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Background: The relative cardiovascular safety of gonadotropin-releasing hormone (GnRH) antagonists compared with GnRH agonists in men with prostate cancer and known atherosclerotic cardiovascular disease remains controversial. Methods: In this international, multicenter, prospective, randomized, open-label trial, men with prostate cancer and concomitant atherosclerotic cardiovascular disease were randomly assigned 1:1 to receive the GnRH antagonist degarelix or the GnRH agonist leuprolide for 12 months. The primary outcome was the time to first adjudicated major adverse cardiovascular event (composite of death, myocardial infarction, or stroke) through 12 months. Results: Because of slower-than-projected enrollment and fewer-than-projected primary outcome events, enrollment was stopped before the 900 planned participants were accrued. From May 3, 2016, to April 16, 2020, a total of 545 patients from 113 sites across 12 countries were randomly selected. Baseline characteristics were balanced between study groups. The median age was 73 years, 49.8% had localized prostate cancer; 26.3% had locally advanced disease, and 20.4% had metastatic disease. A major adverse cardiovascular event occurred in 15 (5.5%) patients assigned to degarelix and 11 (4.1%) patients assigned to leuprolide (hazard ratio, 1.28 [95% CI, 0.59–2.79]; P =0.53). Conclusions: PRONOUNCE (A Trial Comparing Cardiovascular Safety of Degarelix Versus Leuprolide in Patients With Advanced Prostate Cancer and Cardiovascular Disease) is the first, international, randomized clinical trial to prospectively compare the cardiovascular safety of a GnRH antagonist and a GnRH agonist in patients with prostate cancer. The study was terminated prematurely because of the smaller than planned number of participants and events, and no difference in major adverse cardiovascular events at 1 year between patients assigned to degarelix or leuprolide was observed. The relative cardiovascular safety of GnRH antagonists and agonists remains unresolved. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02663908.

Background: Androgen independence is the most challenging problem in the treatment of advanced prostate cancer. Although most patients with early-stage prostate cancer can be cured with surgical and/or radiation treatment, the remainder of patients ultimately recur with metastatic disease upon development of resistance to anti-androgen therapy. Epithelial mesenchymal transition (EMT) and lineage plasticity has been proposed as key mechanisms underlying resistance in treatment-induced prostate cancer with neuroendocrine features (NEPC). There has been a rise in treatment-induced NEPC with increased use of anti-androgen therapies. ABI1 regulates EMT by suppressing FYN-STAT3 activation downstream from noncanonical WNT pathway, but the interaction of ABI1 with androgen pathway is not known. We sought to determine the effect of neoadjuvant hormone treatment (NHT) on ABI1 expression levels in different tumor types. Methods: Here we analyzed ABI1 expression (IHC) in tissue microarray containing 75 tumors with no prior treatment, 198 patients subjected to NHT prior to surgery and 39 castration resistant tumors (total n=307). Androgen-induced ABI1 expression was determined upon R1881 treatment by Western blotting and immunofluorescence in hormone- sensitive LNCaP cells. Results: ABI1 expression was significantly downregulated in tumors from patients undergoing NHT(p Conclusion: ABI1 is an androgen sensitive gene. ABI1 expression is increased in CRPC, most likely secondary to androgen receptor reactivation. It is subsequently downregulated in NEPC, hence, we hypothesize that this may be a key mechanism driving the NEPC phenotype through promoting EMT. Further understanding of the role ABI1 may play in this transformation will provide a more mechanistic understanding of prostate cancer progression and maylead to improved targeted treatment options. Citation Format: Leszek Kotula, Baylee A. Porter, Xiang Li, Maria A. Ortiz, Rakesh Khanna, Fan Zhang, Sonia H. Kung, Ladan Fazli, Martin E. Gleave, Gennady Bratslavsky, Jeffrey S. Ross. ABI1 and androgen dependence in prostate cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 340.

The incidence of renal cell carcinoma (RCC) continues to increase in the USA in part due to earlier detection with prevalent imaging (Potretzke et al. in J Kidney Cancer VHL 2:30, [1], AUA guidelines [4]).

Charged Particle Monitor (CPM) on-board the AstroSat satellite is an instrument designed to detect the flux of charged particles at the satellite location. A Cesium Iodide Thallium (CsI(Tl)) crystal is used with a Kapton window to detect protons with energies greater than 1 MeV. The ground calibration of CPM was done using gamma-rays from radioactive sources and protons from particle accelerators. Based on the ground calibration results, energy deposition above 1 MeV are accepted and particle counts are recorded. It is found that CPM counts are steady and the signal for the onset and exit of South Atlantic Anomaly (SAA) region are generated in a very reliable and stable manner., Comment: 9 pages, 8 figures, 5 tables. To appear in JAA special issue on AstroSat

