Robotic-Assisted Radical Bladder Surgery Potentially Benefits Bladder Cancer Patients

About 30 percent of the more than 70,000 bladder cancer cases expected in 2012 are muscle invasive. In such cases, radical cystectomy is the preferred treatment. In a pilot trial, a team of investigators assessed the efficacy of open radical cystectomy (ORC) vs. robotic-assisted laparoscopic radical cystectomy (RARC). While there were no significant differences in treatment outcomes, RARC resulted in decreased estimated blood loss and shorter hospital stay compared to ORC. The results are published in the February 2013 issue of The Journal of Urology.

"In the last decade minimally invasive approaches including robotic-assisted approaches have emerged as viable surgical options for many urological malignancies with the promise of decreased morbidity with shorter hospital stays, faster recovery, and less narcotic analgesic requirements," says lead investigator Dipen J. Parekh, MD, Professor and Chairman of the University of Miami Miller School of Medicine's Department of Urology and Director of robotic surgery; formerly at the University of Texas Health Science Center at San Antonio.

The goal of the clinical trial was to provide preliminary data from a single institution's randomized trial that evaluated the benefits of robotic-assisted vs. open surgery in patients with invasive bladder cancer. The trial, conducted between July 2009 and June 2011, involved 47 patients and was performed at the University of Texas Health Science Center at San Antonio. Primary eligibility was based on candidacy for an open or robotic approach at the discretion of the treating surgeon. Forty patients were randomized individually and equally to either an ORC or RARC group using a computer randomization program. Each of the two study groups was similar in distribution of age, gender, race, body mass index, previous surgeries, operative time, postoperative complications, and final pathological stage.

Investigators evaluated five surgery outcome factors: Estimated blood loss, operative time from incision to closure, transfusion requirements, time to return of bowel function, and length of stay.

The robotic group experienced significantly decreased blood loss, accompanied by a trend toward faster return of bowel function, fewer hospitalizations beyond five days, and fewer transfusions.

"The strength of our study is the prospective randomized nature that eliminates selection biases that may have been present in prior retrospective analyses," says Dr. Parekh. "We also believe that our study demonstrates that a prospective randomized trial comparing traditional open and robotic approaches in bladder cancer is possible."

This investigative team has joined with several institutions nationally to build on its study and has started an advanced randomized clinical trial among multiple institutions to further compare and assess open vs. robotic-assisted radical cystectomy among patients with invasive bladder cancer. It plans to collect intermediate and long-term survival data from these same patients as well as data on quality of life, daily living activities, handgrip strength, and mobility.

How To Start The New Year Healthy

For a lot of people, the start of the New Year also means the start of a healthier lifestyle, which for many has to do with either losing weight or eating healthily. This can seem difficult or out of reach at first, but with a bit of motivation, dedication and discipline it is certainly possible.
The key to losing weight and staying fit is through identifying and changing bad lifestyle habits and behaviors.

Obesity is a serious problem in the United States, with nearly one third of the country's adults with a body mass index (BMI) of 30+ (considered as obese).

The weight-loss industry makes an absolute fortune in selling products to try and help people lose weight, but one of the main problems is discipline and consistency. Only 20 percent of Americans who diet and lose the desired amount of weight actually stay that way for more than a year.

According to Dr. Jessica Bartfield, who specializes in medical weight loss at Gottlieb Memorial Hospital, part of the Loyola University Health System:

"People need a motivation to lose weight and the new year is an opportunity to start fresh. Maybe it was the shock of seeing oneself in recent holiday photos, or not being able to fit into desired party attire that causes a vow to lose weight, and for many more it is a medical event such as a heart attack, the threat of diabetes or high blood pressure."

Bartfield belongs to a team of dedicated doctors who specialize in providing comprehensive surgical and non-surgical programs for weight reduction at The Loyola Center for Metabolic Surgery & Bariatric Care.

Behavioral change is one of the key factors in losing weight, with professional health advice being vital in helping people learn what to do, how to do it and how to maintain their behavior change.

Dr. Bartfield said "Behavior change is the cornerstone of healthy, successful weight loss and it takes about three months to establish a new behavior. Just as you learn to play a musical instrument from a skilled teacher, you need to learn how to lose weight from professionals. You need to practice and make mistakes until you get it right. At Loyola, a team of tried-and-true medical experts can teach you the skills you need to achieve and maintain behavior change."


 She compares making behavioral changes to playing a new musical instrument, each time you expect to hit the right note you might accidentally hit the wrong one. You just need to keep trying and trying until you eventually perfect it. With weight loss, you need to have a similar mindset - do not be put off by a few bumps along the way.

Dr. Bartfield and team identified the best weight loss behaviors by gathering and examining data from 4,000 Americans from The National Weight Control Registry (NWCR). They all lost 30 pounds and kept their weight down for at least five years.

What Are Most Effective Weight Loss Behaviors?

• Eat breakfast within one hour of waking up in the morning. Breakfast is the most important meal of the day and it boosts the body's metabolism by over 20%, which can really help with weight loss.
  
• Consistently measure how much you weigh. Try and weigh yourself each week and track how much weight you've either put on or lost, this will allow you to see what behaviors work for you.
  
• Try and exercise or do moderate physical activity for at least one hour every day. This does not necessarily mean doing cardio for one hour non-stop; a series of activities, such as vacuuming and going up the stairs can all add up to achieving this.
  
• Limit the amount of time you spend idle, watching TV. Try and limit this to a maximum of 10 hours a week. Instead, find activities that are more physically active, more than half of the NWCR members watched TV for fewer than 10 hours a week. Children who have a television in their room are much more likely to become obese, a recent study found.
  
• Make sure you are consistent with your diet plan and behavioral changes. It's no good to eat well and exercise for five days and then have a massive splurge afterwards; you will seriously undermine your progress. If you are consistent for at least 25 days per month, you can achieve substantial weight loss.
  
• Monitor how much physical activity you do during the day and do your best to make sure you make small changes in your life that increase your amount of physical activity. For example, try walking instead of using transportation whenever you can. A simple way to be more physically active is to spend less time in a car.

Aerobic exercises versus resistance training - if your initial aim is to lose weight, bear in mind that aerobic training is much more effective for burning fat than resistance training.