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Article ; Online: Reply to Francesco Montorsi, Armando Stabile, Giorgio Gandaglia, and Alberto Briganti's Letter to the Editor re: K.R. Seetharam Bhat, Marcio Covas Moschovas, Marco Sandri, et al. Outcomes of Salvage Robot-assisted Radical Prostatectomy After Focal Ablation for Prostate Cancer in Comparison to Primary Robot-assisted Radical Prostatectomy: A Matched Analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2021.10.005: Salvage Robotic Radical Prostatectomy for Recurrence After Focal Therapy-The Truth and Consequences.

Patel, Vipul / Bhat, K R Seetharam / Moschovas, Marcio Covas / Noel, Jonathan / Rogers, Travis

European urology focus

2022 Volume 8, Issue 6, Page(s) 1864

MeSH term(s)	Humans ; Male ; Robotics ; Prostatectomy ; Prostate ; Prostatic Neoplasms ; Robotic Surgical Procedures
Language	English
Publishing date	2022-02-23
Publishing country	Netherlands
Document type	Letter ; Comment
ISSN	2405-4569
ISSN (online)	2405-4569
DOI	10.1016/j.euf.2022.02.003
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Article ; Online: Exploring the ethical implications in the telesurgery ERA.

Moschovas, Marcio Covas / Saikali, Shady / Rogers, Travis / Gamal, Ahmed / Perera, Roshane / Reddy, Sumeet / Patel, Vipul

International braz j urol : official journal of the Brazilian Society of Urology

2024 Volume 50, Issue 3, Page(s) 375–377

MeSH term(s)	Humans ; Telemedicine
Language	English
Publishing date	2024-04-10
Publishing country	Brazil
Document type	Editorial
ZDB-ID	2206649-4
ISSN	1677-6119 ; 1677-5538
ISSN (online)	1677-6119
ISSN	1677-5538
DOI	10.1590/S1677-5538.IBJU.2024.0113
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Article ; Online: Neurovascular bundle preservation in robotic-assisted radical prostatectomy: How I do it after 15.000 cases.

Moschovas, Marcio Covas / Patel, Vipul

International braz j urol : official journal of the Brazilian Society of Urology

2021 Volume 48, Issue 2, Page(s) 212–219

Abstract: Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons ... ...

Abstract	Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.
MeSH term(s)	Erectile Dysfunction/etiology ; Erectile Dysfunction/prevention & control ; Humans ; Male ; Prostate/surgery ; Prostatectomy/adverse effects ; Prostatectomy/methods ; Prostatic Neoplasms/complications ; Prostatic Neoplasms/surgery ; Robotic Surgical Procedures/methods ; Treatment Outcome
Language	English
Publishing date	2021-11-17
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	2206649-4
ISSN	1677-6119 ; 1677-5538
ISSN (online)	1677-6119
ISSN	1677-5538
DOI	10.1590/S1677-5538.IBJU.2022.99.04
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Article ; Online: Robotic-assisted radical prostatectomy with a single port platform: current and future perspectives of a referral center.

Moschovas, Marcio Covas / Corder, Cathy / Patel, Vipul

International braz j urol : official journal of the Brazilian Society of Urology

2022 Volume 48, Issue 5, Page(s) 864–866

MeSH term(s)	Humans ; Male ; Prostate/surgery ; Prostatectomy ; Referral and Consultation ; Robotic Surgical Procedures ; Seminal Vesicles
Language	English
Publishing date	2022-07-16
Publishing country	Brazil
Document type	Editorial
ZDB-ID	2206649-4
ISSN	1677-6119 ; 1677-5538
ISSN (online)	1677-6119
ISSN	1677-5538
DOI	10.1590/S1677-5538.IBJU.2022.9978
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Article ; Online: Nerve-sparing robotic-assisted radical prostatectomy: how I do it after 15.000 cases.