280 Background: Prostate cancer is characterized by heterogeneity of mechanisms which are poorly understood but pointing to epithelial plasticity as the key mechanism in progression to metastatic disease. ABI1, a member of WAVE complex and actin cytoskeleton regulator and adaptor protein, is proposed to act as tumor suppressor in prostate cancer, but the mechanism of tumor progression due to Abi1 loss is not clear. Methods: To address Abi1’s role in prostate cancer we used CRISPR-based gene editing and retroviral expression to manipulate Abi1 levels in prostate cancer cell lines. Levels of Abi1 expression in prostate organoid tumor cell lines were evaluated by Western blotting and/or RNA sequencing. Association of Abi1 loss with tumor grade was evaluated by immunohistochemistry. Results: Abi1 expression is downregulated in tumor organoid cell lines from metastatic bone and lymph node biopsies. Moreover, low Abi1 expression is associated with high-grade prostate tumors (GG3 or higher, p < 0.001). Disruption of Abi1 gene in a benign prostate epithelial cell line RWPE-1 resulted in a gain of invasive phenotype, which is characterized by loss of cell-cell adhesion markers and increased migratory ability of RWPE-1 Abi1 KO spheroids. Through RNA sequencing and protein expression analysis we discovered that Abi1 loss leads to activation of non-canonical WNT signaling and EMT pathways, which are rescued by re-expression of Abi1. Furthermore, increase in STAT3 phosphorylation upon Abi1 inactivation and evidence for high affinity interaction of FYN-SH2 domain with Abi1 pY421 support the model that Abi1 acts as a gatekeeper of the non-canonical WNT-EMT pathway activation downstream from FZD2 receptor. The gene expression profile of Abi1-EMT-WNT pathway overlaps with the reported gene signature of high-risk prostate tumors. Conclusions: Abi1 contributes to prostate cancer progression and epithelial plasticity through regulation of EMT-WNT pathways. Understanding of Abi1’s role may provide more mechanistic understanding of prostate cancer tumor progression.

Objective To evaluate the detection of near-infrared fluorescence from prostate tumors stained with a prostate-specific membrane antigen (PSMA)–targeted tracer developed in our institution with a novel robotic imaging system. Methods Prostate cancer cell lines PC3-pip (PSMA positive) and PC3-flu (PSMA negative) were implanted subcutaneously into 6 immunodeficient mice. When tumors reached 5 mm, a PSMA-targeted fluorescent conjugate was injected intravenously. The first 3 mice underwent near-infrared imaging immediately and hourly up to 4 hours after injection to determine the time necessary to obtain peak fluorescence and were killed. The last 3 mice were imaged once preoperatively and were euthanized 120 minutes later. Excision of the tumors was performed by using a novel robotic imaging system to detect near-infrared fluorescence in real time. Specimens were submitted for pathology. Results In the first 3 mice, we found 120 minutes as the time needed to observe peak fluorescence from the PSMA-positive tumors. We identified discrete near-infrared fluorescence from 2 of 3 PSMA-positive tumors with the robotic imaging system. Surgical margins were negative for all excised specimens except for one PSMA-negative tumor. Conclusions Real-time near-infrared fluorescence imaging of prostate cancer is feasible with a novel robotic imaging system. Further research is needed to optimize the signal intensity detectable from prostate cancer with our tracer. Toxicologic studies are needed before its clinical use.

The Cadmium Zinc Telluride Imager (CZTI) is a high energy, wide-field imaging instrument on AstroSat. CZT's namesake Cadmium Zinc Telluride detectors cover an energy range from 20 keV to > 200 keV, with 11% energy resolution at 60 keV. The coded aperture mask attains an angular resolution of 17' over a 4.6 deg x 4.6 deg (FWHM) field of view. CZTI functions as an open detector above 100 keV, continuously sensitive to GRBs and other transients in about 30% of the sky. The pixellated detectors are sensitive to polarisation above ~100 keV, with exciting possibilities for polarisation studies of transients and bright persistent sources. In this paper, we provide details of the complete CZTI instrument, detectors, coded aperture mask, mechanical and electronic configuration, as well as data and products., 9 pages, 6 figures, 1 table. To appear in Astrosat special issue of the Journal of Astronomy and Astrophysics

Biogeography based optimization (BBO) is a type of evolutionary algorithm. It is a population based optimization algorithm and provides clarification about the changing distribution of all species in different environment with time. Color quantization is the process of reducing the number of colors in the image and preserving the most important color information and compromise with other. A color image quantization is necessary if the display on which a specific image is presented works with less colors then the original image. Color quantization plays an important role in many medical imaging. This paper provides methods for quantization of various medical images like MRI, X-Ray using Biogeography Based optimization technique. General Terms Habitats, HSI, SIV, Immigration rate, Emigration rate, HSV, CIEL*a*b, CIEL*u*v KeywordsQuantization, anatomical medical images, evolutionary algorithm.

