Mark Ball - Academia.edu (original) (raw)

Papers by Mark Ball

Research paper thumbnail of Wildlife forensics: “Supervised” assignment testing can complicate the association of suspect cases to source populations

Forensic Science International: Genetics, 2011

Research paper thumbnail of Integrating multiple analytical approaches to spatially delineate and characterize genetic population structure: an application to boreal caribou (Rangifer tarandus caribou) in central Canada

Conservation Genetics, 2010

Research paper thumbnail of Faecal pellet size can be used to differentiate age-classes in caribou: implications for non-invasive genetic studies

Conservation Genetics Resources, 2010

The inability to capture the age structure of a population using non-invasive faecal sampling has... more The inability to capture the age structure of a population using non-invasive faecal sampling has limited the scope of genetic analyses for wildlife research and conservation efforts. To overcome this, faecal morphometrics were examined to determine if differences exist between faeces size and the age of the individual producing it. Using faeces from known age caribou, pellet length distinguished calf and yearling age-classes from adult animals. Pellet width could only discern the calf age-class. Although this data is both area and species specific, gathering baseline data from known age animals prior to noninvasive collections may generate similar results and is recommended.

Research paper thumbnail of Feasibility and Recommendations for Swift Fox Fecal DNA Profiling

The Journal of Wildlife Management, Apr 28, 2010

Abstract: Genetic profiling using fecal samples collected noninvasively in the wild can provide m... more Abstract: Genetic profiling using fecal samples collected noninvasively in the wild can provide managers with an alternative to live-trapping. However, before embarking on a large-scale survey, feasibility of this methodology should be assessed for the focal species. Costs associated with fecal genotyping can be high because of the need for multiple amplifications to prevent and detect errors. Assessing the relative amount of target DNA before genotyping means samples can be eliminated where error rates will be high or amplification success will be low, thereby reducing costs. We collected fecal samples from an endangered population of swift fox (Vulpes velox) and employed target-DNA quantification and a screening protocol to assess sample quality before genetic profiling. Quantification was critical in identifying samples of low quality (68%, <0.2 ng/μL). Comparison of the amplification, from a subset of loci in 25 samples that did not meet the screening criteria, confirmed the effectiveness of this method. The protocol, however, used a considerable amount of DNA, and an assessment of the locus and sample variability allowed us to refine it for future population surveys. Although we did not use <50% of the samples we collected, the remaining samples provided 36 unique genotypes, which corresponded to approximately 70% of animals estimated to be present in the study area. Although obtaining fecal DNA from small carnivores is challenging, our protocol, including the quantification and qualification of DNA, the selection of markers, and the use of postgenotyping analyses, such as DROPOUT, CAPWIRE, and geographic information, provides a more cost-effective way to produce reliable results. The method we have developed is an informative approach that wildlife managers can use to conduct population surveys where the collection of feces is possible without the need for live-trapping.

Research paper thumbnail of Using abomasal parasite counts (APC) to determine the density of caribou (Rangifer tarandus caribou) in Newfoundland, Canada

Abstract Three species of trichostrongylid nematodes were recovered from woodland caribou (Rangif... more Abstract Three species of trichostrongylid nematodes were recovered from woodland caribou (Rangifer tarandus caribou) of Newfoundland, Canada. Ostertagia gruhneri predominated Trichostrongylus axei and Haemonchus contortus in all herds. There was no significant correlation between mean APC and herd density (rs= -0.40, df=4, P=0.60). However, further analysis indicated that worm burden was influenced by climate. APCs were positively correlated with mean annual temperatures (rs= 1.0, df=4, P<0.01), annual rainfall (rs= 1.0, df=4 P<0.01) and negatively correlated with total annual snowfall (rs= -1.0, df=4, P<0.01). The highest APCs were found in caribou of the two most southerly herds (Cape Shore and Avalon), and the lowest occurred in the most northerly herd (St. Anthony).

