Current Limitations and Perspectives in Single Port Surgery: Pros and Cons Laparo-Endoscopic Single-Site Surgery (LESS) for Renal Surgery

Laparo-Endoscopic Single-Site surgery (LESS) for kidney diseases is quickly evolving and has a tendency to expand the urological armory of surgical techniques. However, we should not be overwhelmed by the surgical skills only and weight it against the basic clinical and oncological principles when compared to standard laparoscopy. The initial goal is to define the ideal candidates and ideal centers for LESS in the future. Modification of basic instruments in laparoscopy presumably cannot result in better functional and oncological outcomes, especially when the optimal working space is limited with the same arm movements. Single port surgery is considered minimally invasive laparoscopy; on the other hand, when using additional ports, it is no more single port, but hybrid traditional laparoscopy. Whether LESS is a superior or equally technique compared to traditional laparoscopy has to be proven by future prospective randomized trials

Allogeneic Hematopoietic Stem Cell Transplantation in a Rare Case of Tonsillar Mast Cell Sarcoma

Mast cell sarcoma comprises a rare aggressive mast cell neoplasia with histological, clinical, and genetic features distinct from other mast cell neoplasm. Until now, prognosis is still poor due to high rates of progression to mast cell leukemia and failure of conventional chemotherapies. Our here presented first report about successful allogeneic hematopoietic stem cell transplantation leading to remission in a case of tonsillar MCS represents a promising potential curative treatment option for this rare and often fatal disease. Key-Points: - Mast cell sarcoma (MCS) is a rare, aggressive mast cell neoplasia with a very poor prognosis and a median survival of <18 months. - Allo-HSCT represents a promising potential curative treatment option for this rare and often fatal disease

Neo-glans reconstruction for penile cancer: Description of the primary technique using autologous testicular tunica vaginalis graft

Partial penectomy (glansectomy with/or without distal corporectomy) is an acceptable alternative for smaller distal pT3 penile carcinoma lesions in highly motivated and compliant patients. The authors describe a novel technique of neo-glans reconstruction using a tunica vaginalis (TV) testis allograft. However, due to an unclear resection margin on final histology, the patient underwent re-do surgery with a neo-glans revision using the well-established mesh split-thickness skin graft (STSG) technique. The penile length was preserved and the penile and bulbar part of the urethra was additionally mobilised in order to obtain a natural and aesthetic result for the meatus. Neo-glans reconstruction with TV coverage may be another promising alternative, which certainly requires further evaluation. We believe that the donor-site associated morbidity is minimal when compared to other harvesting sites. However, this is just an assumption, because direct comparison data on grafting techniques and neo-glans reconstruction are not available. Nevertheless, we think that for re-do procedures a standardised approach using a STSG technique should be the treatment method of choice

A practical guide and decision-making protocol for the management of complex renal cystic masses

Objectives: To analyse the management, pathology and outcomes of complex renal cystic masses (CRCM) and to develop a decision-making tool for daily clinical care using the Bosniak classification system for CRCM. Patients and methods: A comprehensive dataset of 185 patients with 188 CRCM and a minimum follow-up of 3 years were analysed for management, pathology and outcomes. Results: We analysed 35 Bosniak II, 34 Bosniak IIF, 58 Bosniak III, and 61 Bosniak IV lesions. The overall incidence of renal cell carcinoma was 8.6%, 29.4%, 62.1%, and 78.7% for each category. Based on our surveillance strategy of Bosniak IIF masses, we recommend computed tomography (CT)/magnetic resonance imaging (MRI) every 2 years after the initial examination. We also recommend performing one MRI (as an adjunct to CT) during the early follow-up period (<4 years). The use of MRI correlation for differential diagnostic purposes has proven useful for marginal Bosniak II, IIF and III cases. Conclusions: From our data, we have created a decision-making protocol to guide urologists in planning a safe and effective diagnostic and treatment strategy for CRCM. The Bosniak classification is a useful tool for clinical decision-making. Uncertainties still remain for Bosniak IIF and III lesions. Our protocol shows that individualised decision-making is necessary in a significant proportion of CRCM