Despite numerous retrospective series of laparoendoscopic single site surgery, cohorts have generally been small and followup largely short-term. Therefore, we report intermediate term outcomes for patients undergoing reconstructive laparoendoscopic single site procedures at a single institution.Upon review of our prospectively maintained laparoendoscopic single site urological database of 185 cases, 32 reconstructive procedures were identified including pyeloplasty (25), ileal interposition (3), ureteroneocystostomy (3) and retrocaval ureter repair (1). Perioperative data were reviewed, and clinical and radiographic success was noted.Median followup was 24.4 months for pyeloplasty, 35 months for ileal interposition, 29.4 months for ureteroneocystostomy and 20 months for retrocaval ureter repair. At last followup 24 of 25 patients treated with pyeloplasty, 2 of 3 with ileal ureter, 3 of 3 with ureteroneocystostomy and 1 of 1 with retrocaval ureter reported being asymptomatic or improved after the procedure. Delayed incisional hernia repair was required in 1 patient. One death occurred during the followup period, remote from the date of surgery. No other complications were noted.Intermediate term results after laparoendoscopic single site reconstructive procedures remain promising. Further followup of this patient population is required to ensure the durability of results. Prospective evaluation is also needed to assess if advantages exist for laparoendoscopic single site reconstructive procedures compared to standard minimally invasive approaches.

Background The aim of this study was to evaluate a novel ultrasound probe specifically developed for robotic surgery by determining its efficiency in identifying renal tumors. Methods The study was carried out using the Da Vinci™ surgical system in one female pig. Renal tumor targets were created by percutaneous injection of a tumor mimic mixture. Single-port and standard robotic partial nephrectomy were performed. Intraoperative ultrasound was performed using both standard laparoscopic probe and the new ProART™ Robotic probe. Probe maneuverability and ease of handling for tumor localization were recorded. Results The standard laparoscopic probe was guided by the assistant. Significant clashing with robotic arms was noted during the single-port procedure. The novel robotic probe was easily introduced through the assistant trocar, and held by the console surgeon using the robotic Prograsp™ with no registered clashing in the external operative field. The average time for grasping the new robotic probe was less than 10 s. Once inserted and grasped, no limitation was found in terms of instrument clashing during the single-port procedure. Conclusions This novel ultrasound probe developed for robotic surgery was noted to be user-friendly when performing porcine standard and especially single-port robotic partial nephrectomy. Copyright © 2011 John Wiley & Sons, Ltd.

Objective: To describe the evolution of robotic partial nephrectomy (PN) technique and to analyze the surgical outcomes in a large single institution experience. Materials and Methods: Retrospective review of our institutional review boardapproved, prospectively maintained, minimally invasive PN database yielded 252 robotic partial nephrectomy (RPN) procedures from June 2007 to October 2010. Our initial experience, adopted from our laparoscopic PN approach included a standard interrupted bolstered renorrhaphy, whereas our contemporary experience included a nonbolstered continuous horizontal mattress stitch for the capsular closure. Perioperative results were evaluated depending on renorrhaphy technique, length of warm ischemia time, and nephrometry scores. Results: Overall, mean tumor size was 3.1 ± 1.6 cm, operative time 190 ± 56 minutes, warm ischemia time 18.2 ± 9.4 minutes, and estimated blood loss 267 ± 275 mL. Significantly better outcomes were noted in the contemporary experience in terms of transfusion rate (8.2% vs 21.9%, P

Objective To compare the intraoperative and early postoperative outcomes of robotic partial nephrectomy (RPN) with those of laparoscopic partial nephrectomy (LPN) outcomes in patients with bilateral synchronous renal tumors. RPN is emerging as an attractive minimally invasive nephron-sparing approach for renal tumors. Methods Our ongoing institutional review board-approved, prospectively maintained, kidney cancer database was used to identify the study population. The medical records of patients who underwent minimally invasive nephron-sparing surgery at our institution from January 2001 to March 2010 were used. A cohort of 9 patients undergoing bilateral RPN was identified and compared with 17 consecutive patients who underwent sequential bilateral LPN. The demographic, intraoperative, postoperative, and short-term renal functional data were retrospectively compared between the 2 groups. Results A total of 18 procedures were performed in the RPN group and 32 in the LPN group. The median warm ischemia time was shorter in the RPN group than in the LPN group (19 vs 37 minutes, respectively; P = .059). The median tumor size was 2.85 and 2.7 cm in the RPN and LPN group, respectively ( P = .03). The final median postoperative glomerular filtration rate was 68.7 mL/min/1.73 m 2 (interquartile range 14-73) and 26.9 mL/min/1.73 m 2 (interquartile range 20-70) in the RPN and LPN groups, respectively ( P = .004). No difference was found in the complications in the RPN group (n = 2) compared with the LPN group (n = 4). Conclusion RPN is a safe and effective minimally invasive nephron-sparing treatment of bilateral synchronous kidney tumors. A trend was seen toward a shorter warm ischemia time and less effects on postoperative renal function compared with the laparoscopic approach.

