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The planar title compound 4,5-dimethyl-1,3-dioxol-2-one, C5H6O3, 1, crystallizes with its molecular C2 axis coincident with a crystallographic mirror plane in space group P21/m. In the plane defined by the b axis and an ac face diagonal, antiparallel linear strands of 1, formed by simple translation, associate to form sheets with close H···H and O···O intermolecular contacts. Between the sheets, parallel strands of 1 place the carbonyl O atom near the five-membered ring centroid of a neighboring molecule with close O···O and O···C contacts. [ABSTRACT FROM AUTHOR]

Purpose: Robotic partial nephrectomies (RPNs) by their nature are associated with renal volume loss. Our goal of this study is to examine renal volume loss over time post partial nephrectomy. Materials and Methods: Fifty patients were followed for 1-year post-RPN with two-layer renorrhaphy and the sliding clip technique. This was done with a preoperative CT scan to assess renal mass and location. Patients post-RPN were imaged at time points 3 days, 6 months, and 12 months. Results: Patient demographics were 82% men with a median (interquartile range [IQR]) age of 57 (45–67) years and all were of Japanese descent. The medians (IQR) for warm ischemia time were 18 minutes (14–22), total operative time was 181.5 minutes (169.3–218.5), and estimated blood loss was 20 mL (10–50). The tumor characteristics had a median (IQR) diameter of 2.8 cm (2.5–3.4) with a RENAL score of 7 (6–8). The renal CT showed median (IQR) volume losses at 3 days of −1% (−7.1, 1.8), at 6 months of −15.3% (−20.6, −11.2), and at 12 months of −16.3% (−19.0, −12.8). Significance was seen at the 3 days to 6 months comparison for volume loss (p < 0.0001). Mean (standard deviation) estimated glomerular filtration rate (GFR) losses were as follows: at discharge 0.5% (12.9), 1 month −6.4% (11.8), 6 months −4.6% (9.8), and 12 months −3.6% (11.9). Statistical analysis showed significance for GFR loss at the comparison between discharge to 1 and 6 months (p = 0.01, p = 0.04). Conclusion: The initial volume loss seen postsurgery from resected healthy tissue was not significant and only became relevant at longer time points, suggesting that loss could be from atrophy. Volume loss over time supports the hypothesis that suture renorrhaphy is a primary cause of volume loss when warm ischemia time is <25 minutes. [ABSTRACT FROM AUTHOR]

Purpose: Our objective is to evaluate a technique for estimating the amount of healthy margin resected during partial nephrectomy (PN). Materials and Methods: The resected healthy margin volume was determined by planimetry (gold standard), which was performed in a prospective manner on 30 freshly resected renal masses by cross-sectional slicing every ~5 mm. A single cross-sectional slice containing the largest tumor diameter (bivalved tumor) was chosen to build a model for estimating the amount of healthy kidney removed. This single-slice technique was then applied to a second series of patients (n = 39) status post PN. Three-dimensional models were created using pre- and postoperative CT scans to determine the overall volume loss following PN. Results: The median (range) for tumor diameter and tumor volume was 3.2 cm (1-6.1) and 10.7 cm3 (0.5-101.9), respectively, for the 30 PN specimens used to build the single-slice estimation equation. The median (range) healthy margin volume calculated by planimetry and single slice technique was 9.0 cm3 (1.0-22.1) and 7.8 cm3 (1.0-31.0), respectively ( p = 0.37). The Pearson correlation was 0.84, and the median (range) percent difference between the planimetry and single slice techniques was -0.5% (-39% to 57%). For the 39 PN patients, the median (range) total renal volume loss, 25.8 cm3 (3-79), was significantly greater than the volume of healthy margin removed during resection, 5.7 cm3 (1-22), p < 0.001. Conclusions: The healthy margin resected during PN differs widely and can be estimated from a single cross-section. The healthy margin resected accounted for <50% of the total volume loss seen during PN. [ABSTRACT FROM AUTHOR]

In this paper, authors studied the boundary controllability results for neutral impulsive integrodifferential evolution systems with time-varying delays in Banach spaces. The sufficient conditions of the boundary controllability are proved under the evolution operator. The results are obtained by using the semigroup theory and the Schaefer fixed point theorems. [ABSTRACT FROM AUTHOR]