Research paper thumbnail of Scallop parasites, pests and diseases: Implications for aquaculture development in Canada

Research paper thumbnail of Feasibility and Recommendations for Swift Fox Fecal DNA Profiling

Journal of Wildlife Management, 2010

Genetic profiling using fecal samples collected noninvasively in the wild can provide managers wi... more Genetic profiling using fecal samples collected noninvasively in the wild can provide managers with an alternative to livetrapping. However, before embarking on a large-scale survey, feasibility of this methodology should be assessed for the focal species. Costs associated with fecal genotyping can be high because of the need for multiple amplifications to prevent and detect errors. Assessing the relative amount of target DNA before genotyping means samples can be eliminated where error rates will be high or amplification success will be low, thereby reducing costs. We collected fecal samples from an endangered population of swift fox (Vulpes velox) and employed target-DNA quantification and a screening protocol to assess sample quality before genetic profiling. Quantification was critical in identifying samples of low quality (68%, ,0.2 ng/mL). Comparison of the amplification, from a subset of loci in 25 samples that did not meet the screening criteria, confirmed the effectiveness of this method. The protocol, however, used a considerable amount of DNA, and an assessment of the locus and sample variability allowed us to refine it for future population surveys. Although we did not use .50% of the samples we collected, the remaining samples provided 36 unique genotypes, which corresponded to approximately 70% of animals estimated to be present in the study area. Although obtaining fecal DNA from small carnivores is challenging, our protocol, including the quantification and qualification of DNA, the selection of markers, and the use of postgenotyping analyses, such as DROPOUT, CAPWIRE, and geographic information, provides a more cost-effective way to produce reliable results. The method we have developed is an informative approach that wildlife managers can use to conduct population surveys where the collection of feces is possible without the need for live-trapping.

Research paper thumbnail of Pathologic Upstaging at the Time of Radical Cystectomy is Associated with Worse Recurrence Free Survival in Patients with BCG-Refractory Bladder Cancer

Research paper thumbnail of MP03-01 Clinical, Pathologic and Genomic Profiles of Exceptional Responders to ANTI-PD1 Therapy in Renal Cell Carcinoma

The Journal of Urology, 2016

Research paper thumbnail of Do Fibrin Sealants Impact Negative Outcomes After Robot-Assisted Partial Nephrectomy?

Http Dx Doi Org 10 1089 End 2013 0136, Oct 1, 2013

Contemporary rates of postoperative hemorrhage after partial nephrectomy (PN) are low. Commercial... more Contemporary rates of postoperative hemorrhage after partial nephrectomy (PN) are low. Commercially available hemostatic agents are commonly used during this surgery to reduce this risk despite a paucity of data supporting the practice. We assessed the impact of fibrin sealant hemostatic agents, a costly addition to surgeries, during robot-assisted partial nephrectomy (RAPN). Between 2007 and 2011, 114 consecutive patients underwent RAPN by a single surgeon (MEA). Evicel fibrin sealant was used in the first 74 patients during renorraphy. The last 40 patients had renorraphy performed without the use of any hemostatic agents. Clinicopathologic, operative, and complication data were compared between groups. Multivariate and univariate logistic regression analysis was performed to test the association between the use of fibrin sealants and operative outcomes. Patient demographic data and clinical tumor characteristics were similar between groups. The use of fibrin sealant did not increase operative time (166.3 vs 176.1 minutes, P=0.28), warm ischemia time (WIT) (14.4 vs 16.1 minutes, P=0.18), or length of hospital stay (2.6 vs 2.4 days, P=0.35). The omission of these agents did not increase estimated blood loss (116.6 vs 176.1 mL, P=0.8) or postoperative blood transfusion (0% vs 2.5%, P=0.17). Univariate analysis demonstrated no association between use of fibrin sealants and increased complications (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Multivariable logistic regression showed no statistically significant predictive value of omission of hemostatic agents for perioperative outcomes (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Perioperative hemorrhage and other major complications after contemporary RAPN are rare in experienced hands. In our study, the use of fibrin sealants during RAPN does not decrease the rate of complications, blood loss, or hospital stay. Furthermore, no impact is seen on operative time, WIT, or other negative outcomes. Omitting these agents during RAPN could be a safe, effective, cost-saving measure.