OBJECTIVE To report our short-term results of robot-assisted partial nephrectomy for treating sporadic multiple ipsilateral renal tumours. METHODS Over a 3-year period, eight patients with two or more ipsilateral renal masses underwent nine robotic partial nephrectomies in our institution. We evaluated the PADUA and R.E.N.A.L. nephrometry scores, intraoperative outcomes, histopathological characteristics, complications according to Clavien classification and renal function outcomes. RESULTS In total, 19 tumours were removed from eight patients in nine procedures. Mean operative time was 199 ± 47 min (median 200; range 150-300). Mean size of the dominant lesion was 3.0 ± 1.1 cm (2.7; 1.6-4.8) and overall mean tumour size was 2.2 ± 1.2 cm (1.9; 0.4-4.8). Mean number of tumours removed per patient was 2.4. Median PADUA and R.E.N.A.L. scores were 7 and 6 (with the predominance of an anterior, non-hilar position), respectively. Excluding the six off-clamp resected tumours, the mean warm ischaemia time was 21 ± 9.2 min (21; 10-35). Mean estimated blood loss was 250 ± 154 mL (200; 100-500) and no patient required transfusion. There were no intraoperative complications or conversion to open surgery. One patient had atrial fibrillation, resolved with anti-arrhythmic drugs. Mean length of stay was 4.2 ± 0.97 days. Sixteen of the nineteen tumours were malignant, most of papillary type and Fuhrman grade II. The mean decrease in glomerular filtration rate was 4%, with a mean follow-up of 14 months. CONCLUSIONS Robotic partial nephrectomy for sporadic ipsilateral multifocal renal tumours is feasible and safe. Off-clamp resection of multiple tumours can also be safely performed in carefully selected lesions.

Objectives To evaluate the safety and feasibility of robotic partial nephrectomy for patients with complex renal masses. Methods We reviewed the data for 164 consecutive patients who had undergone transperitoneal robotic partial nephrectomy at a tertiary care center from February 2007 to June 2010. Of the 112 patients who had available imaging studies to review, 67 were identified and classified as having a moderately or highly complex renal mass according to the R.E.N.A.L. nephrometry score (≥7) (tumor size—[R]adius, location and depth—[E]xophytic or endophytic; nearness to the renal sinus fat or collecting system [N]; anterior or posterior position [A], and polar vs non-polar location [L]). The preoperative, perioperative, pathologic, and functional outcomes data were analyzed. Results The median body mass index was 29.6 kg/m 2 (range 19.9-44.8). Of the 67 patients, 32 were men and 35 were women, with 32 right-sided masses and 35 left-sided masses. The median tumor size was 3.7 cm (range 1.2-11), and the median operative time was 180 minutes (range 150-180). The median estimated blood loss was 200 mL (range 100-375), and the warm ischemia time was 19.0 minutes (range 15-26). The median hospital stay was 3.0 days (range 3-4). The estimated glomerular filtration rate was calculated at a median decrease of 11.1 mL/min/1.73 m 2 (range 9-1.3). According to the Clavien-Dindo classification of surgical complications, 2 grade 1, 12 grade 2, and 1 grade 3 complication occurred. All margins were pathologically negative, except for 1, and, after a mean follow-up of 10 months, no recurrences had developed. Conclusions Robotic partial nephrectomy is a safe and feasible option for moderately or highly complex renal masses determined by the R.E.N.A.L. nephrometry score. The warm ischemia time, blood loss, and complications were increased with highly complex masses.

Background The object of this study was to evaluate the immediate impact of a robotic kidney surgery course on the practice patterns of participating urologists. Methods Two surveys were administered to the participants of the International Symposium on Robotic Kidney and Adrenal Surgery held at the Cleveland Clinic on October 2009. Returned responses were entered into a database. Results were reviewed and analyzed. Results Twenty-seven participants (60% of total registered) completed the end-of-course questionnaire. Mean age was 44 years (range 33–65). Mean time from completion of residency was 14 years (range 1–30). The majority of the attendees (78%) had familiarity with both laparoscopy and robotics, but only 22% of them had completed a formal fellowship or mini-residency training in laparoscopy or robotics. All course components received a mean score above 4.5. 92% of the participants planned to perform a ‘new’ procedure in their practice immediately after the course. Of the 27 participants contacted, 12 (44.4%) returned the 3-month questionnaire. All of them (100%) had performed robotic surgical procedures after the course. Overall, there was an increase of 56% in the robotic cases in the surgical practice of the participants. The actual impact of attending the course on starting or implementing robotic surgery practice was positively rated by the participants (mean score 4.7 ± 0.45 on scale 1–5). Conclusions A course including lectures, video analysis, live surgery and hands-on session with both simulators and an animal laboratory is an effective educational model for immediately spreading robotic skills. Copyright © 2011 John Wiley & Sons, Ltd.

