A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System

To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,comparison was performed between 30 single-port(SP group)and 26 multiport(MP group)cases.Comparisons included operative time,estimated blood loss(EBL),hospital stay,peritoneal violation,pain scores,scar satisfaction,continence,and erectile function.The median operation time and EBL were not different between the two groups.In the SP group,the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients(P<0.001).The median postoperative hospital stay in the SP group was shorter than that in the MP group(P<0.001).The rate of peritoneal damage in the SP group was less than that in the MP group(P=0.017).The pain score and overall need for pain medications in the SP group were lower than those in the MP group(P<0.001 and P=0.015,respectively).Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively(P=0.007).At 3 months,the cancer control,recovery of erectile function,and urinary continence rates were similar between the two groups.It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system.Therefore,epR-spRP can be a treatment option for localized prostate cancer.Although epR-spRP still has a learning curve,it has advantages for postoperative pain and self-assessed cosmesis.In the absence of the single-port robotic surgery platform,we can still provide minimally invasive surgery for patients.

Retroperitoneal kidney transplantation with liver and native kidney mobilization:a safe technique for pediatric recipients

Background Pediatric kidney transplant(KT)using larger,deceased or living donor adult kidneys can be challenging in the pediatric population due to limited space in the retroperitoneum.Liver and native kidney(L/NK)mobilization techniques can be used in smaller and younger transplant recipients to aid in retroperitoneal placement of the renal allograft.Here,we compare the clinical outcomes of pediatric retroperitoneal KT with and without L/NK mobilization.Methods We retrospectively analyzed pediatric renal transplant recipients treated between January 2015 and May 2021.Donor and recipient demographics,intraoperative data,and recipient outcomes were included.Recipients were divided into two groups according to the surgical technique utilized:with L/NK mobilization(Group 1)and without L/NK mobilization(Group 2).Baseline variables were described using frequency distributions for categorical variables and means and standard errors for continuous variables.Tests of association with the likelihood of using L/NK mobilization were performed using standardχ2 tests,t tests,and the log-rank test.Results Forty-six pediatric recipients were evaluated and categorized into Group 1(n=26)and Group 2(n=20).Recipients in Group 1 were younger(6.7±0.8 years vs.15.3±0.7,P<0.001),shorter(109.5±3.7 vs.154.2±3.8 cm,P<0.001)and weighed less(21.4±2.0 vs.48.6±3.4 kg,P<0.001)than those in Group 2.Other baseline characteristics did not difer between Groups 1 and 2.One urologic complication was encountered in Group 2;no vascular or surgical complications were observed in either group.Additionally,no stents or drains were used in any of the patients.There were no cases of delayed graft function or graft primary nonfunction.The median follow-up of the study was 24.6 months post-transplant.Two patients developed death-censored graft failure(both in Group 2,P=0.22),and there was one death with a functioning graft(in Group 2,P=0.21).Conclusions Retroperitoneal liver/kidney mobilization is a feasible and safe technique that facilitates implantation of adult kidney allografts into pediatric transplant recipients with no increased risk of developing post-operative complications,graft loss,or mortality.