Research paper thumbnail of Robot-Assisted Radical Nephrectomy with Inferior Vena Cava Tumor Thrombectomy: Technique and Initial Outcomes

The Canadian Journal of Urology, Feb 1, 2015

Ball MW, GORin Ma, JayRaM G, PieRORaZiO PM, allaF Me. Robot-assisted radical nephrectomy with inf... more Ball MW, GORin Ma, JayRaM G, PieRORaZiO PM, allaF Me. Robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy: technique and initial outcomes. Can J Urol 2015;22(1): 7666-7670. Introduction: To describe our technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) tumor thrombectomy and to present initial results for our first two patients. Materials and methods: Two patients with renal masses with infrahepatic IVC extension underwent RARN with IVC tumor thrombectomy using a four-arm configuration. Both cases were right-sided tumors. Vascular control was obtained with complete cross-clamping of the vena cava with robotic bulldog clamps. Intraoperative ultrasound was used to delineate extent of tumor extension. Specimens were removed en-bloc, and the IVC was closed with 2-layers of 4-0 Prolene. The specimen is extracted through a lower midline incision. Results: Two robotic IVC thrombectomies were successfully completed. There were no conversions, intraoperative or postoperative complications. Median operative time was 243 minutes with a median estimated blood loss of 150 mL. Both patients were able to ambulate independently free of intravenous opioids on postoperate day 1. Median length of stay was 4.5 (range 3-6) days. Final pathology revealed clear cell RCC in both cases with negative surgical margins. Conclusions: Robotic technology may facilitate RN and IVC thrombectomy in the well selected patient and appears to be a safe and feasible approach.

Research paper thumbnail of 1465 Outcomes of Men with an Elevated Psa as Their Sole Preoperative Intermediate or High Risk Feature

Research paper thumbnail of Robotic adrenalectomy: the jury is still out

Gland Surgery, Dec 5, 2015

A minimally-invasive approach is the gold standard for surgical management of the majority of adr... more A minimally-invasive approach is the gold standard for surgical management of the majority of adrenal masses. While laparoscopy has traditionally been used, robotic adrenalectomy is becoming increasingly utilized. This article discusses a recent systematic review and meta-analysis from European Urology that analyzed evidence comparing laparoscopic and robotic adrenalectomy. Robotic adrenalectomy is associated with lower blood loss, length of stay and fewer complications compared to laparoscopic adrenalectomy; however information on efficacy and cost are not addressed. Ultimately, well-done randomized controlled trials (RCTs) are necessary to determine the benefits and cost of robotics in adrenal surgery.

Research paper thumbnail of MP40-11 Validation of Aua Clinical Practice Guidelines for Followup of Kidney Cancer After Robotic Partial Nephrectomy

The Journal of Urology, 2014

Research paper thumbnail of Extent of Renal Vein Invasion Influences Prognosis in Patients with Renal Cell Carcinoma

BJU international, Jan 11, 2015

To compare oncologic outcomes for segmental versus main renal vein invasion (RVI) in patients wit... more To compare oncologic outcomes for segmental versus main renal vein invasion (RVI) in patients with renal cell carcinoma. Patients undergoing extirpative surgery for RCC at our institution from 2003-2013 were stratified into five groups: T2 (n=135), T3a with fat invasion (n=185), T3a with segmental RVI (n=87), T3a with main RVI (n=64), and T3b disease (n=40). Kaplan-Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence-free survival (RFS) and cancer-specific survival (CSS). Harrell's C index was used to compare the prognostic accuracy of current and proposed staging models. At a median follow-up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared to segmental RVI (p = 0.03, p = 0.009, respectively). On multivariable analysis, main RVI had an increased risk of recurrence (HR 2.3, 95% confidence interval [CI] 1.1-4.4, p = 0.03) and CSS (HR 3.5, 95%CI 1.3-9.9, p = 0.02...

Research paper thumbnail of PD15-11 Instrument Life for Robot Assisted Laparoscopic Radical Prostatectomy: Are Ten Lives for Most Instruments Justified?

The Journal of Urology, 2015

RESULTS: Liposomes exhibited normalized surface morphology, particle size of 150 AE 12.33 nm, and... more RESULTS: Liposomes exhibited normalized surface morphology, particle size of 150 AE 12.33 nm, and -2.55 AE 3.21 mV surface charge. Sorafenib-liposome conjugations demonstrated 101.2 AE 1.3% entrapment efficiency based on UV spectrometer. Fluorescent and confocal microscopy consistently confirmed particle uptake by the cell line. MTT assay noted cellular death rates of 2.8% and 7.4 % for Sorafenib alone and Sorafenib loaded nanoparticles, respectively.