Background and Purpose: Functional losses near 20% are seen in the operated kidney during partial nephrectomy. Resected healthy margins are small and ischemia time limited in the modern era. We hypothesize that reconstruction following tumor resection is modifiable and a significant cause of renal function injury. Materials and Methods: A literature review of Medline and Scopus was performed for all available dates focusing on partial nephrectomy, renal function, and renal reconstruction. An additional review was performed evaluating recent advances in biomarkers of acute kidney injury. Results: Serum creatinine is of limited value in measuring renal preservation during partial nephrectomy. Stimulated glomerular filtration rate can estimate renal reserve, but is more difficult to measure. CT-based three-dimensional measurements provide the ability to isolate ipsilateral functional loss. Newer urinary biomarkers of acute kidney injury such as kidney injury molecule-1 and cell cycle markers are emerging and might help to quantify renal function loss in real time. Most prior research has focused on ischemia and enucleation. However, despite minimizing both, significant renal function losses are still seen. Four retrospective controlled studies were found comparing cortical renorrhaphy to omission of cortical renorrhaphy. Three of the four found a statistical benefit to nonrenorrhaphy with the range of volume or functional loss in those three being 3.8% to 11.5% vs 15.6% to 20.4%. Urine leaks and bleeding complications were similar to reported rates for both groups. Conclusion: Studies evaluating renal function preservation after partial nephrectomy should control for reconstructive injury in addition to ischemia time and resected healthy margin. Cortical renorrhaphy is associated with renal volume and functional loss on retrospective studies, which might be especially relevant in the setting of chronic kidney disease or solitary kidney. Newer biomarkers of renal injury should be used when studying predictors of renal injury. [ABSTRACT FROM AUTHOR]

AbstractMinimally invasive pyeloplasty has achieved success that has approached open pyeloplasty. Key principles such as removal of fibrosis, extensive mobilization of the ureteropelvic junction and crossing vessels, and creation of a tension-free, widely spatulated anastamosis are important in successful repair. In this review, we discuss the preparation and operative steps in performing a robotic pyeloplasty. Patient selection and diagnostic approach is discussed in the preoperative setting. Important surgical steps described include port placement, management of crossing vessels, division and spatulation of the ureter, and reanastamosis. Finally, management of more difficult cases is discussed. [ABSTRACT FROM AUTHOR]

Objectives: During the preoperative evaluation of potential kidney donors, the increased sensitivity of spiral computed tomography (CT) could detect more asymptomatic small (less than 4 mm) renal calculi. However, whether these stones will be of consequence later has yet to be determined. We evaluated the rate of spontaneous passage, development of symptoms, and change in the size of asymptomatic renal calculi in donor kidneys transplanted without removal of the calculi. Methods: Five donor kidneys from living donors were transplanted with small (less than 4 mm), asymptomatic renal calculi incidentally detected on CT (eight stones). No donors had any metabolic derangements or history of previous lithiasis. Each kidney was laparoscopically removed and transplanted with the calculi in situ. The recipients were followed up with serial creatinine measurements, history taking, and CT scans. Results: None of the recipients had had any symptoms consistent with the progression of disease, including hydronephrosis, renal failure, or the elevation of serum creatinine at a mean follow-up of 711 ± 334 days. The follow-up CT scans showed spontaneous passage of the stones in 3 patients. In the remaining 2 patients, two of the stones remained stable, and one had increased in size from 1 to 2 mm. Those with the stones remaining had had a significantly shorter length of follow-up (204 ± 72 versus 711 ± 200 days, P <0.05). Conclusions: In our series of 5 patients with small asymptomatic renal calculi, none of the patients have had complications, and only three of the eight stones were still in situ at the latest follow-up visit. Transplantation of small (less than 4 mm), asymptomatic stones in situ can be safely performed with adequate follow-up and monitoring for the development of obstructing transplant stones. [Copyright &y& Elsevier]

The article discusses current evidence for laparoscopic donor nephrectomy (LDN) in terms of both short-term and long-term outcome. The advantages of LDN than open donor nephrectomy includes blood loss, analgesic requirement, hospital stay, convalescence, and cosmesis. Meanwhile, the longer surgery and WIT are the disadvantage factors of LDN. Also, the donor satisfaction remains higher with LDN.

Millions of men are diagnosed annually with prostate cancer worldwide. With the advent of PSA screening, there has been a shift in the detection of early prostate cancer, and there are increased numbers of men with asymptomatic, organ confined disease. Laparoscopic radical prostatectomy is the latest, well accepted treatment that patients can select. We review the surgical technique, and oncologic and functional outcomes of the most current, large series of laparoscopic radical prostatectomy published in English. Positive margin rates range from 2.1-6.9% for pT2a, 9.9-20.6% for pT2b, 24.5-42.3% for pT3a, and 22.6-54.5% for pT3b. Potency rates after bilateral nerve sparing laparoscopic radical prostatectomy range from 47.1 to 67%. Continence rates at 12 months range from 83.6 to 92%. [ABSTRACT FROM AUTHOR]

This article informs that the robot-assisted laparoscopic radical prostatectomy (RALRP) is being increasingly used in several centres around the U.S. Robotic assistance, even for skilled laparoscopic surgeons, could facilitate more accurate dissection because of the instruments with six degrees of freedom. The patient is firmly secured to the operating table with his legs comfortably supported in a low modified lithotomy position, using Allen stirrups. Shoulder braces are not used, as these have on one occasion resulted in shoulder injury.

