Suprapubic transvesical single-port technique for control of lower end of ureter during laparoscopic nephroureterectomy for upper tract transitional cell carcinoma

Context : Various minimally invasive techniques - laparoscopic, endoscopic or combinations of both - have been described to handle the lower ureter during laparoscopic nephroureterectomy but none has received wide acceptance. Aims : We describe an endoscopic technique for the management of lower end of ureter during laparoscopic nephroureterectomy using a single suprapubic laparoscopic port. : Transurethral resectoscope is used to make a full thickness incision in the bladder cuff around the ureteric orifice from 1 o′clock to 11 o′clock. A grasper inserted through the transvesical suprapubic port is used to retract the ureter to complete the incision in the bladder cuff overlying the anterior aspect of the ureteric orifice. The lower end of ureter is subsequently sealed with a clip applied through the port. This is followed by a laparoscopic nephrectomy and the specimen is removed by extending the suprapubic port incision. Our technique enables dissection and control of lower end of ureter under direct vision. Moreover, surgical occlusion of the lower end of the ureter prior to dissection of the kidney may decrease cell spillage. The clip also serves as a marker for complete removal of the specimen. Results : Three patients have undergone this procedure with an average follow up of 19 months. Operative time for the management of lower ureter has been 35, 55 and 40 minutes respectively. A single recurrence was detected on the opposite bladder wall after 9 months via a surveillance cystoscopy. There has been no residual disease or any other locoregional recurrence. Conclusions : The described technique for management of lower end of ureter during laparoscopic nephroureterectomy adheres to strict oncologic principles while providing the benefit of a minimally invasive approach

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Not AvailableBacteriophages play an important role in bacterial control in natural niche however a little is known about Bacillus sp. phages prevailing in cadaver affected soils. In the current study, the Bacillus sp. phage was isolated from the equine cadaver disposal site and characterised to gain an insight into the issue of role of phages in biological dynamics of manure thus formed over years. Firstly, the host bacterium was isolated and identified as Bacillus cereus group member as assessed by phylogenetic analysis and secondly it’s corresponding phage from same soil sample was also enriched and characterised. The phage (VTCCBPA38) was found to belong to family Myoviridae and was active within the temperature range of 4 °C - 45 °C. As assessed by biological sensitivity by spot test, the phage was active against 6/19 (31.6 %) Bacilli tested including Bacillus cereus from goat mastitis. Thus the phage may find potential use in biocontrol of diseases caused by Bacillus sp. Furthermore, this report is valuable as the first study for investigation of Bacillus sp. phage in carcass burial sites.Not Availabl

Optical trapping of thermo-responsive microgel particles by Holographic optical tweezers

Holographic Optical Tweezers (HOT) is a technique in which the phase of trapping laser is modulated for generating steerable, multiple optical traps in a sample chamber. An indigenously developed HOT set-up at Raja Ramanna Centre for Advanced Technology, Indore has been used to trap thermo-responsive poly(N-isopropylacrylamide-co-acrylic acid) (pNIPAM-co-AAc) spherical particles of 1.6 μm diameter suspended in aqueous medium. The videos of the trapped particles were digitally processed to track the particle positions as a function of time. From these measurements lateral trap stiffness for pNIPAM-co-AAc particles was determined as a function of trap power and temperature using Equipartition and Boltzmann Statistics methods. Both the methods gave similar results and the value for the trap stiffness at 25°C with trapping laser power of 33 mW was estimated to be 0.14±0.01μN/m. Since the optical trap stiffness depends on particle size and refractive index which vary as a function of temperature the variation of the measured optical trap stiffness as a function of temperature could be used to determine the volume phase transition of the thermo?responsive microgel particles. The results should also be useful in investigating the interaction between pNIPAM-co-AAc particles trapped in different lattice configurations that can be generated using HOT

Learning Curves and Timing of Surgical Trials: Robotic Kidney Transplantation with Regional Hypothermia.

