Objective:Nowadays robot-assisted partial nephrectomy(RAPN)represents the standard of care for clinical T1(cT1)renal masses,providing similar oncological outcomes when compared to open or laparoscopic PN with advantag...Objective:Nowadays robot-assisted partial nephrectomy(RAPN)represents the standard of care for clinical T1(cT1)renal masses,providing similar oncological outcomes when compared to open or laparoscopic PN with advantages in terms of functional outcomes and lower perioperative comorbidity,when compared to radical nephrectomy.Methods:We performed an extensive literature review of studies regarding RAPN,its evolution,technical aspects and applications,and new technological tools using different combinations of Medical Subject Headings terms“RAPN”,“partial nephrectomy”,“robot-assisted”,“nephron-sparing surgery”,“renal cell carcinoma”,“complex renal masses”,“endophytic renal masses”,and“bilateral renal tumors”.Results:A consistent body of evidence was selected,including original articles,systematic reviews,meta-analyses,and clinical trials having RAPN as the central focus in adult patients,with all its technical nuances.We started our narrative review with a background on PN and its evolution toward the robotic era with a special spotlight on the extending indications for PN in large and highly complex renal masses.Our review continued with an overview of nephron-sparing surgery in bilateral and recurrent masses.RAPN for bilateral synchronous renal masses represents a challenging scenario with no formal recommendations provided by international guidelines and controversial management and decision-making.Additionally,we reported evidence on redo RAPN which seems to be safe and effective.A final overview of the available technological tools,and in particular on three-dimensional reconstruction was provided.Conclusion:RAPN has been established as the standard of care for cT1 renal masses with an expanding spectrum of applications in different scenarios,including large(cT2),highly complex,and bilateral renal masses,as well as the surgical treatment of local recurrences after nephron-sparing surgery with acknowledged advantages in terms of functional outcomes and perioperative risk profiles while maintaining similar oncological outcomes when compared to open or laparoscopic PN and radical treatment.展开更多
Background:The surgical management of patients with benign prostatic hyperplasia(BPH)has considerably evolved through recent years.Nonetheless,benefits and harms of several laser procedures are still to be determined....Background:The surgical management of patients with benign prostatic hyperplasia(BPH)has considerably evolved through recent years.Nonetheless,benefits and harms of several laser procedures are still to be determined.The study aimed to report perioperative and early functional results of patients treated with anatomical photo vaporization of the prostate(aPVP).Methods:Data from consecutive patients treated with aPVP by using a 180-W XPS GreenLight laser were prospectively collected in a single tertiary center between 2020 and 2023.The surgical procedure was divided into a modular step-by-step fashion.Patients were asked to complete self-administered questionnaires at baseline and during follow-up visits.Results:Overall,176 consecutive patients were enrolled.Median age was 65[interquartile range(IQR)63–72]years.The baseline median prostate volume was 61.2(IQR 52.5–71.0)mL,and the median max flow rate(Qmax)was 9.3(IQR 7.8–11.5)mL/s.Median preoperative International Prostate Symptom Score(IPSS)was 25(IQR 22–29).Overall,the median operative time was 42(IQR 31–47)minutes with a median energy/mL of tissue delivered of 2447 kJ/mL.At 3 month-evaluation,significant improvements were observed,with a median Qmax of 28(IQR:24–32)mL/s and a median IPSS reduction of 15(IQR:11–18)points.A strong inverse correlation was identified between energy delivery during initial procedural steps and the severity of postoperative storage symptoms(all p<0.05),underscoring the importance of precise energy modulation.Multivariate analysis identified increased prostate volume(odds ratio[OR]:1.02;95%confidence interval[CI]1.01–1.11;p=0.001)and higher prostate width-to-length ratio(OR:1.28;95%CI 1.04–1.78;p=0.03)as independent predictors of increased energy requirements.Conclusions:aPVP with 180-W XPS GreenLight laser is a safe and effective technique showing worthy early functional results.The limitation of the energy delivered in some key phases of the procedure may be associated with a significant reduction in postoperative irritative symptoms.The shape and dimensions of the prostate also play a critical role in determining the total energy required for complete adenoma removal.展开更多