: ObjectivesTo evaluate the feasibility of laparoscopic partial nephrectomy assisted by a water-cooled, high-density, monopolar device (TissueLink Floating Ball).: MethodsTransperitoneal laparoscopic partial nephrectomy was performed without vascular control for four renal tumors in 3 patients. A flexible ultrasound probe was used to confirm tumor location and depth. Gerota’s fascia was opened distant from the tumor site. Renal fat was dissected from the renal parenchyma except for the fat overlying the tumor. The tumor resection area was marked 1 cm outside the boundaries of the tumor. After application of the TissueLink Floating Ball at the planned surgical margin, the tumor was resected with cold laparoscopic scissors. Bleeding from the vessels of the divided renal parenchyma was controlled with the Floating Ball if necessary. The specimen was sent for frozen section to confirm margin status.: ResultsMean estimated blood loss per tumor was 275 mL. The dissection extended to the collecting system in 2 of 4 cases. In 1 patient, a minor postoperative urine leak resolved spontaneously.: ConclusionsUse of the TissueLink Floating Ball facilitated resection of small renal tumors without renal vascular control. Although further study is necessary, water-cooled, high-density monopolar energy may have a role in laparoscopic partial nephrectomy. [Copyright &y& Elsevier]

• RSS aggregate SCCs showed lower strength than the CGS aggregate SCCs. • Usage of microsilica and GBFS enhanced the mechanical properties of the SCCs. • SCC with compressive strength ≥ 45 MPa can produced using RSS aggregate. • 18 models were developed to predict the mechanical properties SCCs. • Proposed models were compared with the existing models. The present study aims at developing models to predict the various mechanical properties of ternary blended (ground granulated blast furnace slag (GBFS) + microsilica) self-consolidating concretes (SCCs) made with crushed granite stone (CGS) and recycled steel slag (RSS) as coarse aggregate. Ternary blended SCCs were produced in two batches. The first batch contains RSS as coarse aggregate, whereas the second contains CGS as coarse aggregate. The samples were subjected to compression, split tension, flexural, modulus of elasticity, and rebar pull-off tests. Experimental results imply that the mechanical properties of RSS aggregate SCCs were 10 to 21% lower than the CGS aggregate SCCs. Regression analysis was performed with the recorded results, and models were proposed to correlate the various hardened properties of the SCCs with a high correlation coefficient (R2 ≥ 0.94). [ABSTRACT FROM AUTHOR]

The mercury(II) halide complex [1,3-di-tert-butyl-2,4-bis(tert-butylamino)- 1,3,2λ5,4λ5 -diazadiphosphetidine-2,4-diselone-κ² Se,Se' ]diiodidomercury(II) N,N-dimethylformamide monosolvate, [HgI2(C16H38N4P2Se2)]·C3H7NO or (1)- HgI2, 2, containing cis-[(tBuNH)(Se)P(μ-NtBu)2P(Se)(NHtBu)] (1) was synthesized and structurally characterized. The crystal structure of 2 confirms the chelation of chalcogen donors to HgI2 with a natural bite angle of 112.95 (2)°. The coordination geometry around mercury is distorted tetrahedral as indicated by the τ4 geometry index parameter (τ4 = 0.90). In the mercury complex, the exocyclic tert-butylamido substituents are arranged in an (endo, endo) fashion, whereas in the free ligand (1), the exocyclic substituents are arranged in an (exo, endo) pattern. Compound 2 displays non-classical N—H···O hydrogen-bonding interactions with the solvent N,N-dimethylformamide. These interactions may introduce geometrical distortion and deviation from an ideal geometry. An isostructural HgBr2 analogue containing cis-[(tBuNH)(S)P(μ-NtBu)2P(S)(NHtBu)] was also synthesized and structurally characterized, CIF data for the compound being presented as supporting information. [ABSTRACT FROM AUTHOR]

• Described the material characteristics of IF-Slag using XRF, XRD and SEM analysis. • Produced ternary blended SCC mixes with normal and IF-Slag coarse aggregates. • Compared their performance in absorption, RCPT, Electrical resistivity and UPV. • Developed two models to correlate the RCPT and electrical resistivity. This study compares some of the durability characteristics between ternary blended self-compacting concrete (SCC) containing normal crushed stone and induction furnace slag (IF-Slag) as coarse aggregate. Two series of blended (silica fume + ground-granulated blast furnace slag) SCC mixtures were made, one with normal coarse aggregate and the second with IF-Slag aggregate. For comparing the performance of these two series of blended SCC mixtures, the following tests such as water absorption, coefficient of water absorption, volume of permeable pores, rate of capillary absorption, rapid chloride permeability, electrical resistivity, and ultrasonic pulse velocity were conducted. The experimental results showed that the performance of SCC made with IF-Slag coarse aggregate was considerably inferior to the SCC made with normal coarse aggregate. Inclusion of mineral additives improved the microstructure of the binder matrix through their pore refinement effect, which was noticed from the SEM images. Maximum improvement was achieved in the blended mix SCC-10/40, in which the absorption, coefficient of absorption, permeable pore volume and sorptivity values were reduced by around 28%, 40%, 27% and 44% respectively. It also increased the electrical resistance as well as chloride ion penetration resistance of both the series of SCC mixtures. [ABSTRACT FROM AUTHOR]