Moschovas, Marcio Covas / Patel, Vipul

International braz j urol : official journal of the Brazilian Society of Urology

2021 Volume 48, Issue 2, Page(s) 369–370

Abstract: Introduction: Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been proposed by several authors (1). However, even with the robotic surgery ... ...

Abstract	Introduction: Over the years, since Binder and Kramer described the first Robotic-assisted Radical Prostatectomy (RARP) in 2000, different Nerve-sparing (NS) techniques have been proposed by several authors (1). However, even with the robotic surgery advantages, functional outcomes following RARP, especially erection recovery, still challenge surgeons and patients (2, 3). In this scenario, we have described different ways and grades of neurovascular bundle preservation (NVB) using the prostatic artery as a landmark until our most recent technique with lateral prostatic fascia preservation and modified apical dissection (4-6). In this video compilation, we have illustrated the anatomical and technical details of different grades of NVB preservation. Surgical technique: After the anterior and posterior bladder neck dissection, we lift the prostate by the seminal vesicles to access the posterior aspect of the prostate. Then, we incise the Denonvilliers layers and work between an avascular plane to release the posterior NVB from 5 to 1 and 7 to 11 o'clock positions on the right and left sides, respectively6. In sequence, we access the prostate anteriorly by incising the endopelvic fascia bilaterally (close to the prostate) until communicating the anterior and posterior planes. Finally, we control the prostatic pedicles with Hem-o-lok clips and then proceed for the apical dissection preserving the maximum amount of urethra length and periurethral tissues. Considerations: Potency recovery following radical prostatectomy remains a challenge due to its multifactorial etiology. However, basic concepts for nerve-sparing are crucial to achieving optimal outcomes, such as minimizing the amount of traction used on dissection, avoiding excessive cautery, and neural preservation based on anatomical landmarks (arteries and planes of dissection).
MeSH term(s)	Humans ; Male ; Penile Erection ; Prostate/surgery ; Prostatectomy/methods ; Prostatic Neoplasms/surgery ; Robotic Surgical Procedures
Language	English
Publishing date	2021-11-17
Publishing country	Brazil
Document type	Video-Audio Media
ZDB-ID	2206649-4
ISSN	1677-6119 ; 1677-5538
ISSN (online)	1677-6119
ISSN	1677-5538
DOI	10.1590/S1677-5538.IBJU.2022.99.03
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Article ; Online: Re: Trends in Incidence of Metastatic Prostate Cancer in the US.

Rocco, Bernardo / Sighinolfi, Maria Chiara / Coelho, Rafael Ferreira / Covas Moschovas, Marcio / Patel, Vipul

European urology

2022 Volume 82, Issue 3, Page(s) 332–333

MeSH term(s)	Humans ; Incidence ; Male ; Prostate-Specific Antigen ; Prostatic Neoplasms/pathology
Chemical Substances	Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2022-06-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	193790-x
ISSN	1873-7560 ; 1421-993X ; 0302-2838
ISSN (online)	1873-7560 ; 1421-993X
ISSN	0302-2838
DOI	10.1016/j.eururo.2022.04.023
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Zs.A 1247: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 294: Show issues

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Article: Peritoneal Flap Following Lymph Node Dissection in Robotic Radical Prostatectomy: A Novel "Bunching" Technique.

Gamal, Ahmed / Moschovas, Marcio Covas / Jaber, Abdel Rahman / Saikali, Shady / Sandri, Marco / Patel, Ela / Patel, Evan / Rogers, Travis / Patel, Vipul

Cancers

2024 Volume 16, Issue 8

Abstract: Background: Pelvic lymph node dissection (PLND) is recommended while performing robot-assisted radical prostatectomy (RARP) for patients with localized intermediate or high-risk prostate cancer. However, symptomatic lymphoceles can occur after surgery, ... ...