Research paper thumbnail of Prospective Evaluation of (99m)Tc-sestamibi SPECT/CT for the Diagnosis of Renal Oncocytomas and Hybrid Oncocytic/Chromophobe Tumors

European urology, Jan 16, 2015

Nuclear imaging offers a potential noninvasive means of determining the histology of renal tumors... more Nuclear imaging offers a potential noninvasive means of determining the histology of renal tumors. The aim of this study was to evaluate the accuracy of technetium-99m ((99m)Tc)-sestamibi single-photon emission computed tomography/x-ray computed tomography (SPECT/CT) for the differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) from other renal tumor histologies. In total, 50 patients with a solid clinical T1 renal mass were imaged with (99m)Tc-sestamibi SPECT/CT prior to surgical resection. Preoperative SPECT/CT scans were reviewed by two blinded readers, and their results were compared with centrally reviewed surgical pathology data. Following surgery, 6 (12%) tumors were classified as renal oncocytomas and 2 (4%) as HOCTs. With the exception of 1 (2%) angiomyolipoma, all other tumors were renal cell carcinomas (82%). (99m)Tc-sestamibi SPECT/CT correctly identified 5 of 6 (83.3%) oncocytomas and 2 of 2 (100%) HOCTs, resulting in an overall sensitivity of 8...

Research paper thumbnail of Outcomes of partial nephrectomy in patients who meet percutaneous ablation criteria

Central European journal of urology, 2015

Treatment options for small renal masses include partial nephrectomy (PN), ablation and active su... more Treatment options for small renal masses include partial nephrectomy (PN), ablation and active surveillance. We sought to compare patients who met the criteria for percutaneous ablation but underwent robotic PN to the rest of our robotic PN cohort. This was done in order to detect any safety concerns and to define any risk factors that might contraindicate the use of robotic PN, an oncologically superior procedure, in patients who qualify for ablation. Our departmental renal mass registry was queried for patients who underwent robotic PN but also met criteria for percutaneous ablation. These were compared to the rest of the robotic PN cohort. Demographics, perioperative characteristics and recurrence data were compared. Overall, 321 robotic PNs were identified. Of these, 26 (8.1%) met ablation criteria. Among patient characteristics, age and BMI were similar in both groups. Among operative characteristics, estimated blood loss (EBL) and operative time were similar. Warm ischemia tim...

Research paper thumbnail of Instrument Life for Robot-Assisted Laparoscopic Radical Prostatectomy and Partial Nephrectomy: Are Ten Lives for Most Instruments Justified?

Urology, Jan 12, 2015

To investigate the rate of premature instrument exchange during robot-assisted laparoscopic radic... more To investigate the rate of premature instrument exchange during robot-assisted laparoscopic radical prostatectomy (RALRP) and robot-assisted partial nephrectomy (RAPN). The majority of robotic instruments have a predetermined lifespan of 10 uses; however, it is unknown if instruments are routinely exchanged before 10 uses in clinical practice. We retrospectively reviewed instrument use in consecutive RALRP and RAPN cases performed by high-volume robotic surgeons at 1 tertiary care center between January 2011 and October 2014. The number of instruments used per case was evaluated and instances of additional instrument utilization were noted. Exchange number was compared between the first and second half of cases performed. Operative times were compared between cases with and without exchange. Student's t-test and Pearson's χ(2)-test were used to determine statistical significance. Three surgeons performed 1579 RALRP procedures and 2 surgeons performed 313 RAPN procedures. Dur...

Research paper thumbnail of Robotic adrenalectomy: the jury is still out

Gland surgery, 2015

A minimally-invasive approach is the gold standard for surgical management of the majority of adr... more A minimally-invasive approach is the gold standard for surgical management of the majority of adrenal masses. While laparoscopy has traditionally been used, robotic adrenalectomy is becoming increasingly utilized. This article discusses a recent systematic review and meta-analysis from European Urology that analyzed evidence comparing laparoscopic and robotic adrenalectomy. Robotic adrenalectomy is associated with lower blood loss, length of stay and fewer complications compared to laparoscopic adrenalectomy; however information on efficacy and cost are not addressed. Ultimately, well-done randomized controlled trials (RCTs) are necessary to determine the benefits and cost of robotics in adrenal surgery.