• IFS is porous in nature, and it has randomly distributed voids and microcracks. • The usage of IFS aggregate improved the flowability of SCC. • The usage of IFS aggregate decreased the mechanical performance of SCC. • Strength reduction due to IFS aggregate can be minimized using mineral additions. This study compares the fresh and mechanical performance of ternary blended self-compacting concrete (SCC) mixes made with induction furnace slag (IFS) and natural crushed stone as coarse aggregate. Two series of ternary blended SCC were produced, first with natural coarse aggregate and the next with IFS coarse aggregate. Fresh characteristics such as unconfined flowability, passing ability, and segregation resistance of all the SCC mixes were assessed. Their mechanical properties were evaluated through compressive strength, splitting tensile strength, modulus of rupture, elastic modulus, and pull-off bond strength tests. From the above tests, it was inferred that the fresh properties of SCC mixes were considerably enhanced with the usage of IFS coarse aggregate, but the mechanical performance of SCC mixes containing IFS coarse aggregate were slightly inferior to the similar mixes made with the natural crushed stone coarse aggregate. In both the aggregate series, comparing to the SCC made only with cement, utilization of 10% silica fume (SF) and upto 30% ground granulated blast furnace slag (GGBFS) enhanced the mechanical properties of the SCC mixes through their secondary hydration process. [ABSTRACT FROM AUTHOR]

I am delighted to present the second volume of the I Atlas of Videourology. i The I Atlas i is a source for comprehensive instruction in surgical technique from experts in the field, including a full-length manuscript with details of surgical steps, instruments, troubleshooting, and review of outcomes using the technique, if appropriate. The accompanying video consists of a video of the entire surgery as well as easily accessible video segments of each step of the operation. This second issue has 6 modules with modules for urethral stricture management, laparoscopic partial nephrectomy, and robotic ureteral reimplantation and Boari flap reconstruction. [Extracted from the article]

Objective: This study developed and evaluated a mental workload-based adaptive automation (MWL-AA) that monitors surgeon cognitive load and assist during cognitively demanding tasks and assists surgeons in robotic-assisted surgery (RAS). Background: The introduction of RAS makes operators overwhelmed. The need for precise, continuous assessment of human mental workload (MWL) states is important to identify when the interventions should be delivered to moderate operators' MWL. Method: The MWL-AA presented in this study was a semi-autonomous suction tool. The first experiment recruited ten participants to perform surgical tasks under different MWL levels. The physiological responses were captured and used to develop a real-time multi-sensing model for MWL detection. The second experiment evaluated the effectiveness of the MWL-AA, where nine brand-new surgical trainees performed the surgical task with and without the MWL-AA. Mixed effect models were used to compare task performance, objective- and subjective-measured MWL. Results: The proposed system predicted high MWL hemorrhage conditions with an accuracy of 77.9%. For the MWL-AA evaluation, the surgeons' gaze behaviors and brain activities suggested lower perceived MWL with MWL-AA than without. This was further supported by lower self-reported MWL and better task performance in the task condition with MWL-AA. Conclusion: A MWL-AA systems can reduce surgeons' workload and improve performance in a high-stress hemorrhaging scenario. Findings highlight the potential of utilizing MWL-AA to enhance the collaboration between the autonomous system and surgeons. Developing a robust and personalized MWL-AA is the first step that can be used do develop additional use cases in future studies. Application: The proposed framework can be expanded and applied to more complex environments to improve human-robot collaboration. [ABSTRACT FROM AUTHOR]

The article discusses the report "Development of a standardised training curriculum for robotic surgery: a consensus statement from an international multidisciplinary group of experts," by K. Ahmed and colleagues. Topics include the application of a standardised training curriculum for robotic surgery training, the use of virtual reality simulation, and the critical role of non-technical skills such as leadership, trouble-shooting, communication, and teamwork in avoiding adverse events.

Purpose: The role of robotic partial nephrectomy (RPN) is becoming increasingly prevalent in managing small renal masses. Renal functional outcomes have been reported with relation to the amount of healthy renal parenchyma resected and ischemia time; however, there is limited data on the effect of renorrhaphy on long-term renal function. Our aim is to evaluate the impact of renorrhaphy technique on renal functional outcomes. Methods: A nonsystematic literature review was performed to retrieve articles assessing renorrhaphy techniques and renal function outcomes, specifically focusing on single-layer vs. traditional two-layer renorrhaphy. Results: Performing single-layer renorrhaphy while omitting cortical renorrhaphy appears to improve renal function postoperatively, based on very limited studies in the literature that were evaluated. Conclusion: Single-layer renorrhaphy may be associated with improved postoperative renal function and could prove to be useful in patients with chronic renal insufficiency or solitary kidney. The ongoing clinical trial NCT02131376 may provide further information on the impact of renorrhaphy technique on long-term renal function. [ABSTRACT FROM AUTHOR]

The article focuses on the evaluation on the three standardized robotic surgery training methods. It states that the robotic surgery industry has required that in vivo training must be undertaken in one of their official training facilities before surgeons will be authorized to use the technology. It mentions that even if training is important, there is lack of evidence that in vivo training contribute enough value to be mandatory in any credentialing process.