PURPOSE: Outcomes of surgical procedures can be affected by multiple factors including surgical skill and learning curve (LC). These factors need to be considered for optimal timing of surgical trials. We used the LC cumulative summation (CUSUM) method to describe the number of cases associated with competency of a single surgeon learning the technique of robotic kidney transplantation (RKT). METHODS: Thirty-three patients underwent Vattikuti Urology Institute technique of RKT at a center that recently adopted this procedure (study group). Anastomoses times and short-term functional outcomes were compared with an established RKT program (reference group). LCs were evaluated using CUSUM analysis using target values from the reference group. RESULTS: Mean ± standard deviation for console time, rewarming time (RWT), arterial anastomosis, venous anastomosis, and ureterovesical anastomosis times for the study group was 187 ± 34.6 minutes, 58.03 ± 17.81 minutes, 19.36 ± 5.91 minutes, 21.97 ± 6.78 minutes, and 22.55 ± 4.24 minutes, respectively, significantly longer than reference group (p \u3c 0.001 for all). Mean ± standard deviation for serum creatinine at discharge and 1 month in the study group was 1.43 ± 0.57 mg/dL and 1.23 ± 0.35 mg/dL, respectively, similar to the reference group (p = 0.074 at discharge and p = 0.163 at 1 month). The LC was short, with competence achieved for RWT within 9, proficiency within 16, and mastery within 21 cases. Longer anastomosis times during the LC did not affect graft function. CONCLUSIONS: The LC of RKT is short, with improving skill up to 20-25 cases. The procedure is reproducible by surgeons experienced with open transplant and robotic surgery for other procedures, with comparable outcomes and low complication rates at a new center during adoption

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Not AvailableKlebsiella pneumoniae is an important emerging pathogen of humans and animals which may lead to major clinical implications including mortality. Moreover the increased use of antibiotics has promoted emergence of carbapenem resistant strains and extended spectrum β-lactamase producers (ESBLs) of K. pneumoniae. Recently, phage therapy has gained momentum as a conceivable alternative against emerging antibiotic resistance. OBJECTIVE: With the aim to explore the efficacy of phage therapy against virulent K. pneumoniae infection, the current study was undertaken to assess the therapeutic effects of a novel lytic phage-VTCCBPA43 in pneumonic mouse model. METHODS: The tailed phage - VTCCBPA43 was assessed for it's growth kinetics, in vitro host range analysis, temperature and pH sensitivity. The protein constituents were analysed by SDS-PAGE and Lc MS/MS and the therapeutic efficacy was observed 2 hr post challenge with virulent K. pneumoniae in BALB/c mouse model. RESULTS: The phage-VTCCBPA43 was found to exhibit high temperature (upto 80 °C) tolerant property. It was most active at pH 5, had a burst size of 172 PFU/ml and exhibited a narrow host range. It was identified as KP36 like phage by shotgun proteomics. Following intranasal application of a single dose of 2 × 109 PFU/mouse post challenge, presence of biologically active phage in vivo and a significant reduction of bacterial load in lungs at all time points was observed which was even more impressive at 96hpi, 6dpi and 10dpi. The loss of severity of lesions suggested overall beneficial effects of phage therapy using BPA43 in the pneumonic mouse model. CONCLUSION: The current research represents first in vivo evidences for effective phage therapy against K. pneumoniae infection by using intranasal route.Not Availabl

Retroperitoneal versus transperitoneal robot-assisted partial nephrectomy: Comparison in a multi-institutional setting.