Research paper thumbnail of Wildlife forensics: “Supervised” assignment testing can complicate the association of suspect cases to source populations

Forensic Science International: Genetics, 2011

Research paper thumbnail of Integrating multiple analytical approaches to spatially delineate and characterize genetic population structure: an application to boreal caribou (Rangifer tarandus caribou) in central Canada

Conservation Genetics, 2010

Research paper thumbnail of Faecal pellet size can be used to differentiate age-classes in caribou: implications for non-invasive genetic studies

Conservation Genetics Resources, 2010

The inability to capture the age structure of a population using non-invasive faecal sampling has... more The inability to capture the age structure of a population using non-invasive faecal sampling has limited the scope of genetic analyses for wildlife research and conservation efforts. To overcome this, faecal morphometrics were examined to determine if differences exist between faeces size and the age of the individual producing it. Using faeces from known age caribou, pellet length distinguished calf and yearling age-classes from adult animals. Pellet width could only discern the calf age-class. Although this data is both area and species specific, gathering baseline data from known age animals prior to noninvasive collections may generate similar results and is recommended.

Research paper thumbnail of Feasibility and Recommendations for Swift Fox Fecal DNA Profiling

The Journal of Wildlife Management, Apr 28, 2010

Abstract: Genetic profiling using fecal samples collected noninvasively in the wild can provide m... more Abstract: Genetic profiling using fecal samples collected noninvasively in the wild can provide managers with an alternative to live-trapping. However, before embarking on a large-scale survey, feasibility of this methodology should be assessed for the focal species. Costs associated with fecal genotyping can be high because of the need for multiple amplifications to prevent and detect errors. Assessing the relative amount of target DNA before genotyping means samples can be eliminated where error rates will be high or amplification success will be low, thereby reducing costs. We collected fecal samples from an endangered population of swift fox (Vulpes velox) and employed target-DNA quantification and a screening protocol to assess sample quality before genetic profiling. Quantification was critical in identifying samples of low quality (68%, <0.2 ng/μL). Comparison of the amplification, from a subset of loci in 25 samples that did not meet the screening criteria, confirmed the effectiveness of this method. The protocol, however, used a considerable amount of DNA, and an assessment of the locus and sample variability allowed us to refine it for future population surveys. Although we did not use <50% of the samples we collected, the remaining samples provided 36 unique genotypes, which corresponded to approximately 70% of animals estimated to be present in the study area. Although obtaining fecal DNA from small carnivores is challenging, our protocol, including the quantification and qualification of DNA, the selection of markers, and the use of postgenotyping analyses, such as DROPOUT, CAPWIRE, and geographic information, provides a more cost-effective way to produce reliable results. The method we have developed is an informative approach that wildlife managers can use to conduct population surveys where the collection of feces is possible without the need for live-trapping.

Research paper thumbnail of Using abomasal parasite counts (APC) to determine the density of caribou (Rangifer tarandus caribou) in Newfoundland, Canada

Abstract Three species of trichostrongylid nematodes were recovered from woodland caribou (Rangif... more Abstract Three species of trichostrongylid nematodes were recovered from woodland caribou (Rangifer tarandus caribou) of Newfoundland, Canada. Ostertagia gruhneri predominated Trichostrongylus axei and Haemonchus contortus in all herds. There was no significant correlation between mean APC and herd density (rs= -0.40, df=4, P=0.60). However, further analysis indicated that worm burden was influenced by climate. APCs were positively correlated with mean annual temperatures (rs= 1.0, df=4, P<0.01), annual rainfall (rs= 1.0, df=4 P<0.01) and negatively correlated with total annual snowfall (rs= -1.0, df=4, P<0.01). The highest APCs were found in caribou of the two most southerly herds (Cape Shore and Avalon), and the lowest occurred in the most northerly herd (St. Anthony).