Objectives: Indications for surgical treatment of bladder diverticula include tumor, lower urinary tract symptoms refractory to medical treatment, renal dysfunction or recurrent urinary tract infections. We describe the technique and report the outcomes of robotic bladder diverticulectomy at our institution. Methods: A chart review of patients who underwent robotic bladder diverticulectomy at our institution from 2007 to 2010 was carried out. Indications for the procedure were: lower urinary tract symptoms (LUTS) not responding to medical treatment (2 patients), ureteral obstruction (1 patient), tumor arising in a diverticulum (2 patients) and diverticulum secondary to neurogenic bladder (1 patient). One patient also had renal dysfunction associated with ureteral insertion into the diverticulum and therefore underwent ipsilateral ureteroneocystostomy. Other additional procedures included transurethral resection of the prostate (1 patient) and bilateral pelvic lymph node dissection (1 patient). Perioperative and postoperative outcomes were analyzed. Results: Six patients (median age 61.5 years, range 19–75) underwent da Vinci diverticulectomy using a transperitoneal approach without the need for open conversion. Median operative time was 232 min (135–360 min.). Median estimated blood loss was 100 mL (50–150 mL). The Foley catheter was removed after a negative cystogram and median time to catheter removal was 7 days (7–12 days). Median hospital stay was 3 days (2–5 days). The only complication was a urinary tract infection managed with antibiotics. Conclusions: Robotic surgery represents a reasonable minimally invasive treatment option for resection of bladder diverticula when indicated.

Laparoendoscopic single-site surgery (LESS) is a novel technique that aims to perform abdominal surgery through a single incision. Various access techniques and ports exist. This review will attempt to describe the currently available ports as well as highlight their advantages and disadvantages.

OBJECTIVES To describe novel robotic laparoendoscopic single-site surgery (R-LESS) instruments, and present the initial laboratory experience in urology. METHODS The VeSPA surgical instruments (Intuitive Surgical, Sunnyvale, CA) were designed to be used with the DaVinci Si surgical system. A multichannel port and curved cannulae were inserted through a single 3.5-cm umbilical incision. The port allowed 1 scope, 2 robotic instruments, and a 5- to 12-mm assistant instrument. Four pyeloplasties (right 2, left 2), 4 partial nephrectomies (right 2, left 2), and 8 nephrectomies (right 4, left 4) were performed in 4 female farm pigs (mean weight, 34.5 kg). Technical feasibility and efficiency were assessed in addition to perioperative outcomes. RESULTS All 16 R-LESS procedures were performed successfully without the addition of laparoscopic ports or open conversion. Mean total operative time was 110 minutes (range, 82-127), and mean blood loss was 20 mL (range, 10-100). Mean warm ischemia time for partial nephrectomy was 14.8 minutes (range, 12-20). There were no intraoperative complications. No robotic system failures occurred, and robotic instrument clashing was found to be minimal. One needle driver malfunctioned and assistant movement was limited. CONCLUSIONS R-LESS kidney surgery using the VeSPA instruments is feasible and efficient in the porcine model. The system offers a wide range of motion, instrument and scope stability, improved ergonomics, and minimal instrument clashing. Although preliminary experience is encouraging, further refinements are expected to optimize urological applications of this robotic technology.

Background Laparoendoscopic single-site (LESS) surgery is challenging. To help overcome current technical and ergonomic limitations, the da Vinci robotic platform can be applied to LESS. Objectives Our aim was to describe the surgical technique and to report the early outcomes of robotic LESS (R-LESS) radical prostatectomy (RP). Design, setting, and participants A retrospective review of prospectively captured R-LESS RP data was performed between May 2008 and May 2010. A total of 20 procedures were scheduled (12 with and 8 without pelvic lymph node dissection). Surgical procedure R-LESS prostatectomy was performed using the methods outlined in the paper and in the supplemental video material. Interventions All patients underwent R-LESS RP by one high-volume surgeon. Single-port access was achieved via a commercially available multichannel port. The da Vinci S and da Vinci Si surgical platform was used with pediatric and standard instruments. Measurements Preoperative, perioperative, pathologic, and functional outcomes data were analyzed. Results and limitations The mean age was 60.4 yr; body mass index was 25.4kg/m 2 . The mean operative time was 189.5min; estimated blood loss was 142.0ml. The average length of stay was 2.7 d, and the visual analog pain score at discharge was 1.4 of 10. Four focal positive margins were encountered, with two occurring during the first three cases. Pathology revealed a Gleason score of 3+3 in 3 patients, 3+4 in 11 patients, 4+3 in 4 patients, and 4+4 in 2 patients. There were a total of four complications according to the Clavien system including one grade 1, two grade 2, and one grade 4. The median follow-up has been 4 mo (range: 1–24 mo). Study limitations include the small sample size, the short follow-up, and the lack of comparative cohort. Conclusions The R-LESS RP is technically feasible and reduces some of the difficulties encountered with conventional LESS RP.

