[Medico-economic evaluation of the impact of measures to adapt to the switch to surgery robot-assisted in urology]. / Évaluation médico-economique de l'impact de mesures d'adaptation au virage de la chirurgie robot-assistée en urologie.

INTRODUCTION: The development of robot-assisted urological surgery is held back by the lack of robust medico-economic analyses and their heterogeneity. We conducted a medico-economic study to evaluate the implementation of measures to optimize the transition to robotic surgery. METHOD: We carried out a single-center, controlled study from the point of view of the public healthcare establishment for 4 years. Economic data collection was based on a micro-costing method and revenues from stay-related groups. Clinical data corresponded to mean lengths of stay, operating duration, complications and stays in intensive care. The measures to optimize the transition to robotic, implemented mid-study period, enabled before/after comparison. RESULTS: Altogether, 668 patients undergoing robotic surgery were included. Robotic activity increased significantly from periods 1 to 2 to 256% (P=<0.001) as did the overall proportion of robotic by 45% to 85% (P=<0.001). The mean lengths of stay fell significantly, 6.8 d vs. 5.1 d (P<0.001). Costs and revenues increased significantly, resulting in a persistent deficit for the activity €226K vs. €382K (P=<0.001). With increased volume of activity, the deficit per operation and the cost per minute of robotic operating room fell significantly, €3,284 vs. €1,474/procedure (P=<0.001) and €27 vs €24/min (P=<0.029), tending towards a break-even point (=zero deficit) at 430 operations per year. CONCLUSIONS: Robotic-assisted surgery can be significantly optimized by implementing measures for the robotic turn to reach a break-even point at 430 operations per year. A better multidisciplinary case mix could lower the break-even volume of activity in short term. LEVEL OF EVIDENCE: 3.

[Outcomes following the triage of patients for urological cancer and non-cancer surgery during Covid-19 pandemic peak]. / Évaluation des mesures de triages de la première vague pandémique Covid-19 pour sélectionner les patients à opérer pour cancers et urgences urologiques.

INTRODUCTION: Faced with the first wave of Covid-19 pandemic, guidelines for surgical triage were developed to free up healthcare resources. The aim of our study was to assess clinical characteristics and surgical outcomes of triaged patients during the first Covid-19 crisis. METHOD: We conducted a cohort-controlled, non-randomized, study in a University Hospital of south-eastern France. Data were collected prospectively from consecutive patients after triage during the period from March 15th to May 1st and compared with control data from outside pandemic period. Primary endpoint was intensive care unit (ICU) admissions for surgery-related complications. Rates of surgery-specific death, postponed operations, positive PCR testing and Clavien-Dindo complications and data from cancer and non- cancer subgroups were assessed. RESULTS: After triage, 96 of 142 elective surgeries were postponed. Altogether, 71 patients, median age 68 y.o (IQR: 56-75 y.o), sex ratio M/F of 4/1, had surgery, among whom, 48 (68%) had uro-oncological surgery. No patients developed Covid-19 pneumonia in the post-surgery period. Three (4%) were admitted to the ICU, one of whom died from multi-organ failure due to septic shock caused by klebsiella pneumonia following a delay in treatment. Three Covid-19 RT-PCR were done and all were negative. There was no difference in mortality rates or ICU admission rates between control and Covid- era patients. CONCLUSIONS: Surgery after triage during the first Covid-19 pandemic was not associated with worse short-term outcomes. Urological cancers could be operated on safely in our context but delays in care for aggressive genitourinary diseases could be life threatening. LEVEL OF EVIDENCE: 3.

Induction of glycollate oxidase activity in mustard seedlings under the influence of continuous irradiation with red and far-red light.

1. A method was developed for the measurement of glycollate oxidase activity in buffered extracts of white mustard seedlings (Sinapis alba L.). 2. After 36 hours germination in darkness, the activity of the enzyme was followed during the further development of the seedlings kept in darkness or irradiated continuously with red or far-red light. In irradiated seedlings as well as in dark-grown controls, most of the activity was found in the cotyledons. 3. Kinetics of activity induction were studied for both the whole seedlings and the cotyledons. In permanent darkness enzymatic activity increased up to 60 hours after sowing; then a nearly constant activity level was maintained. When the seedlings were exposed to continuous far-red light, an increase of enzymatic activity was observed. This light-mediated increase showed a lag-phase wich was dependent on the age of the seedlings. When irradiation was started 36 hours after sowing, it took at least 12 hours for the differences between light and dark activity to become significant; in seedlings irradiated 60 hours after sowing, the lag-phase -if any- was less than 6 hours. The magnitude of the photoresponse diminished with increasing age of the seedlings. After interruption of irradiation in the phase of vigorous activity induction, the activity kept rising for about 8 hours and resulted in a stable intermediary activity level. Continuous far-red light, started 36 hours after sowing, caused a threefold activity increase in cotyledons after 42 hours and the maximal level of activity was light-independent. An activity induction was also obtained under continuous irradiation with red light. When irradiation was started 36 hours after sowing, a lag-phase of about 6 hours was found. Then the activity rose to a constant level inferior to that in continuous far-red light. With 60 hours old seedlings, no significant differences were observed in the response to either red or far-red light. 4. The involvement of phytochrome in the photoresponse was shown by means of the conventional induction-reversion experiments. 5. The induction pattern of glycollate oxidase in mustard is compared with that of other glyoxysome enzymes and dicussed with respect to the problem of compartment biogenesis. Dissimilarities in the induction patterns of the individual enzymes indicate the absence of a uniform regulatory mechanism for the entire glyoxysome compartment of the cells.