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Robotic-assisted radical prostatectomy (RARP) is the current standard of care with long term cure in organ-confined disease. The introduction of nerve-sparing (NS) to standard RARP has shown positive results in terms of functional outcomes in addition to the oncological outcomes. This article reviews the current perspectives of NS-RARP in terms of applied anatomy of the prostatic fascial planes, the neurovascular bundle (NVB), various NS techniques and postoperative functional outcomes. A non-systematic review was done using PubMed, Embase and Medline databases to retrieve and analyse articles in English, with following keywords “prostate cancer”, “robotic radical prostatectomy”, “nerve-sparing”. The Delphi method was used with an expert panel of robotic surgeons in urology to analyse the potency outcomes of various published comparative and non-comparative studies. The literature has shown that NS-RARP involves various techniques and approaches while there is a lack of randomized studies to suggest the superiority of one over the other. Variables such as preoperative risk assessments, baseline potency, surgical anatomy of individual patients and surgeons’ expertise play a major role in the outcomes. A tailored approach for each patient is required for applying the NS approach during RARP.

Background The purpose of this study is to evaluate risk factors for pneumonia following THA and TKA. Methods Patients were identified from the American College of Surgeons National Quality Improvement Database (NSQIP) who experienced postoperative pneumonia after undergoing primary THA and TKA. Results Many characteristics including old age, anemia, diabetes, cardiac comorbidities, dialysis, and smoking were independent risk factors for postoperative pneumonia after THA or TKA. Conclusion This analysis offers new evidence on risk factors associated with the development of pneumonia after THA and TKA. These risk factors can help guide clinicians in preventing postoperative pneumonia after THA and TKA.

Purpose We describe the first case of Ehlers Danlos Syndrome (EDS) reported in the English language ophthalmic literature to have undergone Laser In Situ Keratomileusis (LASIK) surgery. Observations We review our patient's specific postoperative complications of myopic regression, Salzmann nodular degeneration, and dry eye syndrome, as well as the risks and consequences of performing LASIK on patients with this collagen disorder. Conclusions and importance Refractive errors may prompt EDS patients to seek laser vision correction, placing them at increased risk for complications such as myopic regression, keratectasia, and dry eye syndrome. Aberrant wound healing and collagen dysfunction may have influenced our patient's myopic regression and Salzmann nodule degeneration post-LASIK. Currently, EDS is considered a relative contraindication in LASIK due to a presumed higher risk of postoperative keratectasia; however, we believe it is possible that not all forms of EDS need to be an absolute contraindication to LASIK. More research is warranted to determine preoperative risk stratification for laser vision surgery in each subtype of EDS.

Most people will require surgery during their lifetime, and, for a significant proportion, this will lead to chronic postsurgical pain. The incidence of chronic pain after surgery varies significantly by site of surgical procedure; however most reports support an incidence of at least 10% of patients having pain 1 year after surgery. This patient population suffers a significant cost in terms of the related distress, lost productivity, and emotional anguish. There are many factors that can contribute to the likelihood of developing acute and chronic postsurgical pain. Achieving a better understanding of these factors has helped in developing more appropriate treatments and preventative interventions that can help with the prevention and treatment of chronic postsurgical pain. Good perioperative analgesia and minimization of tissue injury continue to be important goals for both anesthesiologists and surgeons in the perioperative period. Multimodal analgesia remains the simplest method by which anesthesiologists could have an impact on the development on chronic postsurgical pain (CPSP) along with the addition of screening for psychological risk factors and the identification of high-risk surgeries. Identifying high-risk patients with psychological, genetic, and other preoperative risk factors should help with targeting these patients to ensure that they are managed appropriately. This chapter will discuss the extent of the problem of CPSP, the factors associated with development, the typical presentation of CPSP, the genetics of CPSP, and possible methods of preventing CPSP.

In the last decades, a strong relationship has been identified between cancer and cardiovascular (CV) diseases. From an etiopathogenic point of view, there are two main reasons for this relationship: common risk factors have been reported for both entities (like age, smoking, obesity, or diabetes mellitus) and cancer has been described as a proinflamatory systemic status which could lead to CV damage. In addition to this, the development of more effective cancer therapies coupled with earlier diagnosis has improved survival in cancer patients and, as they get older, they are at risk of age-related cardiac diseases. It is also remarkable that new chemotherapeutic agents have been demonstrated to induce CV off-target effects. To avoid them, algorithms for treatment and follow-up have been designed. Although most of these focus on CV disease-naive patients, those with previously known CV disease are more vulnerable to cardiotoxicity as they have less or no cardiac reserves. Risk stratification is warranted in this subgroup of patients and, according to this, an intensive control of CV risk factors coupled with an immediate follow-up must be done. On the other hand, if surgical cancer treatment is decided, patients with known cardiac disease must undergo a preoperative risk evaluation in order to assess their risk and to detect myocardial ischemia. Cardiologists and oncologists should work together in this evaluation and identify the most life-threatening situations.

Once a patient is diagnosed with prostate cancer, the decision to proceed with therapy and which therapy is an extremely complex one. Variables that factor into treatment decisions are inherent to the patient (comorbidity, life expectancy, preferences) and to their cancer (disease aggressiveness and potential for cure). Although most decisions are likely made based on physician and patient experiences and bias, objective predictive models based on pretreatment variables allow for more accurate predictions of prognosis and outcome. Pretreatment tools have been used with a variety of different goals including predicting pathologic outcomes, nonprostate-cancer related mortality, and biochemical and prostate-cancer-specific survival. To this end, there now exists an extensive list of predictive tools that can be used as decision aids after an initial diagnosis of prostate cancer. The focus of this chapter will be the most commonly used and studied pretreatment decision tools.