Research paper thumbnail of Scallop parasites, pests and diseases: Implications for aquaculture development in Canada

Research paper thumbnail of Feasibility and Recommendations for Swift Fox Fecal DNA Profiling

Journal of Wildlife Management, 2010

Genetic profiling using fecal samples collected noninvasively in the wild can provide managers wi... more Genetic profiling using fecal samples collected noninvasively in the wild can provide managers with an alternative to livetrapping. However, before embarking on a large-scale survey, feasibility of this methodology should be assessed for the focal species. Costs associated with fecal genotyping can be high because of the need for multiple amplifications to prevent and detect errors. Assessing the relative amount of target DNA before genotyping means samples can be eliminated where error rates will be high or amplification success will be low, thereby reducing costs. We collected fecal samples from an endangered population of swift fox (Vulpes velox) and employed target-DNA quantification and a screening protocol to assess sample quality before genetic profiling. Quantification was critical in identifying samples of low quality (68%, ,0.2 ng/mL). Comparison of the amplification, from a subset of loci in 25 samples that did not meet the screening criteria, confirmed the effectiveness of this method. The protocol, however, used a considerable amount of DNA, and an assessment of the locus and sample variability allowed us to refine it for future population surveys. Although we did not use .50% of the samples we collected, the remaining samples provided 36 unique genotypes, which corresponded to approximately 70% of animals estimated to be present in the study area. Although obtaining fecal DNA from small carnivores is challenging, our protocol, including the quantification and qualification of DNA, the selection of markers, and the use of postgenotyping analyses, such as DROPOUT, CAPWIRE, and geographic information, provides a more cost-effective way to produce reliable results. The method we have developed is an informative approach that wildlife managers can use to conduct population surveys where the collection of feces is possible without the need for live-trapping.

Research paper thumbnail of Pathologic Upstaging at the Time of Radical Cystectomy is Associated with Worse Recurrence Free Survival in Patients with BCG-Refractory Bladder Cancer

Research paper thumbnail of MP03-01 Clinical, Pathologic and Genomic Profiles of Exceptional Responders to ANTI-PD1 Therapy in Renal Cell Carcinoma

The Journal of Urology, 2016

Research paper thumbnail of Do Fibrin Sealants Impact Negative Outcomes After Robot-Assisted Partial Nephrectomy?

Http Dx Doi Org 10 1089 End 2013 0136, Oct 1, 2013

Contemporary rates of postoperative hemorrhage after partial nephrectomy (PN) are low. Commercial... more Contemporary rates of postoperative hemorrhage after partial nephrectomy (PN) are low. Commercially available hemostatic agents are commonly used during this surgery to reduce this risk despite a paucity of data supporting the practice. We assessed the impact of fibrin sealant hemostatic agents, a costly addition to surgeries, during robot-assisted partial nephrectomy (RAPN). Between 2007 and 2011, 114 consecutive patients underwent RAPN by a single surgeon (MEA). Evicel fibrin sealant was used in the first 74 patients during renorraphy. The last 40 patients had renorraphy performed without the use of any hemostatic agents. Clinicopathologic, operative, and complication data were compared between groups. Multivariate and univariate logistic regression analysis was performed to test the association between the use of fibrin sealants and operative outcomes. Patient demographic data and clinical tumor characteristics were similar between groups. The use of fibrin sealant did not increase operative time (166.3 vs 176.1 minutes, P=0.28), warm ischemia time (WIT) (14.4 vs 16.1 minutes, P=0.18), or length of hospital stay (2.6 vs 2.4 days, P=0.35). The omission of these agents did not increase estimated blood loss (116.6 vs 176.1 mL, P=0.8) or postoperative blood transfusion (0% vs 2.5%, P=0.17). Univariate analysis demonstrated no association between use of fibrin sealants and increased complications (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Multivariable logistic regression showed no statistically significant predictive value of omission of hemostatic agents for perioperative outcomes (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Perioperative hemorrhage and other major complications after contemporary RAPN are rare in experienced hands. In our study, the use of fibrin sealants during RAPN does not decrease the rate of complications, blood loss, or hospital stay. Furthermore, no impact is seen on operative time, WIT, or other negative outcomes. Omitting these agents during RAPN could be a safe, effective, cost-saving measure.

