Recent Advances and New Perspectives in Surgery of Renal Cell Carcinoma

Renal cell carcinoma (RCC) is one of the most common types of cancer in the urogenital system. For localized renal cell carcinoma, nephron-sparing surgery (NSS) is becoming the optimal choice because of its advantage in preserving renal function. Traditionally, partial nephrectomy is performed with renal pedicle clamping to decrease blood loss. Furthermore, both renal pedicle clamping and the subsequent warm renal ischemia time affect renal function and increase the risk of postoperative renal failure. More recently, there has also been increasing interest in creating surgical methods to meet the requirements of nephron preservation and shorten the renal warm ischemia time including assisted or unassisted zero-ischemia surgery. As artificial intelligence increasingly integrates with surgery, the three-dimensional visualization technology of renal vasculature is applied in the NSS to guide surgeons. In addition, the renal carcinoma complexity scoring system is also constantly updated to guide clinicians in the selection of appropriate treatments for patients individually. In this article, we provide an overview of recent advances and new perspectives in NSS

A population based study on Kidney Cancer in Norway (2008 - 2013). Aspects of biopsy use, surgical treatment and outcome

Aims: The aim of this study was to explore whole nation data, reveal trends and obtain updated numbers on kidney cancer (KC) treatment in the six-year period from 2008- 2013. The field of KC management has undergone substantial changes over the last few decades regarding surgical approaches, the use of pretreatment biopsies, surveillance and management of metastatic disease. We wanted to evaluate patient outcomes, and to see if new guidelines were implemented. Material and methods: Data on 4,449 patients diagnosed with KC (ICD10 code 64) was extracted from the Cancer Registry of Norway for all three articles. In Paper I, an analysis is performed on patients with data on biopsies (n=4,051). For Paper II, the data subset constitutes all patients with a surgically treated localized kidney cancer ≤7cm (n=2,420). Paper III includes all surgically treated Norwegian patients (n=3,273), both with localized and advanced disease, operated on in hospitals performing more than 4 KC surgeries/year. Results: Paper I: A renal mass biopsy (RMB) was performed in 20.2% of all patients. From the first to the second half of the study period, the use of RMB increased from 9.1 to 11.5 % for localized disease, and was doubled among patients for observation. Predictors of RMB were older patients, tumor < 4 cm, multiple tumors and second primary cancer. Fewer patients with metastatic disease were without histopathology verification in the second period. Those without RMB had poorer survival. The majority of biopsies were performed in patients who had a cytoreductive nephrectomy (CN), and CN was performed in 35% of all patients. Paper II: There was a 28% increase in surgically treated patients, with tumors ≤ 7 cm and the rates of partial nephrectomy (PN) increased, while the rate of radical nephrectomy (RN) decreased. PN was performed for 58% of tumors ≤ 4cm and for 14% of tumors 4.1-7cm. There was also an increase for minimally invasive (MIM) approaches. The regional differences in the distribution of PN and RN were less pronounced at the end of the study period. Furthermore, our results indicate a possible survival benefit for a patient undergoing PN vs. RN. Paper III: RN was performed in 69% of the patients and PN in 31%. Overall, the 30- day mortality (TDM) was 0.89%, whereas the rate for localized and metastatic disease was 0.73% and 2.6%, respectively. TDM was higher in older patients and lower for PN and MIM procedures. The odds ratio for TDM in a low-volumecompared to a high-volume hospital was 3.35 and 4.98 for patients with localized and metastatic disease, respectively Conclusion: These studies demonstrate that trends in KC diagnostics and treatment are in line with international recommendations, and that Norwegian urologists seem to adapt to changes in guidelines. Lastly, patient outcomes in regard to TDM are in line with previous reports

25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p &lt; 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p &lt; 0.001). Males were significantly more likely to be admitted than females (p &lt; 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Basic Principles and Practice in Surgery

This publication aims to support young doctors and surgery residents during their training period. A surgical residency is a crucial period for a young doctor. A great volume of theoretical information along with difficult and demanding practical skills need to be acquired in a relatively short period of time. This book is a tool for rapid, correct acquisition of elementary surgical notions and techniques, which are the basis for the training of today's surgery resident

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

AUGMENTED REALITY AND INTRAOPERATIVE C-ARM CONE-BEAM COMPUTED TOMOGRAPHY FOR IMAGE-GUIDED ROBOTIC SURGERY

Minimally-invasive robotic-assisted surgery is a rapidly-growing alternative to traditionally open and laparoscopic procedures; nevertheless, challenges remain. Standard of care derives surgical strategies from preoperative volumetric data (i.e., computed tomography (CT) and magnetic resonance (MR) images) that benefit from the ability of multiple modalities to delineate different anatomical boundaries. However, preoperative images may not reflect a possibly highly deformed perioperative setup or intraoperative deformation. Additionally, in current clinical practice, the correspondence of preoperative plans to the surgical scene is conducted as a mental exercise; thus, the accuracy of this practice is highly dependent on the surgeon’s experience and therefore subject to inconsistencies. In order to address these fundamental limitations in minimally-invasive robotic surgery, this dissertation combines a high-end robotic C-arm imaging system and a modern robotic surgical platform as an integrated intraoperative image-guided system. We performed deformable registration of preoperative plans to a perioperative cone-beam computed tomography (CBCT), acquired after the patient is positioned for intervention. From the registered surgical plans, we overlaid critical information onto the primary intraoperative visual source, the robotic endoscope, by using augmented reality. Guidance afforded by this system not only uses augmented reality to fuse virtual medical information, but also provides tool localization and other dynamic intraoperative updated behavior in order to present enhanced depth feedback and information to the surgeon. These techniques in guided robotic surgery required a streamlined approach to creating intuitive and effective human-machine interferences, especially in visualization. Our software design principles create an inherently information-driven modular architecture incorporating robotics and intraoperative imaging through augmented reality. The system's performance is evaluated using phantoms and preclinical in-vivo experiments for multiple applications, including transoral robotic surgery, robot-assisted thoracic interventions, and cocheostomy for cochlear implantation. The resulting functionality, proposed architecture, and implemented methodologies can be further generalized to other C-arm-based image guidance for additional extensions in robotic surgery