Abstract	Background: Pelvic lymph node dissection (PLND) is recommended while performing robot-assisted radical prostatectomy (RARP) for patients with localized intermediate or high-risk prostate cancer. However, symptomatic lymphoceles can occur after surgery, adding significant morbidity to patients. Our objective is to describe a novel Peritoneal Bladder Flap Bunching technique (PBFB) to reduce the risk of clinically significant lymphoceles in patients undergoing RARP and PLND. Methods: We evaluated 2267 patients who underwent RARP with PLND, dividing them into two groups: Group 1, comprising 567 patients who had the peritoneal flap (PBFB), and Group 2, comprising 1700 patients without the flap; propensity score matching carried out at a 1:3 ratio. Variables analyzed included estimated blood loss (EBL), operative time, postoperative complications, lymphocele formation, and the development of symptomatic lymphocele. Results: The two groups exhibited similar preoperative characteristics after matching. There was no statistically significant difference in the occurrence of lymphoceles between the flap group and the non-flap group, with rates of 24% and 20.9%, respectively ( Conclusion: We have demonstrated a modified technique for a peritoneal flap (PBFB) with the initial elimination of postoperative symptomatic lymphoceles and promising short-term outcomes.
Language	English
Publishing date	2024-04-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers16081547
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Article: Current advances of liquid biopsies in prostate cancer: Molecular biomarkers.

Alahdal, Murad / Perera, Roshane A / Moschovas, Marcio Covas / Patel, Vipul / Perera, Ranjan J

Molecular therapy oncolytics

2023 Volume 30, Page(s) 27–38

Abstract: Prostate cancer (PCa) incidence is increasing and endangers men's lives. Early detection of PCa could improve overall survival (OS) by preventing metastasis. The prostate-specific antigen (PSA) test is a popular screening method. Several advisory groups, ...

Abstract	Prostate cancer (PCa) incidence is increasing and endangers men's lives. Early detection of PCa could improve overall survival (OS) by preventing metastasis. The prostate-specific antigen (PSA) test is a popular screening method. Several advisory groups, however, warn against using the PSA test due to its high false positive rate, unsupported outcome, and limited benefit. The number of disease-related biopsies performed annually far outweighs the number of diagnoses. Thus, there is an urgent need to develop accurate diagnostic biomarkers to detect PCa and distinguish between aggressive and indolent cancers. Recently, non-coding RNA (ncRNA), circulating tumor DNA (ctDNA)/ctRNA, exosomes, and metabolomic biomarkers in the liquid biopsies (LBs) of patients with PCa showed significant differences and clinical benefits in diagnosis, prognosis, and monitoring response to therapy. The analysis of urinary exosomal ncRNA presented a substantial correlation among Exos-miR-375 downregulation, clinical T stage, and bone metastases of PCa. Furthermore, the expression of miR-532-5p in urine samples was a vital predictive biomarker of PCa progression. Thus, this review focuses on promising molecular and metabolomic biomarkers in LBs from patients with PCa. We thoroughly addressed the most recent clinical findings of LB biomarker use in diagnosing and monitoring PCa in early and advanced stages.
Language	English
Publishing date	2023-07-19
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2372-7705
ISSN	2372-7705
DOI	10.1016/j.omto.2023.07.004
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Article ; Online: Muscle fatigue and physical discomfort reported by surgeons performing robotic-assisted surgery: a multinational survey.

Patel, Ela / Saikali, Shady / Mascarenhas, Anya / Moschovas, Marcio Covas / Patel, Vipul

Journal of robotic surgery

2023 Volume 17, Issue 5, Page(s) 2009–2018

Abstract: Robotic surgery has revolutionized surgical procedures and has provided many advantages over traditional laparoscopic and open surgeries. Despite the benefits, there are concerns about the physical discomfort and injuries that may be experienced by ... ...

Abstract	Robotic surgery has revolutionized surgical procedures and has provided many advantages over traditional laparoscopic and open surgeries. Despite the benefits, there are concerns about the physical discomfort and injuries that may be experienced by surgeons during robotic surgeries. This study aimed to identify the most common muscle groups implicated in robotic surgeons' physical pain and discomfort. A questionnaire was created and sent to 1000 robotic surgeons worldwide, with a response rate of 30.9%. The questionnaire consisted of thirty-seven multiple-choice questions, three short answer questions, and one multiple-option question pertaining to the surgeon's workload as well as their level of discomfort while and after performing surgery. The primary endpoint was to identify the most common muscle groups implicated in robotic surgeons' physical pain and discomfort. Secondary endpoints were to highlight any correlation between age group, BMI, hours of operation, workout regimen, and significant pain levels. The results showed that the most common muscle groups implicated in physical pain and discomfort were the neck, shoulders, and back, with many of the surgeons attributing their muscular fatigue and discomfort to the ergonomic design of the surgeon console. Despite the level of surgeon comfort the robotic console provides when compared to other conventional forms of surgery, the findings suggest the need for better ergonomic practices during robotic surgeries to minimize physical discomfort and injuries for surgeons.
MeSH term(s)	Humans ; Robotic Surgical Procedures/methods ; Muscle Fatigue ; Surveys and Questionnaires ; Pain ; Surgeons ; Laparoscopy/adverse effects
Language	English
Publishing date	2023-04-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2268283-1
ISSN	1863-2491 ; 1863-2483
ISSN (online)	1863-2491
ISSN	1863-2483
DOI	10.1007/s11701-023-01608-9
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Article ; Online: Comparison between intra- and postoperative outcomes of the da Vinci SP and da Vinci Xi robotic platforms in patients undergoing radical prostatectomy.

Moschovas, Marcio Covas / Loy, David / Patel, Evan / Sandri, Marco / Moser, Daniel / Patel, Vipul

Journal of robotic surgery

2023 Volume 17, Issue 4, Page(s) 1341–1347

Abstract: The new SP robot incorporates a single trocar that houses a flexible camera and three bi-articulated arms, which minimize the number of incisions needed to assess the surgical site, allowing for a less invasive procedure. To compare the postoperative ... ...

Abstract	The new SP robot incorporates a single trocar that houses a flexible camera and three bi-articulated arms, which minimize the number of incisions needed to assess the surgical site, allowing for a less invasive procedure. To compare the postoperative pain scale and outcomes in patients with similar demographic characteristics undergoing robotic-assisted radical prostatectomy (RARP) with SP and Xi robots, One-hundred consecutive patients undergoing RARP with the SP robot were matched, using a propensity score (PS), with 100 patients from a cohort of 1757 who were operated on with the da Vinci Xi from June 2019 to January 2021. We described and compared the perioperative pain scores and outcomes of both groups. The SP group had less blood loss (50 cc vs. 62.5 cc, P < 0.001) and longer operative time (114 min. vs. 94 min, P < 0.001). The only period we could show a difference in postoperative pain scores was 6 h after surgery, with a small advantage for the SP (2 vs. 2.5, P < 0.001). Both groups had satisfactory postoperative continence recovery, 91% vs. 90% for the SP and Xi, respectively. The groups had a mean follow-up of 24.5 and 22 months for SP and Xi, respectively. The tumor stage and percentage of positive surgical margins were similar between groups (15% vs. 15%, P = 1). Patients undergoing RARP with the SP had longer operative times with less blood loss than the Xi. However, despite the lower number of abdominal incisions on the SP, the groups had similar intraoperative performance, and we were unable to demonstrate clinically significant differences in postoperative pain scores between the groups 6, 12, and 18 h after surgery.
MeSH term(s)	Male ; Humans ; Robotics ; Robotic Surgical Procedures/methods ; Prostatectomy/methods ; Laparoscopy/methods ; Pain, Postoperative/prevention & control ; Treatment Outcome
Language	English
Publishing date	2023-03-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2268283-1
ISSN	1863-2491 ; 1863-2483
ISSN (online)	1863-2491
ISSN	1863-2483
DOI	10.1007/s11701-023-01563-5
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