The article presents the recommendations of the American Urological Association (AUA) for credentialing computer-assisted surgery or robotic surgery. It is said that there are no national guidelines on surgeon credentialing so they can perform robotic surgery. As such, the Laparoscopy and Robotics Committee of the AUA created a standard operating practice document to guide hospitals in creating requirements for credentialing a surgeon. The requirements are competence in robotic technology and technique, in laparoscopy, and in the surgical procedure.

The article offers information on annual scientific meeting of the Indian American Urological Association to be held on May 7, 2016 in San Diego, California.

Partial nephrectomy (PN) is the preferred surgical treatment for T1 renal tumors whenever technically feasible. When properly performed, it allows preservation of nephron mass without compromising oncologic outcomes. This reduces the postoperative risk of renal insufficiency, which translates into better overall survival for the patients. PN can be technically challenging, because it requires the surgeon to complete the tasks of tumor excision, hemostasis and renorrhaphy, all within an ischemic time of preferably below 30 minutes. The surgeon needs to avoid violating the tumor margins while leaving behind the maximal parenchymal volume at the same time. Variations such as zero ischemia, early unclamping, and selective clamping have been developed in an attempt to reduce the negative impact of renal ischemia, but inevitably add to the steep learning curves for any surgeon. Being able to appreciate the fine details of each surgical step in PN is the fundamental basis to the success of this surgery. The use of the robotic assistance allows a good combination of the minimally invasive nature of laparoscopic surgery and the surgical exposure and dexterity of open surgery. It also allows the use of adjuncts such as concurrent ultrasound assessment of the renal mass and intraoperative fluorescence to aid the identification of tumor margins, all with a simple hand switch at the console. Robot-assisted laparoscopic PN is now the most commonly performed type of PN in the United States and is gaining acceptance on the global scale. In this video, we illustrate the steps of robot-assisted laparoscopic PN and highlight the technical key points for success. [ABSTRACT FROM AUTHOR]

Objectives: To compare overall survival (OS) and immediate postoperative outcomes between partial and radical nephrectomy (RN) for T2 N0 M0 tumors and identify significant factors for poor OS. Patients and Methods: Using the National Cancer Database, we identified patients with T2 N0 M0 renal cancer between 2004 and 2009 who were treated with partial or radical nephrectomy. The partial and RN groups were statistically matched by demographics and tumor characteristics. We used Cox multiple regression to identify significant factors for all-cause mortality and plotted survival curves for both groups. We compared immediate postoperative outcomes between groups by χ2 test and independent samples t-test. Results: After statistical matching, there were 527 patients in each group, with high similarities in age, gender, race, comorbid status, tumor size, histology, and grade. RN was associated with a higher risk of all-cause mortality (hazard ratio: 5.289; p < 0.001) than partial nephrectomy (PN), after adjusting for all available covariates. PN had significantly better OS than RN, with log-rank, Breslow, and Tarone-Ware tests consistently showing p-values of <0.001. Old age, high comorbidity index, and high Fuhrman grade were associated with increased risks of all-cause mortality, while papillary and chromophobe tumors had decreased risks. PN was associated with more positive surgical margins (PSM) than RN (4.4% vs 2.5%, p < 0.001). Conclusion: T2 N0 M0 tumors treated with PN had better OS than those treated with RN, despite more PSM. Age, comorbidity index, histologic subtypes, and Fuhrman grade had significant impacts on OS. [ABSTRACT FROM AUTHOR]

Previous studies in robotic-assisted surgery (RAS) have studied cognitive workload by modulating surgical task difficulty, and many of these studies have relied on self-reported workload measurements. However, contributors to and their effects on cognitive workload are complex and may not be sufficiently summarized by changes in task difficulty alone. This study aims to understand how multi-task requirement contributes to the prediction of cognitive load in RAS under different task difficulties. Multimodal physiological signals (EEG, eye-tracking, HRV) were collected as university students performed simulated RAS tasks consisting of two types of surgical task difficulty under three different multi-task requirement levels. EEG spectral analysis was sensitive enough to distinguish the degree of cognitive workload under both surgical conditions (surgical task difficulty/multi-task requirement). In addition, eye-tracking measurements showed differences under both conditions, but significant differences of HRV were observed in only multi-task requirement conditions. Multimodal-based neural network models have achieved up to 79% accuracy for both surgical conditions. [ABSTRACT FROM AUTHOR]

The article discusses an online course in robotic surgery offered by the Laparoscopic, Robotics and New Surgical Technology Committee of the American Urological Association (AUA). Several experts such as Dr. Elspeth McDougall and Dr. Mani Menon are involved in the creation of the course. The course has nine modules divided into three sections. The course will be available for free to AUA members.

