Extraperitoneal robot-assisted radical prostatectomy with the Hugo™ RAS system: initial experience of a tertiary center with a high background in extraperitoneal laparoscopy surgery.

PURPOSE: The Hugo™ RAS system is a novel robotic platform with innovative features. However, there are currently no available data on extraperitoneal robot-assisted radical prostatectomy (RARP) performed using this system. The objective of this study is to describe the surgical setup and assess the safety and feasibility of the extraperitoneal approach in robotic radical prostatectomy with the Hugo™ RAS system. METHODS: Sixteen consecutive patients diagnosed with localized prostate cancer underwent extraperitoneal RARP ± lymph node dissection at our institution, between March and May 2023. All RARP procedures were performed extraperitoneal with a modular four-arm configuration. The focus was to describe the operative room setup, trocar placement, tilt and docking angles and evaluate the safety and feasibility of this approach with this robotic platform. Secondary outcomes recorded included, total operative time, console time, estimated bleeding, intra- and postoperative complications, and length of stay after surgery. A descriptive analysis was conducted. RESULTS: We report on the first sixteen cases of extraperitoneal robot-assisted radical prostatectomy performed with the new Hugo™ RAS system. All procedures were completed, without the need for conversion or placement of additional ports. No intraoperative complications or major technical failures that would prevent the completion of surgery were recorded. The median operative time was 211 min (IQR 180-277), and the median console time was 152 min (IQR 119-196). The mean docking time was 4.6 min (IQR 4.1-5.2). The median estimated blood loss and the median time to remove the vesical catheter were 200 mL (IQR 150-400) and 8 days (IQR 7-8), respectively. The median length of stay was 2 days (IQR 2-2). Only one minor complication was registered in the first 30 days. CONCLUSION: This study provides evidence of the safety and feasibility of the extraperitoneal approach in RARP with the Hugo™ RAS system. The description of the surgical setup in terms of trocar placement, arm-cart disposition, tilt and docking angles offers valuable information for surgeons interested in adopting this surgical approach with the Hugo™ RAS platform.

Sinus node disfunction in an adolescent with systemic lupus erythematosus.

Cardiac involvement in systemic lupus erythematosus (SLE) is well documented. The pericardium, myocardium and endocardium, as well as the coronary arteries, the valves and the conduction system can all be affected. While pericarditis is common, arrythmias are less frequently described.We present a 13-year-old male, who had fatigue, anorexia, weight loss, myalgias and arthralgias for four months. On physical examination, we identified bradycardia (heart rate 31-50 bpm), oral and nasal ulcers and polyarthritis. The laboratory results showed hemolytic anemia, hypocomplementemia, antinuclear and anti-dsDNA antibodies, hematuria and non-nephrotic proteinuria. Renal function was normal. Lupus nephritis class II was diagnosed by kidney biopsy. On the transthoracic echocardiogram we identified a minimal pericardial effusion, suggesting pericarditis, and, on the electrocardiogram, we detected sinus arrest with junctional rhythm, denoting sinus node dysfunction. The patient was diagnosed with juvenile SLE with cardiac, renal, musculoskeletal and hematologic involvement. Disease remission and cardiac rhythm control were obtained with steroids and mycophenolate mofetil. Currently, the patient is asymptomatic, with normal sinus rhythm.We described an adolescent with SLE who had sinus node dysfunction upon diagnosis. Other cases have been reported in adults but none in juvenile SLE. All SLE patients should have a thorough cardiac examination to promptly diagnose and treat the innumerous cardiac manifestations of this disease.

Semen parameters in testicular tumor patients before orchiectomy: What is the impact of testicular tumor stage and histology?

PURPOSE: To evaluate the influence of testicular cancer histology and stage on sperm parameters in cryopreserved samples collected prior to orchiectomy. MATERIALS AND METHODS: We conducted a retrospective analysis of tumor histology, stage and sperm parameters of patients who underwent pre-orchiectomy sperm cryopreservation for testicular cancer between March 2010 and March 2023. The World Health Organization (WHO) 2010 sperm reference values were used to identify patients with subnormal semen parameters and to further categorize patients by sperm alteration. Localized disease was classified as Stage I, while metastatic disease encompassed Stages II and III. Continuous variables were compared using t-test or Mann Whitney U test, and categorical variables using Chi-square and Fishers exact test. RESULTS: A total of 64 patients was identified, 48 (75%) classified as stage I and 16 (25%) classified as stage II/III. No difference was found in semen parameters between patients with seminoma and patients with non-seminoma germ cell tumor (NSGCT). Patients with stage II/III disease had significantly lower percentages of progressive motility (36% vs 53%, p=0.021) and total motility (60% vs 69%, p=0.015) than stage I patients. When categorizing by sperm alterations according to WHO 2010 reference values, patients with stage II/III disease had significantly higher proportions of asthenozoospermia (38% vs 15%, p=0.048) and teratozoospermia (63% vs 31%, p=0.027) than stage I patients. Elevated tumor markers were not associated with sperm abnormalities. CONCLUSIONS: Patients with metastatic testicular cancer present with worse sperm quality than patients with localized disease. Sperm cryopreservation should be offered to all patients with testicular cancer, and especially emphasized in patients with metastatic disease.

Cotidiano de cuidadoras informales: perspectivas desde la terapia ocupacional / Cotidiano de cuidadoras informais: perspectivas da terapia ocupacional / Daily life of informal caregivers: perspectives from occupational therapy

Resumen Introducción El presente artículo propone comprender el cotidiano de mujeres cuidadoras informales a través de sus narrativas desde la perspectiva de la Terapia Ocupacional bajo las implicancias en las áreas ocupacionales. Objetivo Analizar desde las áreas de ocupación de autocuidado, productividad y ocio, las narrativas de mujeres quienes ejercen el rol de cuidadora informal. Método Investigación cualitativa, con abordaje narrativo para obtener la experiencia de las cuidadoras desde que asumieron este rol, a través de una entrevista semiestructurada que fue realizada a cinco cuidadoras informales pertenecientes a la comuna de Valdivia, Región de Los Ríos (Chile). Resultados Se identificaron repercusiones en el área de autocuidado, expresada en sobrecarga, multiplicidad de roles, trastornos del ánimo y sueño. En productividad, estas mujeres logran compatibilizar su cotidiano con la labor, siendo un factor protector el apoyo de terceros. Por último, en ocio los espacios para sí mismas se ven reducidos drásticamente tanto por la labor, como por la situación sanitaria, imposibilitando un equilibrio en sus rutinas. Conclusión Ejercer el rol de cuidadora implica un cambio en las áreas ocupacionales, que directa e indirectamente afectan su cotidiano, puesto que hay una ruptura abrupta en su rutina, siendo potenciada por la falta de apoyo social y/o por la normalización del desempeño de este rol por mujeres. Además, las medidas de confinamiento por COVID-19 aumentaron el impacto del rol de cuidadora en el cotidiano de estas mujeres, expresada en una mayor carga de trabajo y una disminución significativa del autocuidado.

Resumo Introdução Este artigo se propõe a abordar e compreender o cotidiano de cuidadoras informais e analisar suas narrativas na perspectiva da terapia ocupacional, sob as implicações nas áreas ocupacionais. Objetivo Analisar a partir das áreas de autocuidado, produtividade e lazer, as narrativas de mulheres que exercem a função de cuidadora informal. Método: Pesquisa qualitativa, com abordagem narrativa para obter a história e a experiência das cuidadoras desde que assumiram esse papel, por meio de uma entrevista semiestruturada realizada com cinco cuidadoras informais pertencentes à comuna de Valdivia, Região de Los Ríos (Chile). Resultados Foram identificadas repercussões na área de autocuidado, expressas em sobrecarga, multiplicidade de papéis, distúrbios de humor e sono. Em termos de produtividade, essas mulheres conseguiram conciliar o seu cotidiano com o trabalho, sendo o apoio de terceiros um fator de proteção. Por último, no lazer, os espaços próprios são drasticamente reduzidos tanto pelo trabalho como pela situação de saúde, impossibilitando o equilíbrio em suas rotinas. Conclusão O exercício do papel de cuidadora implica uma mudança nas áreas ocupacionais, o que afeta direta e indiretamente o seu cotidiano, visto que ocorre uma ruptura abrupta em sua rotina, sendo potencializada pela falta de apoio social e/ou pela normalização do desempenho desse papel por mulheres. Além disso, as medidas de confinamento devido à COVID-19 aumentaram o impacto do papel de cuidadora no cotidiano dessas mulheres, expresso em maior carga de trabalho e diminuição significativa do autocuidado.

Abstract Introduction This article proposes to understand the daily life of informal caregivers through their narratives from the perspective of Occupational Therapy under the implications in occupational areas. Objective Analyze from the occupation areas of self-care, productivity and leisure, the narratives of women who exercise the role of informal caregiver. Method Qualitative research, with a narrative approach to obtain the experience of the caregivers since they assumed this role, through a semi-structured interview that was carried out with five informal caregivers belonging to the Valdivia commune, Los Ríos Region (Chile). Results Repercussions were identified in the self-care area, expressed in overload, multiplicity of roles, mood and sleep disorders. In terms of productivity, these women manage to reconcile their daily lives with their work, the support of third parties being a protective factor. Finally, in leisure time, the space for themselves is drastically reduced by both the work and the health situation, making it impossible to balance their routines. Conclusions Exercising the role of caregiver implies a change in occupational areas, which directly and indirectly affects daily life, since there is an abrupt break in the routine, enhanced by the lack of social support and / or the normalization of the performance of this role by women. In addition, the confinement measures due to COVID-19 increased the impact of the role of caregiver in the daily life of these women, expressed in a greater workload and a significant decrease in self-care.