文摘Objective:Nowadays robot-assisted partial nephrectomy(RAPN)represents the standard of care for clinical T1(cT1)renal masses,providing similar oncological outcomes when compared to open or laparoscopic PN with advantages in terms of functional outcomes and lower perioperative comorbidity,when compared to radical nephrectomy.Methods:We performed an extensive literature review of studies regarding RAPN,its evolution,technical aspects and applications,and new technological tools using different combinations of Medical Subject Headings terms“RAPN”,“partial nephrectomy”,“robot-assisted”,“nephron-sparing surgery”,“renal cell carcinoma”,“complex renal masses”,“endophytic renal masses”,and“bilateral renal tumors”.Results:A consistent body of evidence was selected,including original articles,systematic reviews,meta-analyses,and clinical trials having RAPN as the central focus in adult patients,with all its technical nuances.We started our narrative review with a background on PN and its evolution toward the robotic era with a special spotlight on the extending indications for PN in large and highly complex renal masses.Our review continued with an overview of nephron-sparing surgery in bilateral and recurrent masses.RAPN for bilateral synchronous renal masses represents a challenging scenario with no formal recommendations provided by international guidelines and controversial management and decision-making.Additionally,we reported evidence on redo RAPN which seems to be safe and effective.A final overview of the available technological tools,and in particular on three-dimensional reconstruction was provided.Conclusion:RAPN has been established as the standard of care for cT1 renal masses with an expanding spectrum of applications in different scenarios,including large(cT2),highly complex,and bilateral renal masses,as well as the surgical treatment of local recurrences after nephron-sparing surgery with acknowledged advantages in terms of functional outcomes and perioperative risk profiles while maintaining similar oncological outcomes when compared to open or laparoscopic PN and radical treatment.
文摘Background:The surgical management of patients with benign prostatic hyperplasia(BPH)has considerably evolved through recent years.Nonetheless,benefits and harms of several laser procedures are still to be determined.The study aimed to report perioperative and early functional results of patients treated with anatomical photo vaporization of the prostate(aPVP).Methods:Data from consecutive patients treated with aPVP by using a 180-W XPS GreenLight laser were prospectively collected in a single tertiary center between 2020 and 2023.The surgical procedure was divided into a modular step-by-step fashion.Patients were asked to complete self-administered questionnaires at baseline and during follow-up visits.Results:Overall,176 consecutive patients were enrolled.Median age was 65[interquartile range(IQR)63–72]years.The baseline median prostate volume was 61.2(IQR 52.5–71.0)mL,and the median max flow rate(Qmax)was 9.3(IQR 7.8–11.5)mL/s.Median preoperative International Prostate Symptom Score(IPSS)was 25(IQR 22–29).Overall,the median operative time was 42(IQR 31–47)minutes with a median energy/mL of tissue delivered of 2447 kJ/mL.At 3 month-evaluation,significant improvements were observed,with a median Qmax of 28(IQR:24–32)mL/s and a median IPSS reduction of 15(IQR:11–18)points.A strong inverse correlation was identified between energy delivery during initial procedural steps and the severity of postoperative storage symptoms(all p<0.05),underscoring the importance of precise energy modulation.Multivariate analysis identified increased prostate volume(odds ratio[OR]:1.02;95%confidence interval[CI]1.01–1.11;p=0.001)and higher prostate width-to-length ratio(OR:1.28;95%CI 1.04–1.78;p=0.03)as independent predictors of increased energy requirements.Conclusions:aPVP with 180-W XPS GreenLight laser is a safe and effective technique showing worthy early functional results.The limitation of the energy delivered in some key phases of the procedure may be associated with a significant reduction in postoperative irritative symptoms.The shape and dimensions of the prostate also play a critical role in determining the total energy required for complete adenoma removal.
