Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a cont...Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.展开更多
Artificial intelligence(AI)has made considerable progress within the last decade and is the subject of contemporary literature.This trend is driven by improved computational abilities and increasing amounts of complex...Artificial intelligence(AI)has made considerable progress within the last decade and is the subject of contemporary literature.This trend is driven by improved computational abilities and increasing amounts of complex data that allow for new approaches in analysis and interpretation.Renal cell carcinoma(RCC)has a rising incidence since most tumors are now detected at an earlier stage due to improved imaging.This creates considerable challenges as approximately 10%e17%of kidney tumors are designated as benign in histopathological evaluation;however,certain co-morbid populations(the obese and elderly)have an increased peri-interventional risk.AI offers an alternative solution by helping to optimize precision and guidance for diagnostic and therapeutic decisions.The narrative review introduced basic principles and provide a comprehensive overview of current AI techniques for RCC.Currently,AI applications can be found in any aspect of RCC management including diagnostics,perioperative care,pathology,and follow-up.Most commonly applied models include neural networks,random forest,support vector machines,and regression.However,for implementation in daily practice,health care providers need to develop a basic understanding and establish interdisciplinary collaborations in order to standardize datasets,define meaningful endpoints,and unify interpretation.展开更多
Objective:Kidney cancers account for approximately 2%of all newly diagnosed cancer in 2020.Among the primary treatment options for kidney cancer,urologist may choose between radical or partial nephrectomy,or ablative ...Objective:Kidney cancers account for approximately 2%of all newly diagnosed cancer in 2020.Among the primary treatment options for kidney cancer,urologist may choose between radical or partial nephrectomy,or ablative therapies.Nowadays,robotic-assisted partial nephrectomy(RAPN)for the management of renal cancers has gained popularity,up to being considered the gold standard.However,RAPN is a challenging procedure with a steep learning curve.Methods:In this narrative review,different imaging technologies used to guide and aid RAPN are discussed.Results:Three-dimensional visualization technology has been extensively discussed in RAPN,showing its value in enhancing robotic-surgery training,patient counseling,surgical planning,and intraoperative guidance.Intraoperative imaging technologies such as intracorporeal ultrasound,near-infrared fluorescent imaging,and intraoperative pathological examination can also be used to improve the outcomes following RAPN.Finally,artificial intelligence may play a role in the field of RAPN soon.Conclusion:RAPN is a complex surgery;however,many imaging technologies may play an important role in facilitating it.展开更多
Peyronie’s disease(PD)is a benign,progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea(TA)of the penis.This study provides new insights into the pathogenesis of PD based on data ...Peyronie’s disease(PD)is a benign,progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea(TA)of the penis.This study provides new insights into the pathogenesis of PD based on data from different studies regarding the roles of cytokines,cell signaling pathways,biochemical mechanisms,genetic factors responsible for fibrogenesis.A growing body of literature has shown that PD is a chronically impaired,localized,wound healing process within the TA and the Smith space.It is caused by the influence of different pathological stimuli,most often the effects of mechanical stress during sexual intercourse in genetically sensitive individuals with unusual anatomical TA features,imbalanced matrix metalloproteinase/tissue inhibitor of metalloproteinase(MMP/TIMP),and suppressed antioxidant systems during chronic inflammation.Other intracellular signal cascades are activated during fibrosis along with low expression levels of their negative regulators and transforming growth factor-β1 signaling.The development of multikinase agents with minimal side effects that can block several signal cell pathways would significantly improve fibrosis in PD tissues by acting on common downstream mediators.展开更多
文摘Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.
文摘Artificial intelligence(AI)has made considerable progress within the last decade and is the subject of contemporary literature.This trend is driven by improved computational abilities and increasing amounts of complex data that allow for new approaches in analysis and interpretation.Renal cell carcinoma(RCC)has a rising incidence since most tumors are now detected at an earlier stage due to improved imaging.This creates considerable challenges as approximately 10%e17%of kidney tumors are designated as benign in histopathological evaluation;however,certain co-morbid populations(the obese and elderly)have an increased peri-interventional risk.AI offers an alternative solution by helping to optimize precision and guidance for diagnostic and therapeutic decisions.The narrative review introduced basic principles and provide a comprehensive overview of current AI techniques for RCC.Currently,AI applications can be found in any aspect of RCC management including diagnostics,perioperative care,pathology,and follow-up.Most commonly applied models include neural networks,random forest,support vector machines,and regression.However,for implementation in daily practice,health care providers need to develop a basic understanding and establish interdisciplinary collaborations in order to standardize datasets,define meaningful endpoints,and unify interpretation.
文摘Objective:Kidney cancers account for approximately 2%of all newly diagnosed cancer in 2020.Among the primary treatment options for kidney cancer,urologist may choose between radical or partial nephrectomy,or ablative therapies.Nowadays,robotic-assisted partial nephrectomy(RAPN)for the management of renal cancers has gained popularity,up to being considered the gold standard.However,RAPN is a challenging procedure with a steep learning curve.Methods:In this narrative review,different imaging technologies used to guide and aid RAPN are discussed.Results:Three-dimensional visualization technology has been extensively discussed in RAPN,showing its value in enhancing robotic-surgery training,patient counseling,surgical planning,and intraoperative guidance.Intraoperative imaging technologies such as intracorporeal ultrasound,near-infrared fluorescent imaging,and intraoperative pathological examination can also be used to improve the outcomes following RAPN.Finally,artificial intelligence may play a role in the field of RAPN soon.Conclusion:RAPN is a complex surgery;however,many imaging technologies may play an important role in facilitating it.
文摘Peyronie’s disease(PD)is a benign,progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea(TA)of the penis.This study provides new insights into the pathogenesis of PD based on data from different studies regarding the roles of cytokines,cell signaling pathways,biochemical mechanisms,genetic factors responsible for fibrogenesis.A growing body of literature has shown that PD is a chronically impaired,localized,wound healing process within the TA and the Smith space.It is caused by the influence of different pathological stimuli,most often the effects of mechanical stress during sexual intercourse in genetically sensitive individuals with unusual anatomical TA features,imbalanced matrix metalloproteinase/tissue inhibitor of metalloproteinase(MMP/TIMP),and suppressed antioxidant systems during chronic inflammation.Other intracellular signal cascades are activated during fibrosis along with low expression levels of their negative regulators and transforming growth factor-β1 signaling.The development of multikinase agents with minimal side effects that can block several signal cell pathways would significantly improve fibrosis in PD tissues by acting on common downstream mediators.