OBJECTIVES: To evaluate retroperitoneal robot-assisted partial nephrectomy (RAPN) against transperitoneal approach in a multi-institutional prospective database, after accounting for potential selection bias that may affect this comparison. PATIENTS AND METHODS: Post-hoc analysis of the prospective arm of the Vattikuti Collective Quality Initiative database from 2014-2018. Six hundred and ninety consecutive patients underwent RAPN by 22 surgeons at 14 centers in nine countries. Patients who had surgery at centers not performing retroperitoneal approach (n=197) were excluded. Inverse probability of treatment weighting was done to account for potential selection bias by adjusting for age, gender, body mass index, comorbidities, side of surgery, location/size/complexity of tumor, renal function, American Society of Anesthesiologists score, and year of surgery. Operative and perioperative outcomes were compared between weighted transperitoneal and retroperitoneal cohorts. RESULTS: 99 patients underwent retroperitoneal RAPN; 394 underwent transperitoneal RAPN. Hospital stay in days-median 3.0 (Interquartile range [IQR] 2.0-4.0) transperitoneal vs. 1.0 (1.0-3.0) retroperitoneal; p CONCLUSIONS: In a multi-institutional setting, both retroperitoneal and transperitoneal approach to RAPN have comparable operative and perioperative outcomes, except for shorter hospital stay with the retroperitoneal approach

Retroperitoneal vs Transperitoneal Robot-assisted Partial Nephrectomy: Comparison in a Multi-institutional Setting.

OBJECTIVES: To evaluate retroperitoneal robot-assisted partial nephrectomy (RAPN) against transperitoneal approach in a multi-institutional prospective database, after accounting for potential selection bias that may affect this comparison. PATIENTS AND METHODS: Post-hoc analysis of the prospective arm of the Vattikuti Collective Quality Initiative database from 2014 to 2018. Six hundred and ninety consecutive patients underwent RAPN by 22 surgeons at 14 centers in 9 countries. Patients who had surgery at centers not performing retroperitoneal approach (n = 197) were excluded. Inverse probability of treatment weighting was done to account for potential selection bias by adjusting for age, gender, body mass index, comorbidities, side of surgery, location/size/complexity of tumor, renal function, American Society of Anesthesiologists score, and year of surgery. Operative and perioperative outcomes were compared between weighted transperitoneal and retroperitoneal cohorts. RESULTS: Ninety-nine patients underwent retroperitoneal RAPN; 394 underwent transperitoneal RAPN. Hospital stay in days-median 3.0 (Interquartile range [IQR] 2.0-4.0) transperitoneal vs 1.0 (1.0-3.0) retroperitoneal; P \u3c .001, and blood loss in mL-125 (50-250) transperitoneal vs 100 (50-150) retroperitoneal; P = .007-were lower in the retroperitoneal group. There were no differences in operative time (P = .6), warm ischemia time (P = .6), intraoperative complications (P = .99), conversion to radical nephrectomy (P = .6), postoperative major complications (P = .6), positive surgical margins (P = .95), or drop in estimated glomerular filtration rate (P = .7). CONCLUSION: In a multi-institutional setting, both retroperitoneal and transperitoneal approach to RAPN have comparable operative and perioperative outcomes, except for shorter hospital stay with the retroperitoneal approach

Conversion of Robot Assisted Partial Nephrectomy to Radical Nephrectomy; a Prospective Multi-Institutional Study

OBJECTIVE: To assess the incidence and factors affecting conversion from robot-assisted partial nephrectomy (RAPN) to radical nephrectomy. METHODS: Between November 2014 and February 2017, 501 patients underwent attempted RAPN by 22 surgeons at 14 centers in 9 countries within the Vattikuti Collaborative Quality Initiative database. Patients were permanently logged for RAPN prior to surgery and were analyzed on an intention-to-treat basis. Multivariable logistic regression with backward stepwise selection of variables was done to assess the factors associated with conversion to radical nephrectomy. RESULTS: Overall conversion rate was 25 of 501 (5%). Patients converted to radical nephrectomy were older (median age [interquartile range] 66.0 [61.0-74.0] vs 59.0 [50.0-68.0], P = .012), had higher body mass index (BMI) (median 32.8 [24.9-40.9] vs 27.8 [24.6-31.5] kg/m CONCLUSION: RAPN was associated with a low rate of conversion. Independent predictors of conversion were BMI and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion