A comparative study of peri-operative outcomes for 100 consecutive post-chemotherapy and primary robot-assisted and open retroperitoneal lymph node dissections.

PURPOSE: To describe and compare differences in peri-operative outcomes of robot-assisted (RA-RPLND) and open (O-RPLND) retroperitoneal lymph node dissection performed by a single surgeon where chemotherapy is the standard initial treatment for Stage 2 or greater non-seminomatous germ cell tumour. METHODS: Review of a prospective database of all RA-RPLNDs (28 patients) and O-RPLNDs (72 patients) performed by a single surgeon from 2014 to 2020. Peri-operative outcomes were compared for patients having RA-RPLND to all O-RPLNDs and a matched cohort of patients having O-RPLND (20 patients). Further comparison was performed between all patients in the RA-RPLND group (21 patients) and matched O-RPLND group (18 patients) who had previous chemotherapy. RA-RPLND was performed for patients suitable for a unilateral template dissection. O-RPLND was performed prior to the introduction of RA-RPLND and for patients not suitable for RA-RPLND after its introduction. RESULTS: RA-RPLND showed improved peri-operative outcomes compared to the matched cohort of O-RPLND-median blood loss (50 versus 400 ml, p < 0.00001), operative duration (150 versus 195 min, p = 0.023) length-of-stay (1 versus 5 days, p < 0.00001) and anejaculation (0 versus 4, p = 0.0249). There was no statistical difference in complication rates. RA-RPLND had lower median lymph node yields although not significant (9 versus 13, p = 0.070). These improved peri-operative outcomes were also seen in the post-chemotherapy RA-RPLND versus O-RPLND analysis. There were no tumour recurrences seen in either group with median follow-up of 36 months and 60 months, respectively. CONCLUSIONS: Post-chemotherapy RA-RPLND may have decreased blood loss, operative duration, hospital length-of-stay and anejaculation rates in selected cases and should, therefore, be considered in selected patients. Differences in oncological outcomes require longer term follow-up.

Ureteric stent card register - a 5-year retrospective analysis.

INTRODUCTION: Ureteric stenting is a common urological procedure. Forgotten stents have a well-documented morbidity and mortality. Therefore, we asked the question, is a stent register an important factor in reducing the number of lost or overdue stents? PATIENTS AND METHODS: We conducted a retrospective review of 203 patients who had ureteric stents inserted in the operating theatre, for the 5-year period 1 December 1998 to 1 December 2003. We analysed all stent cards, patient notes and theatre logs; where no record of stent removal was found, we contacted the patient, their GP or their local hospital. RESULTS: A total of 191 patients were identified from the stent card register. An additional 12 patients were found from the theatre logs, but with no record in the stent card register. Of the 203 patients, 8 had bilateral stents. The most common indication for stenting was stone disease. Of the 203 patients, 11 had overdue stents and 51 had no record of the stents ever being removed. The 51 presumed 'forgotten' stents were traced, and it was found that 42 patients had had their stents removed by other hospitals, and 9 patients died with stents in situ, but before they were due for removal. CONCLUSIONS: Our current stent card tracking system is ineffective, because it was infrequently reviewed. However, despite overdue and 'forgotten' stents which were removed by other hospitals, no patients came to any real harm and we had no lost stents. Our stent register system did not appear to play any role in terms of preventing stent loss, and it seems likely that there are other more effective safeguards in place to prevent this from happening. However, if a stent register was required at all, a computerised system would be preferable. Alternatively, patients could share some of the responsibility of stent tracking with their clinicians.