Extraperitoneal robot assisted laparoscopic prostatectomy with Versius system: single centre experience.

INTRODUCTION: Versius Surgical System (CMR Surgical, Cambridge, UK) is a novel tele-operated robotic surgical system designed to assist surgeons for minimally invasive surgery which is gaining momentum in the world of robotic surgery. We describe our single centre experience with Versius and report the advantages and challenges posed by this new robotic system in a series of 53 extraperitoneal robotic assisted laparoscopic prostatectomies (eRALP) for prostate cancer (PCa). MATERIALS AND METHODS: Data of 53 eRALP performed with Versius in our centre were collected and analysed, Descriptive statistics were used to report our results. RESULTS: In 16 months we performed 53 eRALP: 18 (34%) with PLND, 33 (62%) nerve sparing cases. Mean setup time was 15 min, mean console time was 100 min and mean operative time was 130 min. We observed a substantial reduction of console time and set-up time after only 5 procedures. In the first 4 procedures, the dissection of the neurovascular bundle was performed laparoscopically, to switch back to robotic assisted approach afterwards. No major system failures were observed. No major intra-operative and post-operative complications occurred. Mean follow-up time was 9 months (range 3-15 months); no patients experienced biochemical recurrence or metastatic progression over this period, 8 (15%) patients had adjuvant radiotherapy based on unfavourable pathology report (positive surgical margins or positive limphnodes). CONCLUSION: This represents to our knowledge the largest extraperitoneal RALP case series with Versius, and it aims to provide solid clinical proof of the safety, effectiveness and versatility of this innovative system. In our experience, this platform represents a good option for every urologic surgeon who wants to start a robotic programme and it appears particularly suitable for urologists with a large laparoscopic expertise.

Male infertility and urological tumors: Pathogenesis and therapeutical implications.

Most genitourinary tract cancers have a negative impact on male fertility. Although testicular cancers have the worst impact, other tumors such as prostate, bladder, and penis are diagnosed early and treated in relatively younger patients in which couple fertility can be an important concern. The purpose of this review is to highlight both the pathogenetic mechanisms of damage to male fertility in the context of the main urological cancers and the methods of preserving male fertility in an oncological setting, in light of the most recent scientific evidence. A systematic review of available literature was carried out on the main scientific search engines, such as PubMed, Clinicaltrials.Gov, and Google scholar. Three hundred twenty-five relevant articles on this subject were identified, 98 of which were selected being the most relevant to the purpose of this review. There is a strong evidence in literature that all of the genitourinary oncological therapies have a deep negative impact on male fertility: orchiectomy, partial orchiectomy, retroperitoneal lymphadenectomy (RPLND), radical cystectomy, prostatectomy, penectomy, as well as radiotherapy, chemotherapy, and hormonal androgen suppression. Preservation of fertility is possible and includes cryopreservation, hormonal manipulation with GnRH analogs before chemotherapy, androgen replacement. Germ cell auto transplantation is an intriguing strategy with future perspectives. Careful evaluation of male fertility must be a key point before treating genitourinary tumors, taking into account patients' age and couples' perspectives. Informed consent should provide adequate information to the patient about the current state of his fertility and about the balance between risks and benefits in oncological terms. Standard approaches to genitourinary tumors should include a multidisciplinary team with urologists, oncologists, radiotherapists, psycho-sexologists, andrologists, gynecologists, and reproductive endocrinologists.

[The importance of DNA-cytometry for the prediction of nasopharyngeal malignancy].

The method of DNA-cytometry was applied to examine patients presenting with nasopharyngeal malignancy. The results obtained in laboratory studies were compared with clinical observations and data of medical histories. It was shown that diploid and aneuploid nasopharyngeal tumours are represented in an equal proportion. The number of the latter tumours increased with the progress of the neoplastic process. The diploid and aneuploid tumours were characterized by the equally frequent occurrence of metastasis. The survivorship rate of patients presenting with diploid tumours during the first year after the onset of the disease was significantly higher than in the patients having aneuploid nasopharyngeal cancer. The results of the study indicate that DNA-ploidy can not be used as a predictor of the development of the neoplastic process in patients with nasopharyngeal cancer, nor does it have a predictive value for the evaluation of the efficacy of chemo/radiotherapy. Nevertheless, the data obtained may be useful for the selection of patients for the more intensive adjuvant therapy.

[Restoration of speech function in oncological patients with maxillary defects].