An exciting era of discovery in the field of scarless urological surgery has just begun. Hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy has been reported by a few groups in the last two years. Recently, our group at the Cleveland Clinic was able to demonstrate the feasibility of a transvaginal pure NOTES nephrectomy. During this pioneering period, a critical appraisal of results and a scrupulous determination of benefits are of utmost importance. Further studies are awaited to define the actual role of NOTES in the management of urological diseases.

Laparoscopic surgery is frequently used in urology and the introduction of the da Vinci surgical system has served to further increase the demand for these procedures. Yet, laparoscopy is not without its drawbacks including port site complications, such as bleeding, hernia, internal organ damage and scarring. To further decrease morbidity of standard laparoscopy, newer techniques such as laparoendoscopic single-site surgery (LESS) are currently being investigated. LESS is technically challenging and reduces instrument triangulation and robust retraction, and is associated with a steep learning curve. To help overcome current limitations we have introduced the da Vinci surgical system to LESS and report our experience with robotic laparoendoscopic single-site surgery.

Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been succesfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

Surgical techniques for prostate cancer , Surgical techniques for prostate cancer , کتابخانه دیجیتال جندی شاپور اهواز

Rodent models have been described to investigate lung preservation and reperfusion injury but have significant disadvantages. In large animals single lung transplant studies are probably optimal but problems remain over the ability to rigorously separate the lungs for assessment while promoting medium to long-term animal survival for meaningful investigation. Our aim was to develop a novel and refined large animal model to assess reperfusion injury in the transplanted lung, overcoming the difficulties associated with existing models. Specifically, small animal models of lung transplantation usually have short perfusion times (often one hour) and include extracorporeal circuits while larger animal models often require the contralateral lung to be excluded after transplantation-an unphysiological situation under which to evaluate the graft. A porcine model of left lung allotransplantation was developed in which native and donor lungs are individually ventilated. Sampling catheters placed within the graft lung allowed specimen withdrawal without mixing of blood from the contralateral lung after reimplantation. The model permits a variety of clinical scenarios to be simulated with the native lung supporting the animal irrespective of function in the graft. This model has been used in over 60 transplant procedures with a postoperative survival time of 12 h being readily achieved. The mean operating time was 2.6 h. The mortality rate is 4% in our series. We have found the model to be reliable, reproducible and flexible. We propose this model as an adaptable investigation for evaluating lung reperfusion injury and preservation.

Objective: Rodent models have suggested that initial low-pressure reperfusion of transplanted lungs reduces injury after ischemia. We investigated this phenomenon and the use of pentoxifylline in a porcine model of left single lung transplantation. Methods: Donor lungs were preserved with Euro-Collins solution for a mean ischemic time of 18.4 hours. Neutrophil trapping in the graft, pulmonary artery pressure, and gas exchange were assessed over a 12-hour period. Partial occlusion of the contralateral pulmonary artery allowed manipulation of the pulmonary artery pressure in the transplanted lung. Group A ( n = 5) was perfused at a mean pulmonary artery pressure of 20 mm Hg, group B was reperfused at a mean pulmonary artery pressure of 45 mm Hg for 10 minutes before reducing the pressure to the same as group A, and group C was reperfused at a mean pressure of 20 mm Hg for 10 minutes, then increased to a mean of 45 mm Hg for the remainder of the experiment. Group D was reperfused as in group A with the addition of intravenous pentoxifylline. Results: Leukocyte sequestration was observed in the first 10 minutes after reperfusion in groups A, B, and C, with maximal sequestration at 2 minutes. Significantly more sequestration was observed in the first 6 minutes in group B than in groups A and C, which were similar. Pentoxifylline significantly reduced leukocyte sequestration. Pulmonary venous oxygen tension in the allograft lung was worst in group B. Groups A and C were similar, but group D was superior to all other groups ( p Conclusions: Low-pressure reperfusion, even when limited to the first 10 minutes, modulates reperfusion injury possibly through a leukocyte-dependent mechanism. The addition of pentoxifylline in the recipient confers significant additional benefit. (J Thorac Cardiovasc Surg 1998;115:1335-41)

Purpose: Prostate cancer is the most common genitourinary malignancy to affect male renal transplant recipients, with a cumulative incidence rate of 3.1% in the U.S. We present our experie...

AstroSat is a multi-wavelength satellite launched on 2015 September 28. The CZT Imager of AstroSat on its very first day of operation detected a long duration gamma-ray burst (GRB) namely GRB 151006A. Using the off-axis imaging and spectral response of the instrument, we demonstrate that CZT Imager can localise this GRB correct to about a few degrees and it can provide, in conjunction with Swift, spectral parameters similar to that obtained from Fermi/GBM. Hence CZT Imager would be a useful addition to the currently operating GRB instruments (Swift and Fermi). Specifically, we argue that the CZT Imager will be most useful for the short hard GRBs by providing localisation for those detected by Fermi and spectral information for those detected only by Swift. We also provide preliminary results on a new exciting capability of this instrument: CZT Imager is able to identify Compton scattered events thereby providing polarisation information for bright GRBs. GRB 151006A, in spite of being relatively faint, shows hints of a polarisation signal at 100-300 keV (though at a low significance level). We point out that CZT Imager should provide significant time resolved polarisation measurements for GRBs that have fluence 3 times higher than that of GRB 151006A. We estimate that the number of such bright GRBs detectable by CZT Imager is 5 - 6 per year. CZT Imager can also act as a good hard X-ray monitoring device for possible electromagnetic counterparts of Gravitational Wave events., Comment: Submitted to ApJ

