The Impact on Urology Residents' Learning of Social Media and Web Technologies after the Pandemic: A Step Forward through the Sharing of Knowledge.

The COVID-19 pandemic has impacted urology residents and their training. However, several new technologies or knowledge platforms as social media (SoMe) and web-based learning solutions have filled this gap. Therefore, we aimed to analyze resident's learning curves of new learning modalities, identify the evidence that is provided in the literature, and evaluate the possible impact of such solutions in the future. We conducted a non-systematic literature search using Medline, PubMed, and Embase. In addition, online resources of national and international urology resident societies were queried. The identified paper described SoMe, webinars, podcasts, pre-recorded surgical videos, educational platforms, and mobile apps in the field of urology that are used to gain access to information, teach and provide feedback to residents, and were used under the conditions of the pandemic. The application of those technologies harbors the risk of mis- and disinformation, but have the potential to provide access to education and validated knowledge, training, and feedback and thereby might democratize training of residents in urology globally.

Indocyanine green use in Urology.

PURPOSE: Indocyanine green (ICG) is being used more and more in Urology along with advances in minimal invasive surgery, guiding excision and reconstruction, highlighting anatomic structures and functional features with oncologic guidance still being debatable. The purpose of this paper was to explore ICG use in urologic procedures. METHODS: We present our experience (37 cases) of using ICG fluorescence guidance in urologic operations performed using 3D laparoscopy and FireFly® fluorescence imaging mode of Da Vinci X robot. The operations were the following: pelvic lymphadenectomy in radical prostatectomy, totally intracorporeal orthotopic ileal neobladder reconstruction, vesicovaginal fistula repair, partial nephrectomy and pyeloplasty. Barnard's test was used to compare postoperative complications (digestive fistula, ureteral stricture) for totally intracorporeal ileal neobladders performed with (group e, 27 cases) vs. without (group 2, 28 cases) ICG guidance. RESULTS: ICG under near-infrared fluorescence offered a precise identification of ischemic structures- vaginal wall, distal ureteral end, ileal loop, along with vascularized tissues allowing an optimal pyeloplasty and nephron sparing surgery with partial unclamping. It also allowed the identification of a lymph node during radical prostatectomy that otherwise would not have been excised during the routinely performed pelvic lymphadenectomy. There were no complications of ICG usage and the complication rate (digestive fistula, ureteral strictures) was significantly lower (p=0.002716) for group 1 compared with group 2. CONCLUSIONS: ICG facilitates the identification of key elements (anatomy and pathological structures) in the laparoscopic and robotic treatment of both malignant and benign urologic diseases, with possible impact on perioperative complications, along with oncologic and functional postoperative outcomes.

Laparoscopic cytoreductive nephrectomy and adrenalectomy for metachronous RCC metastases-Case report.

INTRODUCTION: We report the case of a 69 y.o. man with a left solitary kidney presenting 3 tumoral masses and suspicion of a left adrenal nodular tumor. PRESENTATION OF CASE: 48 months previously, the patient underwent laparoscopic right radical nephrectomy and adrenalectomy for a clear cell renal carcinoma, with a tumor free adrenal gland. 3D laparoscopic transperitoneal left cytoreductive nephrectomy and left adrenalectomy were performed within 23 min warm ischemia with no need of post operatory hemodialysis. The pathology exam reported metachronous metastases on left adrenal gland and on a left multifocal tumoral solitary kidney from the contralateral clear cell renal carcinoma prior diagnosed and treated at this patient. DISCUSSION: Cytoreductive nephrectomy on a solitary kidney brings technical challenges for the laparoscopic approach, especially when the tumor presents as multifocal lesions. Contralateral metachronous metastases and adrenal involvement in case of renal carcinoma are scarcely presented in the literature. CONCLUSION: The "en bloc" excision of the tumoral masses optimized warm ischemia time and improved the technical approach, even if the endophytic presentation imposed difficulty.

Totally intracorporeal 3D laparoscopic orthotopic neobladder reconstruction following radical cystectomy for infiltrative bladder tumors: the experience of modified Studer and modified Y-shaped ileal reconstruction techniques.

PURPOSE: We report our experience with 23 cases in utilizing ileum to perform totally intracorporeal 3D laparoscopic neobladder reconstruction using two different surgical techniques. METHODS: Patients candidates for reconstructive surgery were in a good biological status with a body mass index (BMI) in the range of 18.5-25 and presented a muscle-infiltrative bladder tumor with negative nodal frozen sections performed during the operation. Twenty-one modified Studer neobladder and 2 modified Y-shaped neobladder techniques for totally intracorporeal 3D laparoscopic ileal neobladder cases were performed using drawings and intra-operative images. An emphasis was made on different tips and tricks that can be applied when using ileum for the neobladder reconstruction, to avoid surgical complications and obtain optimal functional results. RESULTS: The operations were performed in a mean time of 5 h, with a mean blood loss of 350 ml and grade II postoperative Clavien Dindo complications. The 23 patients were discharged after a mean hospital stay of 21 days and had a functional ileal neobladder after a mean of 30 days. The results were monitored also on the long-term, taking into account functional results and possible complications from utilizing ileum as a urinary reservoir. CONCLUSION: Resecting a digestive segment and using it as a urinary reservoir may lead to multiple complications. Therefore, laparoscopic technical adaptations and highly skilled surgical teams are required for performing a totally intracorporeal 3D laparoscopic orthotopic ileal neobladder reconstruction.