Speech quality was evaluated in 188 patients with acquired maxillary defects. Prosthetic treatment of 29 patients was preceded by pharmacopsychotherapy. Sixty three patients had lessons with a logopedist and 66 practiced self-tuition based on the specially developed test. Thirty patients were examined for the quality of speech without preliminary preparation. Speech quality was assessed by auditory and spectral analysis. The main forms of impaired speech quality in the patients with maxillary defects were marked rhinophonia and impaired articulation. The proposed analytical tests were based on a combination of "difficult" vowels and consonants. The use of a removable prostheses with an obturator failed to correct the affected speech function but created prerequisites for the formation of the correct speech stereotype. Results of the study suggest the relationship between the quality of speech in subjects with maxillary defects and their intellectual faculties as well as the desire to overcome this drawback. The proposed tests are designed to activate the neuromuscular apparatus responsible for the generation of the speech. Lessons with a speech therapist give a powerful emotional incentive to the patients and promote their efforts toward restoration of speaking ability. Pharmacopsychotherapy and self-control are another efficacious tools for the improvement of speech quality in patients with maxillary defects.

[DNA flow cytometry in the prognostication of certain malignant neoformations]. / Protochnaia DNK-tsitometriia v prognozirovanii techeniia nekotorykh zlokachestvennykh novoobrazovanii.

The study has been concerned with DNA ploidy and its significance for prognosis of different neoplasms. The investigation included 314 patients: primary cancer of the lung (96), head and neck (146) and large bowel (72). Patients received surgery alone or surgery plus either radiotherapy or chemotherapy; they were followed up for 6-20 months. DNA levels were assayed in resected material using an ICP-22 flow cytometer. Diploid and aneuploid cancers were detected in 20.4-53.6 and 43.6-79.6%, respectively. The recurrence rates in cases of aneuploid cancers were more than 3 times those of diploidy (21.0-43.2 and 4.5-14.5%, respectively). Overall 5-year survival in diploid patients was twice that in aneuploid ones. Similarly, survival after surgery alone, preoperative chemotherapy and postoperative radiotherapy among diploid patients was longer than in aneuploid ones. Hence, DNA ploidy examination of tumors is of great informative value in prognosing tumor process and working out individually-tailored approach to treatment.

[Primary and delayed combined plastic repair of pharngoesophagostomies in patients with laryngopharyngeal cancer]. / Pervichnaia i otsrochennaia kombinirovannaia plastika faringoézofagostom u bol'nykh rakom gortanoglotki.

Primary and delayed combined plastic surgery using massive musculocutaneous pedicle flaps composed of musculus pectoralis major, musculus sternocleidomastoideus, musculus trapezius in combination with cellulocutaneous and skin flaps provides appropriate plastic repair of total and subtotal defects of the pharynx and cervical esophagus after combined interventions for oropharyngeal cancer stage III-IV. Composite flaps warrant good and satisfactory functional and cosmetic outcomes in the majority of patients without additional hospital stay.

[Morphological and biological features of squamous cell carcinoma of the larynx]. / Morfologicheskie i biologicheskie osobennosti ploskokletochnogo raka gortani.

The study of morphological and biological criteria of laryngeal squamous cell carcinoma in 81 patients proved essential in the disease prognosis. In grade I malignancy 90 +/- 6.7% of patients were 3 years free of recurrences and metastases, in grade 11 - 76 +/- 8.6%, in grade III - 50 +/- 15.8%. Aneuploid laryngeal tumors produced recurrences 6 times more frequently than diploid ones. 3-year recurrence--and metastases-free survival was reported in 88.7 +/- 6.3% of patients with diploid and 59.3 +/- 7.7%. 7% with aneuploid tumors (p < 0.05).

[The use of clindamycin and netilmicin for preventing postoperative wound infection in patients with cancer of the upper respiratory and digestive tracts]. / Primenenie klindamitsina i netilmitsina dlia profilaktiki posleoperatsionnoi ranevoi infektsii u bol'nykh rakom verkhnikh dykhatel'nykh i pishchevaritel'nykh putei.

Clindamycin (2.7 g/day) and netilmicin (5.6 mg/kg) were used for 6-10 days in 27 patients with laryngeal and oral cancer versus beta-lactam antibiotics and aminoglycosides received by 56 matched patients to prevent infection of the operative wound. Suppuration was observed in 11.1 and 41.4% of the patients, respectively (p < 0.05), the temperature rose over 38 degrees C in 22.2% and 42.9% of the patients, respectively (p < 0.05). The regimens showed similar toxicity. The findings proved high efficacy of clindamycin combination with netilmicin in infection prophylaxis in patients operated on for upper respiratory and digestive tract cancer.

[Postoperative prolonged analgesia without the use of narcotic analgesics]. / Posleoperatsionnoe prodlennoe obezbolivanie bez ispol'zovaniia narkoticheskikh anal'getikov.