Research paper thumbnail of Robot-Assisted Radical Nephrectomy with Inferior Vena Cava Tumor Thrombectomy: Technique and Initial Outcomes

The Canadian Journal of Urology, Feb 1, 2015

Ball MW, GORin Ma, JayRaM G, PieRORaZiO PM, allaF Me. Robot-assisted radical nephrectomy with inf... more Ball MW, GORin Ma, JayRaM G, PieRORaZiO PM, allaF Me. Robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy: technique and initial outcomes. Can J Urol 2015;22(1): 7666-7670. Introduction: To describe our technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) tumor thrombectomy and to present initial results for our first two patients. Materials and methods: Two patients with renal masses with infrahepatic IVC extension underwent RARN with IVC tumor thrombectomy using a four-arm configuration. Both cases were right-sided tumors. Vascular control was obtained with complete cross-clamping of the vena cava with robotic bulldog clamps. Intraoperative ultrasound was used to delineate extent of tumor extension. Specimens were removed en-bloc, and the IVC was closed with 2-layers of 4-0 Prolene. The specimen is extracted through a lower midline incision. Results: Two robotic IVC thrombectomies were successfully completed. There were no conversions, intraoperative or postoperative complications. Median operative time was 243 minutes with a median estimated blood loss of 150 mL. Both patients were able to ambulate independently free of intravenous opioids on postoperate day 1. Median length of stay was 4.5 (range 3-6) days. Final pathology revealed clear cell RCC in both cases with negative surgical margins. Conclusions: Robotic technology may facilitate RN and IVC thrombectomy in the well selected patient and appears to be a safe and feasible approach.

Research paper thumbnail of 1465 Outcomes of Men with an Elevated Psa as Their Sole Preoperative Intermediate or High Risk Feature

Research paper thumbnail of Robotic adrenalectomy: the jury is still out

Gland Surgery, Dec 5, 2015

A minimally-invasive approach is the gold standard for surgical management of the majority of adr... more A minimally-invasive approach is the gold standard for surgical management of the majority of adrenal masses. While laparoscopy has traditionally been used, robotic adrenalectomy is becoming increasingly utilized. This article discusses a recent systematic review and meta-analysis from European Urology that analyzed evidence comparing laparoscopic and robotic adrenalectomy. Robotic adrenalectomy is associated with lower blood loss, length of stay and fewer complications compared to laparoscopic adrenalectomy; however information on efficacy and cost are not addressed. Ultimately, well-done randomized controlled trials (RCTs) are necessary to determine the benefits and cost of robotics in adrenal surgery.

Research paper thumbnail of MP40-11 Validation of Aua Clinical Practice Guidelines for Followup of Kidney Cancer After Robotic Partial Nephrectomy

The Journal of Urology, 2014

Research paper thumbnail of Extent of Renal Vein Invasion Influences Prognosis in Patients with Renal Cell Carcinoma

BJU international, Jan 11, 2015

To compare oncologic outcomes for segmental versus main renal vein invasion (RVI) in patients wit... more To compare oncologic outcomes for segmental versus main renal vein invasion (RVI) in patients with renal cell carcinoma. Patients undergoing extirpative surgery for RCC at our institution from 2003-2013 were stratified into five groups: T2 (n=135), T3a with fat invasion (n=185), T3a with segmental RVI (n=87), T3a with main RVI (n=64), and T3b disease (n=40). Kaplan-Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence-free survival (RFS) and cancer-specific survival (CSS). Harrell's C index was used to compare the prognostic accuracy of current and proposed staging models. At a median follow-up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared to segmental RVI (p = 0.03, p = 0.009, respectively). On multivariable analysis, main RVI had an increased risk of recurrence (HR 2.3, 95% confidence interval [CI] 1.1-4.4, p = 0.03) and CSS (HR 3.5, 95%CI 1.3-9.9, p = 0.02...

Research paper thumbnail of PD15-11 Instrument Life for Robot Assisted Laparoscopic Radical Prostatectomy: Are Ten Lives for Most Instruments Justified?

The Journal of Urology, 2015

RESULTS: Liposomes exhibited normalized surface morphology, particle size of 150 AE 12.33 nm, and... more RESULTS: Liposomes exhibited normalized surface morphology, particle size of 150 AE 12.33 nm, and -2.55 AE 3.21 mV surface charge. Sorafenib-liposome conjugations demonstrated 101.2 AE 1.3% entrapment efficiency based on UV spectrometer. Fluorescent and confocal microscopy consistently confirmed particle uptake by the cell line. MTT assay noted cellular death rates of 2.8% and 7.4 % for Sorafenib alone and Sorafenib loaded nanoparticles, respectively.