A 40-year-old religious Hindu male presented with his fourth episode of mania along with repetitive plucking of hair. This unusual behaviour was explained by him as a way to ‘attain divinity by discarding the impure demoniac hair’. He had not shown this symptom in the previous episodes. With treatment of the mood disorder the hair plucking also disappeared. Hair removal has an important religious-cultural meaning in eastern India. Possible implication of the symptom is discussed. A case is made for reporting hair plucking as a symptom rather than a syndrome and it may at times represent a culture-specific symptom.

To review and synthesize the evidence available in the literature on laparoendoscopic single-site (LESS) pyeloplasty and other reconstructive procedures.A literature search was performed to capture original articles related to LESS urological reconstructive procedures. We outlined the differences in technique and clinical outcomes related to their safety and efficacy.We found 28 retrospective studies, with a total of 146 patients. Procedures included pyeloplasty (91), ureterolithotomy (44), sacrocolpopexy (4), bladder diverticulectomy (4), partial cystectomy (2), one of which associated to augmentation cystoplasty, ureteroneocystostomy (1), ileal ureter (1), and retrocaval ureter (1). Mean operative time was 215 minutes for LESS pyeloplasty and 186 minutes for LESS ureterolithotomy. The mean estimated blood loss was 73 milliliters for pyeloplasty and 108 milliliters for ureterolithotomy. Mean length of stay was 2.7 days for pyeloplasty and 3.8 days for ureterolithotomy.Urological LESS reconstructive surgery is feasible and safe for different procedures. A solid laparoscopic experience is strongly advised prior attempting LESS reconstructive procedures due to its technical complexity. Future studies should prioritize prospective and randomized designs comparing LESS with standard laparoscopy.

The RENAL nephrometry score (RNS) was developed to quantify complexity of renal tumors in a reproducible manner. We aim to determine whether individual categories of the RNS have different impact on the warm ischemia time (WIT) for patients undergoing robotic partial nephrectomy (RPN). In a retrospective analysis of a prospectively maintained database, we identified 251 consecutive patients who underwent RPN between January 2007 and June 2010. RNS was determined in 187 with available imaging. Univariable analysis and multivariable linear regression analysis were performed to identify which factors were more significantly associated with WIT. Overall RNS was of low (4–6), moderate (7–9), and high complexity (10–12) in 84 (45 %), 80 (43 %), and 23 (12 %) patients, respectively. There was no association between gender (p = 0.6), BMI (p = 0.3), or anterior/posterior location (A) (p = 0.8), and WIT. On univariable analysis, longer WIT was associated with size (R) >4 cm (p

The desire to decrease morbidity from multiple port sites and progress toward a natural orifice approach has stimulated interest in laparoendoscopic single-site (LESS) surgery. Limitations, however, including clashing of instruments and loss of triangulation, have prevented widespread dissemination of LESS. To overcome these problems, the advantages of the robotic platform have been applied to single-site surgery. The objective of this article is to review our experience and summarize the current literature pertaining to robot-assisted LESS renal surgery.Twenty-eight robot-assisted LESS kidney procedures were identified from our prospectively maintained LESS database. These included 11 radical nephrectomies, 5 partial nephrectomies, 3 nephroureterectomies, 7 pyeloplasties, 1 simple nephrectomy, and 1 renal cyst decortication. Perioperative and postoperative data were analyzed.Of 28 cases, 4 conversions occurred. The remaining procedures were performed with no extraincisional trocars. Mean follow-up was 11.3 months for radical nephrectomy, 21.3 months for partial nephrectomy, 17.8 months for nephroureterectomy, 12.9 months for pyeloplasty, 4 months for simple nephrectomy, and 1.6 months for renal cyst decortication. Patients who underwent radical nephrectomy, partial nephrectomy, and nephroureterectomy all had negative surgical margins and have remained disease free during the follow-up period. Six of seven patients who underwent pyeloplasty reported complete resolution of symptoms while the seventh reports significant improvement.We present a large experience with robot-assisted LESS kidney surgery demonstrating the wide variety of procedures that can be performed. Further follow-up of this patient population is needed to document continued oncologic efficacy and durability of results.