Intravenous prolonged analgesia with analgin, diazepam and no-spa was used in the early postoperative period in 59 patients with acute surgical pathology of the abdominal cavity organs. The technique used ensured a marked analgetic effect. The combination of analgin, diazepam and no-spa, as compared to promedol, promoted to an earlier recovery of the respiration function, which was an effective measure preventing the onset of pulmonary complications.

[Postoperative analgesia using moradol in emergency surgery]. / Posleoperatsionnoe obezbolivanie moradolom v neotlozhnoi khirurgii.

Moradol was used for postoperative analgesia in 39 patients subject to urgent surgery. Promedol was used as a control. It has been found that a marked pain syndrome in the early postoperative period in patients examined was characterized by certain deviations of the parameters studied. Moradol, as compared to promedol, has a better analgesic effect, causing milder respiration and hemodynamic changes. With intravenous drug injection, a more profound analgesia is associated with a greater respiratory depression.

[Postoperative lymphotropic antibiotic therapy of urology patients with suppurative-septic complications]. / Posleoperatsionnaia limfotropnaia antibiotikoterapiia u urologicheskikh bol'nykh s gnoino-septicheskimi oslozhneniiami.

Antibiotic treatment plays an important role in the prevention of pyoseptic complications of urologic surgery. However, conventional treatment results in irregular distribution of the antibiotic agent through the liquid media of the body, the emergence of resistant bacterial strains and lymphostasis, while higher doses increase toxic effect on the kidneys, aggravating the clinical condition. Treatment efficiency has been shown to be dependent on the effective dose of the drug in the inflammation focus, which is achieved through its endolymphatic administration. These techniques, however, are complicated and time-consuming. These shortcomings are avoided when lymphotropic antibiotic treatment (LAT), based on the combination of mechanical action on venous outflow and regional stimulation of lymphogenic absorption, using lymphostimulating effects of hemodilution and heparin, is administered. Some hemostatic parameters were examined in 49 patients (aged 50.4 +/- 7.4 years) following urologic operations. LAT was used in 28 of those. It is shown to provide a better antibiotic saturation of the lymphatic system, as compared to conventional treatment. LAT prevents postoperative pyoseptic complications, reduces 4 to 6-fold the consumption of antibacterial drugs and alleviates their urinary side-effects. Owing to its simplicity and effectiveness, the method can be recommended for wide-scale clinical application.

[Preanesthetic preparation and induction anesthesia in acute cholecystitis in middle-aged and elderly patients]. / Prednarkoznaia podgotovka i vvodnyi narkoz pri ostrom kholetsistite u bol'nykh pozhilogo i starcheskogo vozrasta.

Under examination there were 59 elderly and senile patients with acute cholecystitis subjected to emergency operations. It was found that among 3 kinds of initial narcosis smooth course was notable in the phentanyl-sombrevin initial narcosis. The administration of thalamonal-sombrevin initial narcosis results in a certain inhibition of blood circulation, and gives adequate anesthesia during endotracheal intubation. The initial sombrevin narcosis is followed by inhibition of blood circulation and fails to give sufficiently deep anesthesia during intubation of the trachea.

[Selection of the method of postoperative analgesia in emergency proctology]. / Vybor metoda posleoperatsionnogo obezbolivaniia v neotlozhnoi proktologii.

Different kinds of postoperative analgesia were used in 106 patients after urgent proctological operations. A comparative analysis of the objective and subjective data obtained have shown that epidural anesthesia is the most effective method of postoperative analgesia in urgent proctology.

[Hemodynamic function of patients with diffuse suppurative peritonitis]. / Sostoianie gemodinamiki u bol'nykh s razlitym gnoinym peritonitom.

A complex examination of central hemodynamics and contracting function of the heart was performed in 85 patients in the preoperative period. It was established that the toxic phase of peritonitis is characterized by the disturbed central hemodynamics and worse contracting function of the myocardium which are found to aggravate the process in the terminal phase and to require intensive prophylactic and curative measures. The authors consider that the shock index and coefficient of the functional state of central hemodynamics can be used in urgent cases for the assessment of the functional state of blood circulation.

[Basic principles of resuscitation and intensive therapy in patients with acute gastrointestinal hemorrhage]. / Osnovnye printsipy reanimatsii i intensivnoi terapii u bol'nykh s ostrym zheludochno-kishechnym krovotecheniem.

The authors analyze results of the treatment of 537 patients with acute gastro intestinal hemorrhages. All the patients were subjected to intensive therapy for the maintenance and recovery of vital functions of the organism. When the intensive therapy failed to give the necessary results the question was solved in favour of surgical interventions.