Objective: Management of symptomatic ureteropelvic junction (UPJ) obstruction with hydronephrosis and discordant Tc-99 mercaptoacetyltriglycine (MAG-3) renal scintigraphy is challenging. In this study we describe long-term outcomes of patients who underwent robot-assisted laparoscopic pyeloplasty for the correction of symptomatic UPJ obstruction with discordant preoperative Tc-99m MAG-3 renal scintigraphy. Methods: Patients undergoing robot-assisted laparoscopic pyeloplasty for symptomatic UPJ obstruction at a single academic center from 2009 to 2021 were retrospectively reviewed. Patients were categorized into three groups with varying degrees of obstruction based on preoperative MAG-3 imaging: Group 1: no obstruction (Lasix T1/2 clearance <10 minutes), Group 2: equivocal obstruction (Lasix T1/2 clearance 10–20 minutes), and Group 3: obstruction (Lasix T1/2 clearance >20 minutes. Pyeloplasty success was defined as resolution of symptoms and improvement/stable computed tomography (CT) imaging or MAG-3 scintigraphy. Failure was defined as persistence of symptoms with either obstruction on functional imaging, worsening hydronephrosis, or subsequent intervention. Results: A total of 125 cases were identified, with a median patient age of 35 years. Dismembered pyeloplasty technique was performed in 98.4% of cases. Median preoperative split renal function on MAG-3 scintigraphy was the only statistically significant (p = 0.003) difference in preoperative characteristics between the three groups. There were 15 postoperative complications, with a rate of Clavien–Dindo grade 3 or higher complications of 4.8%. Overall pyeloplasty success was 92.8%, with success rates of 100% (15/15) and 97% (32/33) in the no obstruction and equivocal obstruction groups, respectively. Median time to pyeloplasty failure was 20.4 months. Conclusion: Robot-assisted laparoscopic pyeloplasty is a safe and effective surgical intervention for correcting UPJ obstruction. Patients with symptoms of UPJ obstruction and discordant functional imaging studies demonstrate similar or improved success rates after pyeloplasty compared with patients with documented high-grade obstruction. Based on these findings preoperative renal scan may not be reliable in appropriate selection of candidacy for pyeloplasty. [ABSTRACT FROM AUTHOR]

Objective: To describe the long-term outcomes of robot-assisted laparoscopic pyeloplasty (RALP) for the correction of ureteropelvic junction (UPJ) obstruction.Methods: A retrospective electronic medical record review of RALPs from October 2002 to July 2014 was performed, with additional follow-up for patients released from regular urological care obtained by phone. RALP success was defined as resolution of symptoms of UPJ obstruction, improved hydronephrosis radiographically, or resolution of obstruction on follow-up Tc-99m mercaptoacetyltriglycine renal scan, intravenous pyelogram, or Whitaker test. RALP failure was defined as persistence of symptoms with obstruction demonstrated on functional imaging or requirement for a subsequent UPJ procedure.Results: A total of 129 cases were identified, with an average patient age of 34.3 years. Stented RALP was performed in 80.6% of cases whereas 19.4% of patients underwent stentless RALP. A dismembered technique was performed in 90.7% of pyeloplasties, whereas 9.3% were nondismembered Fenger, Y-V, or flap pyeloplasties. Five intraoperative complications and 18 postoperative complications (Clavien I-IIIb) were described. One hundred twenty-nine patients received follow-up for a mean of 33.8 months (range 1-147 months). RALP was successful in 125/129 (96.9%), with an 8-year failure-free survival of 91.5%. When considering only stented pyeloplasties, the 8-year failure-free survival was 96.3%.Conclusion: RALP is a safe and effective minimally invasive method for correction of UPJ obstruction, resulting in lasting improvement in symptoms and resolution of obstruction for most patients. [ABSTRACT FROM AUTHOR]

Most studies in urothelial cancer have examined smoking status (current, former, never), but often fail to quantify smoking burden/exposure, which has been shown to be prognostic in other malignancies. The impact of smoking burden on oncologic outcomes for upper tract urothelial carcinoma (UTUC) remains understudied with current literature providing mixed results.;Limitations of the;existing literature;include the lack;of patients who received neoadjuvant chemotherapy (NAC) and only a low proportion of patients receiving adjuvant therapy (AC). The relationship between smoking burden and pathologic downstaging after NAC in UTUC is largely unknown, and survival data has been mixed. We therefore performed a contemporary analysis of smoking burden;on oncologic outcomes in patients with UTUC undergoing radical nephroureterectomy (RNUx) utilizing a larrge;multicentered, multinational cohort (ROBUUST 2.0). We performed a retrospective analysis from a large multicentered cohort of 1,730 patients with UTUC across 17 institutions from 2005-2022. We excluded patients with incomplete smoking history, pathologic data, non-urothelial histology, and prior or concurrent cystectomy. All patients underwent RNUx. Smoking history included current smoking status, cigarettes per day (CPD), total pack-years (TPY), and cumulative smoking exposure. Based on prior studies, cumulative smoking exposure was stratified as light (≤19 CPD & ≤19 years smoking), or heavy (>20 CPD & >20 years smoking), with all other cases being moderate exposure. For analysis, light and moderate smoking exposure groups were combined.;Survival outcomes of cancer specific (CSS) and overall survival (OS) were assessed using the Kaplan-Meier method and multivariable competing risk regression to adjust for competing risk of non-cancer mortality from smoking exposure. A multivariable regression analysis was performed to examine odds of achieving pathologic down-staging;(

