Adapting the robotic platform to small operating theaters: our experience with the side-docking technique for robotic-assisted laparoscopic prostatectomy.

INTRODUCTION: Conventionally, in robotic-assisted laparoscopic prostatectomy (RALP), the robot is entered between the abducted legs of the patient. This approach may present drawbacks, including the limited access to the perineum, the inevitable abduction of the patient's legs, and the limited space available in small operating theaters. To overcome these problems, in our center, we use, from over 5 years, a side-docking technique. We herein describe our technique and a series of patients who underwent RALP using such side-docking procedure. METHODS: In our department, we have applied the side-docking technique for over 5 years, mainly in RALP procedures. The series reported includes 268 men undergoing RALP ± extended lymph node dissection (ePLND) between mid-2010 and 2014. After trocart positioning, the robot is entered at a 45° angle compared to the patient's main axis, coming in from the right side. Patient's legs are minimally abducted to <10°. RESULTS: Mean docking time, from skin incision to full docking was 13 min. 41 % (109/268) of patients underwent simultaneous ePLND, dissecting nodes up till at least the iliac bifurcation. No conversion to open surgery was required. External collisions are infrequent with this configuration: No re-docking was necessary in this cohort. CONCLUSIONS: Side-docking of the da Vinci robot is a safe alternative for RALP. In our department, this technique has faced the proof of time and is routinely used.

Diffuse xanthogranulomatous pyelonephritis with complex spontaneous pyeloduodenal fistula: A case report.

Xanthogranulomatous pyelonephritis is a rare and severe form of chronic pyelonephritis. Spontaneous pyeloduodenal fistula is an extremely rare complication of xanthogranulomatous pyelonephritis. We present a rare case of xanthogranulomatous pyelonephritis complicated by a complex pyeloduodenal and ureteromuscular fistulae with a cutaneous opening. A 57-year-old male patient presented with chronic right flank pain and cutaneous discharge at the right lower quadrant. Xanthogranulomatous pyelonephritis was suspected on preoperative computed tomographic urography owing to the presence of fat deposits and complex pyeloduodenal and ureteromuscular fistulae. Open nephrectomy and fistula closure were performed and the patient recovered uneventfully. Xanthogranulomatous pyelonephritis was confirmed pathologically.

Synchronous Renal Cell Carcinoma and Hepatocellular Carcinoma.

The coexistence of multiple synchronous primary malignancies is uncommon. The coexistence of hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) is even rarer. We present a case of a 44-year-old male patient with a history of chronic hepatitis B and a right renal mass treated by radical nephrectomy. At the 2-month follow-up, a new lesion was detected in the left lobe of the liver. Postsurgery histologic evaluation with immunohistochemical study of both lesions confirmed the renal and hepatic lesions to be RCC and HCC, respectively.

Generalized lymphangiomatosis-A rare manifestation of lymphatic malformation.

Lymphangiomatosis is a rare benign proliferation and dilation of the lymphatic channels that can involve multiple organs with a variety of clinical presentations. We report a case of generalized lymphangiomatosis in a 16-year-old male who presented with a subcutaneous swelling and pain over his lower back area. The patient was diagnosed of generalized lymphangiomatosis with involvement of soft tissues, pulmonary, thoracic and lumbosacral vertebrae, and spinal canal which subsequently confirmed by cytology. In this case report, we aim to discuss radiological features of the relevant differentials, and the patient's symptoms. We also briefly discuss the treatment options as well as prognosis.

Extragastrointestinal stromal tumor presenting as an exophytic prostatic mass.

Extragastrointestinal stromal tumors (EGISTs) are uncommon manifestation of gastrointestinal stromal tumors originating from cells outside the gastrointestinal tract. Documented sites of EGISTs include the omentum, mesentery, retroperitoneum, and prostate gland. Prostatic EGISTs are rare entities, which have been sporadically observed, yet all of them were found to be confined within enlarged prostates. We herein report a rare case of EGIST in a 66-year-old man, presenting as a large exophytic prostatic mass.

Comparing conventional laparoscopic to robotic-assisted extended pelvic lymph node dissection in men with intermediate and high-risk prostate cancer: a matched-pair analysis.

BACKGROUND: In intermediate and high-risk prostate cancer patients, a robotic-assisted approach is increasingly being used for prostatectomy and extended pelvic lymph node dissection (ePLND). This is reducing the number of conventional laparoscopic radical prostatectomies (LR P) and laparoscopic ePLNDs for prostate cancer in Europe. Aim of this study is to compare laparoscopic ePLND to robotic-assisted ePLND in a cohort of patients with intermediate and high risk prostate cancer. METHODS: We performed a matched-pair analysis matching 1:1 70 patients who underwent LRP+ePLND (2004-2009) to 70 who underwent RAR P+ePLND (2010-2014). All patients presented with intermediate or high-risk prostate cancer according to D'Amico classification. Patients were retrospectively analyzed. Differences in pathologic characteristics and postoperative complications across the two groups were assessed using Wilcoxon Rank sum or χ2 Test. RESULTS: LRP was associated with shorter OR times and decreased blood loss (P<0.001). However, in the robotic-assisted arm, more lymph nodes were retrieved (18 vs. 12; P<001). No significant difference in positive surgical margins was found across the two techniques (P=0.9). Lymphocele formation and prolonged lymphorrea were specifically addressed as complications, with no significant difference emerging from our analyses (P>0.74). CONCLUSIONS: In this matched-pair analysis comparing patients with intermediate and high-risk prostate cancer, a robotic-assisted approach was associated to a higher lymph node yield compared to conventional laparoscopy. However, this increase in node yield was balanced with longer OR times, increased blood loss, similar postoperative complications and similar oncologic outcomes. Larger and prospective studies in patients at high risk are necessary to validate these findings.