Augmented Reality to Guide Selective Clamping and Tumor Dissection During Robot-assisted Partial Nephrectomy: A Preliminary Experience.

ABSTRACT Introduction to explore the feasibility of augmented reality (AR) to guide arterial clamping during robot-assisted partial nephrectomy (RAPN). Patients and Methods 15 consecutive patients with T1 renal mass underwent RAPN guided by AR. The 3D virtual model derived by computed tomography was superimposed on the actual view provided by the Da Vinci video stream thought AR technology. Preoperative plan of arterial clamping based on 2D conventional imaging, on 3D model and the effective intraoperative surgical approach guided by AR were compared using the McNeamar test. Results The plan of arterial clamping based on 2D preoperative imaging was recorded as follows: no clamping in 3 (20%), clamping of the main artery in 10 (66.7%) and selective clamping in 1 (6.7%) and super-selective clamping in 1 (6.7%) cases. After revision of the 3D model, the plan of clamping was modified as follows: no clamping in 1 (6.7%), clamping of the main artery in 2 (13.3%), selective clamping in 8 (53.3%) and super-selective clamping in 4 (26.7%) cases (p=0.03). The effective intraoperative clamping approach guided by AR-guidance was performed as planned in 13 (86.7%) patients. Conclusion AR for 3D guided renal surgery is useful to increase the adoption of selective clamping during RAPN

The role of MRI-guided biopsy for diagnosis of prostate cancer; comparison between FUSION and "IN-BORE" approaches

The aim of the present study is to evaluate the difference in terms of feasibility and detection rate of two magnetic resonance imaging (MRI) guided biopsy approaches (MRI fusion versus "in-bore" MRI) in a single tertiary centre

Secondary bladder amyloidosis due to Crohn's disease: a case report and literature review

The presence of amyloid deposits in bladder walls is a rare histological finding. It can be linked to primary (limited to bladder) or secondary (systemic, associated with chronic inflammatory disorders) amyloidosis. Secondary bladder involvement is very uncommon; it usually presents with gross hematuria, which is challenging to manage, due to frail bladder mucosa and/or necrosis. We present a case of 54-year old man with secondary bladder amyloidosis due to Crohn's disease, that caused gross hematuria and severe anemia, which was managed conservatively by endoscopic transurethral resection, diatermocoagulation, clot evacuation and urinary drainage by bilateral percutaneous nephrostomy, with spontaneous resolution. Secondary bladder amyloidosis is a rare condition that presents with severe hematuria, difficult to control with standard management. Owing to chronic nature of the disease, treatment should be aimed to a conservative approach whenever possible. In case of failure, invasive procedures should be considered as salvage therapies

Postoperative outcomes of Fast Track enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and Trifecta proposal

BACKGROUND: We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC.METHODS: We considered 191 patients submitted to RC between January 2017 and January 2019. Patients followed FT or standard management according to surgeon's preference. Preoperative and intraoperative characteristics, alongside with postoperative outcomes were compared between the two groups. Trifecta was defined as follows: inhospital stay (HS) 64 10 days, time to defecation (TtD) below the overall mean and no major ( 65 Clavien-Dindo grade III) complications. Finally, Trifecta achievement rates were assessed in both groups.RESULTS: 75 patients (39%) followed the FT protocol and 116 (61%) standard management. The two groups were homogeneous for preoperative, intraoperative and pathological characteristics. Patients in the FT group had shorter TtD (5 vs. 6 days p=0.006), HS (12 vs. 14 days p=0.008) and lower readmission rate (8% vs. 19% p=0.04). Early complication rates and grades were similar, while less late complications were found in FT group (6.7% vs. 21.6% p=0,006). Trifecta achievement rate was higher for FT group (31% vs. 8% p<0.001). Single-item failure percentages for HS, TtD and major grade complications were respectively 90%, 60% and 19%, with no difference between the two groups.CONCLUSIONS: FT protocol can safely consent faster bowel recovery and earlier discharge after RC, plus reducing readmission rates. Using a Trifecta incorporating essential perioperative outcomes, could improve standardized quality assessment for RC

Air leak and intraoperative bleeding in thoracic surgery: a Delphi consensus among the members of Italian society of thoracic surgery

BACKGROUND: Persistent air leak and the management of intraoperative blood loss are common threats in thoracic surgical practice. The availability of new procedures, technology and materials is constantly evolving topical hemostats and surgical sealants must be added to this toolkit. Topical hemostats and surgical sealants differ according to their chemical nature and physical characteristics, to their origin and mechanism of action, regulatory/registration and vigilance paths. A Delphi consensus was set to highlight the different points of view on the use of topical haemostatic products and sealants among the members of Italian Society of thoracic surgery. METHODS: The board was formed by a group of five Italian experts; in the first phase after a careful review of the scientific literature and two rounds, the board finally generated 16 consensus statements for testing across a wider audience. During the second phase, the statements were collated into a questionnaire, which was electronically sent to a panel of 46 Italian surgeons, experts in the field. RESULTS: Out of 46 Italian surgeons, 33 (72%) panel members responded to the Delphi questionnaire. All the items reached a positive consensus, with elevated levels of agreement, as demonstrated by the presence of a 100% consensus for nine items. For the remaining 7 statements the minimum level of consent was 88% (29 participants approved the statement and 4 disagreed) and the maximum was 97% (32 participants approved the statement and 1 was in disagreement). CONCLUSIONS: The present Delphi analysis shows that air leak and intraoperative bleeding are clinical problems well known among thoracic surgeons. Nevertheless, the aim of the scientific societies and of the group of experts is to execute the education activities in the surgery community. This Delphi survey suggest the need of wider and updated scientific information about technical and registration characteristics of most recent technologic solutions, such as the of topical hemostats and surgical sealants to provide healthcare and administrative staff with the opportunity to work and interact through a common and shared language and eventually to guarantee minimal requirements of assistance