Introduction Living donor evaluation involves imaging to determine the choice of kidney for nephrectomy. Our aim was to study the diagnostic accuracy and correlation between CT-based volume measurements and split renal function ( SRF) as measured by nuclear renography in potential living donors and its impact on kidney selection decision. Methods We analyzed 190 CT-based volume measurements in healthy donors, of which 65 donors had a radionuclide study performed to determine SRF. Results There were no differences in demographics, anthropometric measurements, total volumes, eGFR, creatinine clearances between those who required a nuclear scan and those who did not. There was a significant correlation between CT-volume-measurement-based SRF and nuclear-scan-based SRF (Pearson coefficient r 0.59; p < 0.001). Furthermore, selective nuclear-based SRF allowed careful selection of donor nephrectomy, leaving the donor with the higher functioning kidney in most cases. There was also a significantly higher number of right-sided nephrectomies selected after nuclear-based SRF studies. Conclusion CT-based volume measurements in living donor imaging have sufficient correlation with nuclear-based SRF. Selective use of nuclear-scan-based SRF allows careful selection for donor nephrectomy. [ABSTRACT FROM AUTHOR]

Background and Purpose: Laparoendoscopic single-site (LESS) surgery offers potential improvements in cosmesis and recovery over standard laparoscopy (SL). We report the factors with which patients are most concerned in choosing surgery and how these affect preference for LESS. In addition, we rate the satisfaction of scars after laparoscopy. Patients and Methods: Patients followed after a laparoscopic procedure completed two surveys. First, patients rated, on a 5-point Likert scale, the importance of pain, recovery time, cost, treatment success, scars, and complications in choosing surgery. In addition, they were asked their preference for LESS. In the second survey, the impact of scars on body image and cosmesis was assessed. Results: Seventy-nine patients (median age 54.8 years, 65% male and 35% female) were treated for malignancy (53), donation (15), and benign indications (9). Treatment success (4.71±0.81) and complications (4.22±1.16) were most important, followed by pain (3.43±1.21) and convalescence (3.65±1.11), P<0.05. Cost was rated 2.68±1.38, and cosmesis was 2.22±1.13 ( P<0.005). Cosmesis score increased in females (2.59±1.08 vs 2.02±1.12), patients <50 years (2.59±1.09 vs 2.02±1.12), and benign surgical indication (3.33±1.12 vs 2.07±1.06), P<0.05. LESS was preferred in 30.4%, SL in 39.2%. Concern for cosmesis was associated with LESS preference (48.5% vs 17.8%, P=0.004). Sex, age, and surgical indication also influenced this. On the body image scale, patients scored a mean 18.8±1.5 of 20. Patients rated scar appearance 8.31±1.80 of 10. Conclusion: Patients who were treated with laparoscopy were most concerned with success and complication. Preference for LESS was influenced by concerns for cosmesis, sex, age, and surgical indication. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Malfunctions of the robotic surgical system have been reported, and the critical failure rate leading to converting or aborting the case occurs in less than 1% of cases. However, little is known about how global robotic experience with time and the advent of newer robotic surgical systems impact robot malfunctions. In this study, we characterize the changes in type and consequences of robot malfunctions over time and by type of robotic system used (da Vinci or da Vinci S). OBJECTIVES [ABSTRACT FROM AUTHOR]

AbstractObjective:Robot-assisted laparoscopic pyeloplasty (RALP) has been shown to be an efficacious treatment for ureteropelvic junction obstruction. Although the use of a ureteral stent is commonplace, the water-tight anastomosis possible with robotic assistance may obviate its need. We report a feasibility study of unstented RALPs and present our experience with both the stented (SRP) and unstented (URP) approach.Materials and Methods:A retrospective review of RALPs completed at our institution from 2003 to 2008 was performed. Thirty-five patients had postoperative stents. Seventeen RALPs were completed without ureteral stents. Narcotic requirements, operative time, estimated blood loss, daily drain output, length of stay, and complications were examined.Results:Fifty-two patients underwent RALP without conversion to open procedure (35 SRP, 17 URP). Operative time was significantly less in the URP group (p= 0.01). URPs required less narcotics and had shorter length of stay. Three complications were reported after SRP, whereas two patients with URP experienced transient ureteral obstruction, which resolved after 4 weeks with an indwelling ureteral stent. Postoperative renograms showed improved drainage in all but four patients (two SRPs and two URPs), each of whom had subjective improvement in symptoms postoperatively.Conclusions:Our data suggest that URP is a safe and feasible procedure for the treatment of ureteropelvic junction obstruction. There were no clinically significant differences between the stented and unstented groups. Further prospective evaluation is needed; however, URP can be performed by an experienced surgeon in a carefully selected patient. [ABSTRACT FROM AUTHOR]

Objectives: To report an initial clinical urologic experience using single-port surgery compared to the traditional laparoscopic technique for nephrectomy. Methods: A total of 11 patients underwent laparoscopic nephrectomy using the laparoendoscopic single-site surgery (LESS) procedure, with 1 R-port used for each. A group of 10 patients who previously underwent simple nephrectomies by 1 of the 2 surgeons were selected for comparison. The intraoperative and postoperative narcotic analgesia requirements were compared between the 2 groups. The Student t test was used to compare the means. All complications, clinical data, and technical issues with performing the procedure were noted. Results: All LESS simple nephrectomy procedures were completed uneventfully. There were no intraoperative complications in the LESS group. Postoperative complications included pyrexia and port site bruising with 2 patients. Operative time showed no significant difference in the LESS group compared to the traditional laparoscopic group (151 vs 165 minutes). Narcotic analgesia requirements showed no significant difference in both intraoperative and postoperative usage analyses (P = .15 and P = .55, respectively). Conclusions: The LESS technique can be performed safely compared to traditional laparoscopy. With no significant difference in operative time and relatively few complications, this is a feasible technique for simple nephrectomy. Even though there is no significant difference in intraoperative and immediate postoperative narcotic usage, the procedure has obvious cosmetic advantages. [Copyright &y& Elsevier]

AbstractIntroduction and Objective:There have been many reports regarding the use of intraoperative ultrasound to identify vascular structures. However, few have examined the application of Doppler technology for the identification and dissection of hilar vessels during laparoscopic renal surgery (LRS). We describe the design and utility of what is, to our knowledge, the only available disposable laparoscopic Doppler probe (LDP).Methods:A disposable 18-inch, 8-MHz LDP (Vascular Technology, Inc., Nashua, NH) was inserted through a 5-mm laparoscopic port during LRS and moved systematically in a cephalad direction along the medial aspect of the kidney in an attempt to obtain an audible signal from the vessels of the renal hilum. Various endpoints such as ease of probe use, time to identification of vessels, and detection of aberrant vessels were recorded.Results:A total of 20 patients underwent LRS by a single surgeon (C.P.S.). The LDP was shown to be very easy to use in the identification of the renal hilum. The mean time for the identification of all renal vessels by LDP survey was 34.9 seconds. The mean time to surgical isolation of all hilar vessels was 44.6 minutes. There were no technical difficulties or complications as a result of Doppler probe use.Conclusions:The use of the LDP provides a fast, efficient, and simple means of identifying the renal hilum during LRS. This technology may have added benefit and utility in patients with anomalous vessels, significant adhesions, or during laparoscopic surgery by less experienced surgeons. [ABSTRACT FROM AUTHOR]

Objective: To identify preoperative characteristics in patients with renal masses that influence operative time during robot-assisted partial nephrectomy (RAPN) and evaluate the relationship between operative time and length of stay (LOS), complication rates, and overall outcome. Materials and Methods: We queried our institutional database to identify a cohort of patients who underwent RAPN by two experienced robotic surgeons between 2012 and 2019. A multivariable regression model was developed to analyze operative time, LOS, and any grade complication within 30 days postoperatively using the bootstrap resampling technique. Results: A total of 392 patients were included. On multivariable analyses, prior abdominal surgery (p = 0.001) was associated with 22 minutes of increase in operating room time, as well as adhesive perirenal fat (22 minutes, p = 0.001). For each one unit increase in nephrometry score, there was a 4-minute increase in operating room time (p = 0.028), and for each one-cm increase in tumor size, there was an associated 12-minute increase in operating room time (p < 0.001). For each 1 year increase in age, there was an associated 0.024-day increase in LOS [odds ratio (OR) (0.013–0.035)]; in addition, for every one-cm increase in tumor size there was a 0.18-day associated increase in LOS [OR (0.070–0.28)]. Each 1-hour increase in operating room time was associated with a 0.25-day increased LOS [OR (0.092–0.41)]. Only tumor size was found to be associated with any grade complication. Conclusions: Patients with a history of abdominal surgery, larger complex tumors, and significant Gerota's fat undergoing robotic partial nephrectomy should anticipate longer operative times. Older patients with larger tumors and longer operative times can anticipate a longer LOS. Tumor size appears to be the common determinant of all three outcomes: operative time, LOS, and any grade Clavien complication. [ABSTRACT FROM AUTHOR]