Extraperitoneal robot-assisted radical prostatectomy by the da Vinci and Versius System: first comparative analysis.

BACKGROUND: Robotic-assisted surgery (particularly with the da Vinci Surgical System) has revolutionized urological interventions. The advent of the Versius Surgical System introduces a compelling alternative. This study compares outcomes of extraperitoneal robot-assisted radical prostatectomy (eRARP) using da Vinci and Versius, presenting the largest case series to date. METHODS: A retrospective analysis of 106 consecutive patients undergoing eRARP (July 2021-July 2023) with da Vinci and Versius. Surgical techniques involved extraperitoneal approaches, with a single surgeon ensuring consistency. Baseline characteristics, perioperative outcomes, and pathology results were analyzed. RESULTS: Baseline characteristics were comparable between da Vinci and Versius groups. While no significant differences were observed in overall operative time, estimated blood loss, and length of hospital stay, variations were noted in pelvic lymphadenectomy rates and nerve-sparing procedures. Pathology results revealed no significant disparities in International Society of Urological Pathology (ISUP) grades and positive surgical margins. However, a notable difference emerged in pathological N stage, with Versius showing a higher percentage of positive lymph nodes. CONCLUSIONS: This study provides a comprehensive comparative analysis of da Vinci and Versius in eRARP, representing the largest case series to date. While overall outcomes were similar, nuances in lymphadenectomy rates and Pathological N stage merit attention. Ongoing research and longer-term follow-up will refine our understanding, guiding urological surgeons in optimal robotic system selection.

External validation of a nomogram for outcome prediction in management of medium-sized (1-2 cm) kidney stones.

BACKGROUND: Stone nomogram by Micali et al., able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations. METHODS: External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan). RESULTS: Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.59-0.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis. CONCLUSIONS: According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value.

Partial nephrectomy series using Versius robotic surgical system: technique and outcomes of an initial experience.

Partial nephrectomy (PN) represents a procedure where the use of a robot has further enabled successful completion of this complex surgery. The results of this procedure using Versius Robotic Surgical System (VRSS) still need to be evaluated. Our working group described the technique and reported the initial results of a series of PN using VRSS. We presented our setting, surgical technique and outcomes for PN, using VRSS. Between 2022 and 2023, 15 patients underwent PN performed by two surgeons in two different centers. Fifteen patients underwent PN. The median lesion size identified on preoperative imaging was 4 (IQR 2.3-5) cm. Median PADUA score was 8 (IQR 7-9). Two procedures were converted to radical nephrectomy for enhanced oncological disease control. Of the 13 nephrectomies that were completed as partial, 7 were performed clampless and 6 with warm ischemia clamping. Median clamping time was 10 (IQR 9-11) minutes. No procedure was converted to open. Median blood loss was 200 (IQR 100-250) mL. Median total operative time was 105 (IQR 100-110) minutes. Median console time was 75 (IQR 66-80) minutes. Median set-up time was 13 (IQR 12-14) minutes. No intraoperative complications were reported. The median hospitalization time was 4 (IQR 3.5-4) days. None of the patients were transfused and none of the patients required readmission. In a pathology report, one patient had a positive surgical margin. Our initial experience suggests that performing PN using VRSS is feasible with good short-term outcomes.