The aim of this study was to evaluate a novel ultrasound probe specifically developed for robotic surgery by determining its efficiency in identifying renal tumors.The study was carried out using the Da Vinci™ surgical system in one female pig. Renal tumor targets were created by percutaneous injection of a tumor mimic mixture. Single-port and standard robotic partial nephrectomy were performed. Intraoperative ultrasound was performed using both standard laparoscopic probe and the new ProART™ Robotic probe. Probe maneuverability and ease of handling for tumor localization were recorded.The standard laparoscopic probe was guided by the assistant. Significant clashing with robotic arms was noted during the single-port procedure. The novel robotic probe was easily introduced through the assistant trocar, and held by the console surgeon using the robotic Prograsp™ with no registered clashing in the external operative field. The average time for grasping the new robotic probe was less than 10 s. Once inserted and grasped, no limitation was found in terms of instrument clashing during the single-port procedure.This novel ultrasound probe developed for robotic surgery was noted to be user-friendly when performing porcine standard and especially single-port robotic partial nephrectomy.

To report our short-term results of robot-assisted partial nephrectomy for treating sporadic multiple ipsilateral renal tumours.Over a 3-year period, eight patients with two or more ipsilateral renal masses underwent nine robotic partial nephrectomies in our institution. We evaluated the PADUA and R.E.N.A.L. nephrometry scores, intraoperative outcomes, histopathological characteristics, complications according to Clavien classification and renal function outcomes.In total, 19 tumours were removed from eight patients in nine procedures. Mean operative time was 199 ± 47 min (median 200; range 150-300). Mean size of the dominant lesion was 3.0 ± 1.1 cm (2.7; 1.6-4.8) and overall mean tumour size was 2.2 ± 1.2 cm (1.9; 0.4-4.8). Mean number of tumours removed per patient was 2.4. Median PADUA and R.E.N.A.L. scores were 7 and 6 (with the predominance of an anterior, non-hilar position), respectively. Excluding the six off-clamp resected tumours, the mean warm ischaemia time was 21 ± 9.2 min (21; 10-35). Mean estimated blood loss was 250 ± 154 mL (200; 100-500) and no patient required transfusion. There were no intraoperative complications or conversion to open surgery. One patient had atrial fibrillation, resolved with anti-arrhythmic drugs. Mean length of stay was 4.2 ± 0.97 days. Sixteen of the nineteen tumours were malignant, most of papillary type and Fuhrman grade II. The mean decrease in glomerular filtration rate was 4%, with a mean follow-up of 14 months.Robotic partial nephrectomy for sporadic ipsilateral multifocal renal tumours is feasible and safe. Off-clamp resection of multiple tumours can also be safely performed in carefully selected lesions.

Objective: To demonstrate a step-by-step approach to ureteroscopy to treat renal and ureteral calculi, with an emphasis on instrumentation and technique. Methods: Procedures involved with ...

Objective: The Roth-Net retrieval device (US Endoscopy, Mentor OH) has been utilized for gastrointestinal endoscopy since 1993 for tissue retrieval and foreign body retrieval. Our objectiv...

Success with endourological procedures requires expertise and instrumentation. This review focuses on the instrumentation required for ureteroscopy and percutaneous nephrolithotomy, and provides a critical assessment of in vitro and clinical studies that have evaluated the comparative effectiveness of these medical devices.

Nephron-sparing surgery is currently considered the gold standard treatment for T1 renal tumors. As laparoscopic partial nephrectomy (LPN) represents a technically challenging procedure, robotic surgery has been increasingly used during the last few years in the field of nephron-sparing surgery. The aim of this review is to analyze the techniques and outcomes of robotic partial nephrectomy (RPN). Currently available evidence shows that RPN is a feasible and safe procedure for small localized renal tumors and also for selected complex renal tumors. Early comparative studies have demonstrated similar perioperative outcomes between RPN and LPN, with a trend towards a shorter ischemia time for RPN. However, oncological follow-up remains limited and further prospective trials are awaited to confirm the benefits of robotic approach for partial nephrectomy.

The object of this study was to evaluate the immediate impact of a robotic kidney surgery course on the practice patterns of participating urologists.Two surveys were administered to the participants of the International Symposium on Robotic Kidney and Adrenal Surgery held at the Cleveland Clinic on October 2009. Returned responses were entered into a database. Results were reviewed and analyzed.Twenty-seven participants (60% of total registered) completed the end-of-course questionnaire. Mean age was 44 years (range 33-65). Mean time from completion of residency was 14 years (range 1-30). The majority of the attendees (78%) had familiarity with both laparoscopy and robotics, but only 22% of them had completed a formal fellowship or mini-residency training in laparoscopy or robotics. All course components received a mean score above 4.5. 92% of the participants planned to perform a 'new' procedure in their practice immediately after the course. Of the 27 participants contacted, 12 (44.4%) returned the 3-month questionnaire. All of them (100%) had performed robotic surgical procedures after the course. Overall, there was an increase of 56% in the robotic cases in the surgical practice of the participants. The actual impact of attending the course on starting or implementing robotic surgery practice was positively rated by the participants (mean score 4.7 ± 0.45 on scale 1-5).A course including lectures, video analysis, live surgery and hands-on session with both simulators and an animal laboratory is an effective educational model for immediately spreading robotic skills.