Research paper thumbnail of Prospective Evaluation of (99m)Tc-sestamibi SPECT/CT for the Diagnosis of Renal Oncocytomas and Hybrid Oncocytic/Chromophobe Tumors

European urology, Jan 16, 2015

Nuclear imaging offers a potential noninvasive means of determining the histology of renal tumors... more Nuclear imaging offers a potential noninvasive means of determining the histology of renal tumors. The aim of this study was to evaluate the accuracy of technetium-99m ((99m)Tc)-sestamibi single-photon emission computed tomography/x-ray computed tomography (SPECT/CT) for the differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) from other renal tumor histologies. In total, 50 patients with a solid clinical T1 renal mass were imaged with (99m)Tc-sestamibi SPECT/CT prior to surgical resection. Preoperative SPECT/CT scans were reviewed by two blinded readers, and their results were compared with centrally reviewed surgical pathology data. Following surgery, 6 (12%) tumors were classified as renal oncocytomas and 2 (4%) as HOCTs. With the exception of 1 (2%) angiomyolipoma, all other tumors were renal cell carcinomas (82%). (99m)Tc-sestamibi SPECT/CT correctly identified 5 of 6 (83.3%) oncocytomas and 2 of 2 (100%) HOCTs, resulting in an overall sensitivity of 8...

Research paper thumbnail of Outcomes of partial nephrectomy in patients who meet percutaneous ablation criteria

Central European journal of urology, 2015

Treatment options for small renal masses include partial nephrectomy (PN), ablation and active su... more Treatment options for small renal masses include partial nephrectomy (PN), ablation and active surveillance. We sought to compare patients who met the criteria for percutaneous ablation but underwent robotic PN to the rest of our robotic PN cohort. This was done in order to detect any safety concerns and to define any risk factors that might contraindicate the use of robotic PN, an oncologically superior procedure, in patients who qualify for ablation. Our departmental renal mass registry was queried for patients who underwent robotic PN but also met criteria for percutaneous ablation. These were compared to the rest of the robotic PN cohort. Demographics, perioperative characteristics and recurrence data were compared. Overall, 321 robotic PNs were identified. Of these, 26 (8.1%) met ablation criteria. Among patient characteristics, age and BMI were similar in both groups. Among operative characteristics, estimated blood loss (EBL) and operative time were similar. Warm ischemia tim...

Research paper thumbnail of Instrument Life for Robot-Assisted Laparoscopic Radical Prostatectomy and Partial Nephrectomy: Are Ten Lives for Most Instruments Justified?

Urology, Jan 12, 2015

To investigate the rate of premature instrument exchange during robot-assisted laparoscopic radic... more To investigate the rate of premature instrument exchange during robot-assisted laparoscopic radical prostatectomy (RALRP) and robot-assisted partial nephrectomy (RAPN). The majority of robotic instruments have a predetermined lifespan of 10 uses; however, it is unknown if instruments are routinely exchanged before 10 uses in clinical practice. We retrospectively reviewed instrument use in consecutive RALRP and RAPN cases performed by high-volume robotic surgeons at 1 tertiary care center between January 2011 and October 2014. The number of instruments used per case was evaluated and instances of additional instrument utilization were noted. Exchange number was compared between the first and second half of cases performed. Operative times were compared between cases with and without exchange. Student's t-test and Pearson's χ(2)-test were used to determine statistical significance. Three surgeons performed 1579 RALRP procedures and 2 surgeons performed 313 RAPN procedures. Dur...

Research paper thumbnail of Robotic adrenalectomy: the jury is still out

Gland surgery, 2015

A minimally-invasive approach is the gold standard for surgical management of the majority of adr... more A minimally-invasive approach is the gold standard for surgical management of the majority of adrenal masses. While laparoscopy has traditionally been used, robotic adrenalectomy is becoming increasingly utilized. This article discusses a recent systematic review and meta-analysis from European Urology that analyzed evidence comparing laparoscopic and robotic adrenalectomy. Robotic adrenalectomy is associated with lower blood loss, length of stay and fewer complications compared to laparoscopic adrenalectomy; however information on efficacy and cost are not addressed. Ultimately, well-done randomized controlled trials (RCTs) are necessary to determine the benefits and cost of robotics in adrenal surgery.