusing on nephron-sparing approaches and alternative access strategies, specifically through the low anterior access with the SP (single-port) robot. Historically, while only about 10% of nephron-sparing surgeries employed the retroperitoneal technique due to challenges in positioning and multiport access, the advent of the SP robot has significantly altered this landscape.

In this 18-minute presentation, Dr. Link shares the low anterior access technique, which offers a versatile approach to addressing tumors located anywhere in the kidney—anterior, posterior, medial, or lateral—while minimizing the need for complex patient positioning. The primary advantage of this approach is reduced postoperative complications, faster recovery, and less pain, which are of greater importance to patients.

Data from Link’s practice indicate a marked increase in adopting retroperitoneal access using the SP robot, rising from 15% to 80% over recent years. This shift has led to a significant reduction in hospital stays and a streamlined surgical process, resulting in shorter operative times. Dr. Link shares video of the process and includes practical tips for optimizing this approach.

Updates in Radiotherapy for Bladder Cancer

Posted by Daniel A. Hamstra, MD, PhD, FASTRO, FASCO | Dec 2024

Daniel A. Hamstra, MD, PhD, FASTRO, FASCO, explores advances in bladder cancer therapy, focusing on trimodality bladder preservation. In this 21-minute presentation, he compares the North American approach, which requires strict criteria for bladder preservation, including thorough TURBT and an absence of extensive CIS, to a more inclusive UK approach, which tolerates certain conditions such as CIS and hydronephrosis and utilizes non-platinum-based chemotherapy.

Hamstra shares a significant UK phase III trial that illustrates the effectiveness of adding chemotherapy to radiation, enhancing local control and survival, and reducing the need for cystectomy. A multi-institutional study comparing this approach with radical cystectomy indicates comparable metastasis-free and overall survival rates, suggesting trimodality therapy as a viable alternative to surgery.

Hamstra notes that neoadjuvant chemotherapy is emerging as beneficial in bladder preservation, with data supporting its utility across different cancers when combined with radiation. For node-positive bladder cancer, combined chemoradiotherapy (chemoRT) appears as effective as surgery in appropriately selected patients.

Newer immunotherapies and non-platinum regimens continue to expand options, while evidence supports chemoRT as an alternative to radical surgery, especially for patients prioritizing quality of life and organ preservation.

Highlights from GU ASCO and ASCO 2024

Posted by A. Edward Yen, MD | Dec 2024

A. Edward Yen, MD, reviews recent developments in prostate cancer treatment, summarizing key trials from recent oncology meetings. He begins this 29-minute presentation by outlining the evolving treatment landscape, from localized to metastatic castration-resistant prostate cancer. The focus narrows on select phase II and III trials involving novel therapeutics and treatment strategies.

Dr. Yen begins with the BRCAAway trial, which explores abiraterone, olaparib, and their combination in patients with metastatic CRPC harboring BRCA1/2 or ATM mutations. He then moves on to the Contact-02 study, which investigates cabozantinib and atezolizumab versus second-line hormonal therapy in metastatic CRPC patients. Continuing, he shares the results of the Embark study, which examined enzalutamide with or without androgen deprivation therapy in patients with non-metastatic CRPC.

Other notable studies include a negative evaluation of metformin for preventing progression in low-risk prostate cancer and an exploratory phase I trial of a novel human kallikrein-targeted radioligand therapy. Dr. Yen concludes with an overview of ARV-766, a PROTAC androgen receptor degrader showing strong PSA responses, highlighting its potential for future development in targeting resistant androgen receptor mutations in advanced CRPC.

Beyond the Semen Analysis 2024: State of Art Male Fertility Testing

Posted by Larry I. Lipshultz, MD | Nov 2024

Larry I. Lipshultz, MD, critically examines the limitations of traditional semen analysis in evaluating male infertility and advocates for the adoption of advanced diagnostic techniques.

In this 23-minute presentation, Dr. Lipshultz shares that semen analysis still relies on parameters like sperm count, motility, and morphology. Lipshultz underscores the need for innovative tests beyond standard semen analysis, introducing several emerging techniques. He highlights DNA fragmentation testing and epigenetic testing. Emerging assays like non-obstructive azoospermic (NOA) tests and sperm fertility window assessments offer further diagnostic precision. Whole genome sequencing, utilizing advanced nanopore technology, is poised to revolutionize male infertility diagnostics by identifying specific genetic anomalies.

Dr. Lipshultz asserts that traditional semen analysis is outdated and should be supplemented with new advanced, functionally informative tests to enhance diagnostic accuracy and patient care in infertility treatment.

How Has the SP Robot Affected Our Approach to Radical Prostatectomy?

Posted by Jeremy Slawin, MD, MBA | Nov 2024

Jeremy Slawin, MD, MBA, highlights the impact of single-port robotic technology on radical prostatectomy, emphasizing its shift from a traditional multiport, transperitoneal approach to a renewed focus on extra-peritoneal surgery.

In this 21-minute presentation, Slawin explores the evolution of prostatectomy techniques, contrasting the older extra-peritoneal open surgeries with the recent dominance of transperitoneal, multiport robotic procedures driven by advancements in minimally invasive technology. With the advent of the single-port robotic platform, surgeons are revisiting extra-peritoneal approaches.

Dr. Slawin reviews the steps for the SP robotic procedure, pointing out benefits and differences from more traditional procedures. The single-port approach allows all instruments to be introduced through a single cannula, facilitating operations in confined spaces. Slawin shares a video of the process, helping to illustrate these steps and addressing possible questions.

Early outcomes from comparative studies indicate similar surgical margin and continence rates between single-port and multiport approaches. However, there is a trend towards reduced pain, lower opioid usage, and shorter hospital stays with single-port extra-peritoneal surgeries. The challenges include a learning curve, reduced lymph node yields, and the need for technical adjustments, particularly due to arm interdependence and limited instrument strength.