Robot-assisted Radical Prostatectomy with the Dexter Robotic System: Initial Experience and Insights into On-demand Robotics.

We report the world's first case series of ten robot-assisted radical prostatectomy (RARP) procedures performed with the Dexter robotic system (Distalmotion SA, Épalinges, Switzerland). The Dexter system is an open robotic platform that integrates into the existing operating room (OR) equipment. The optional sterile environment for the surgeon console provides flexibility for transition between a robot-assisted surgical procedure and a traditional laparoscopic setup, allowing surgeons to selectively use their preferred laparoscopic devices for specific surgical maneuvers on-demand. Ten patients underwent RARP ± lymph node dissection at Saintes Hospital (Saintes, France). Positioning and docking of the system were quickly mastered by the OR team. All procedures were successfully completed, without any intraprocedural complication, conversion to open surgery, or major technical failure. The median operative time was 230 min (interquartile range [IQR] 226-235), and the median length of stay was 3 d (IQR 3-4). This case series demonstrates the safety and feasibility of RARP with the Dexter system and provides the first insights into what an on-demand robotics platform could offer to hospitals willing to start or expand their robotic surgery program.

Cut-off time for surgery and prediction of orchiectomy in spermatic cord torsion: a retrospective multicentric study over 15 years.

PURPOSE: Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort. METHODS: We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain. RESULTS: 1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87). CONCLUSIONS: Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain.

Torsion of the spermatic cord in adults: a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion.

Acute scrotal pain (ASP) requiring surgical exploration is common in the pediatric population, but little has been reported on this subject with regard to the adult population. The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients. Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion (TT) at 14 French hospitals between January 2005 and December 2019 were included in this study. The main outcome measures were demographic characteristics, pathology found during scrotal exploration, and perioperative outcomes. Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT. Data for 1329 men were analyzed. The median age was 30 (interquartile range [IQR]: 25-35; range: 21-89) years. Regarding the clinical examination, 867 (65.2%) patients presented with an elevation of the testicle, 613 (46.1%) patients with scrotal edema or erythema, and 211 (15.9%) patients with nausea or vomiting. Operative findings identified TT in only 684 (51.5%) patients, epididymo-orchitis in 112 (8.4%) patients, a tumor in 16 (1.2%) patients, and no causes in 475 (35.7%) patients. Orchiectomy for nonviable testes was required in 101 (7.6%) patients. In multivariate analysis, an elevation of the testicle, erythema/swelling, and the presence of nausea/vomiting were found to be associated with the occurrence of TT. Testicular torsion is not exclusive to children and adolescents, so must be considered in males of any age with acute scrotal findings. However, one-third of scrotal explorations in adults did not lead to a diagnosis.

Contralateral Orchiopexy at the Time of Urgent Scrotal Exploration-Is It Safe? A Propensity Score Matched Analysis from the TORSAFUF Cohort.

PURPOSE: We evaluate the safety of immediate contralateral orchiopexy (ICLO) at the time of scrotal exploration for testicular torsion suspicion. MATERIALS AND METHODS: Patient data were retrieved from the TORSAFUF cohort project, which is a multicenter national study conducted at 14 academic French hospitals between 2005 and 2019. Each patient who underwent surgical exploration for testicular torsion suspicion was included. The primary study outcome was the safety of ICLO compared to ipsilateral scrotal exploration alone. The primary outcome of interest was the complication rate within 90 days of surgery. The end point was planned before data collection. RESULTS: Overall, 2,775 patients were included, of whom 1,554 (56%) underwent ICLO. After propensity score matching and multivariable analysis, ICLO was associated with a higher complication rate (OR 1.51, 95% CI 1.1-2.1, p=0.01), especially a higher rate of hematoma (OR 2.9, 95% CI 1.3-6.6, p=0.01), and delayed wound healing (OR 3.0, 95% CI 1.8-5.2, p <0.001). CONCLUSIONS: At the time of scrotal exploration for acute scrotum, ICLO was associated with an increased postoperative complication rate, with a particular increase in hematoma, and delayed wound healing. ICLO should not be performed systematically.

Growth performances, carcass traits, meat quality, and blood metabolic parameters in rabbits of local Algerian population and synthetic line.

AIM: The objective of this work was to study the growth performance, slaughter traits, meat quality, and metabolic profile in rabbits of local Algerian population and a synthetic line. MATERIALS AND METHODS: In total, 120 weaned rabbits were used (60 per group). Growth traits were recorded from weaning (35 days) to slaughter (91 days). At slaughter, carcass traits, meat quality, and metabolic profiles were measured. RESULTS: The synthetic line showed heavier total weight and faster daily weight gain than the local population (+15% and +19%, respectively), better feed conversion (3.92 vs. 4.81 g/g), and heavier weight of cold carcass, and perirenal fat (+15%). No differences were found between the two groups in dressing out percentage, muscular pH, weight of liver, or scapular fat. Wider intestinal villi were found in the synthetic line (+20%, p<0.0001) allowing better absorption surface in this line. The synthetic line also showed higher fat content (3.41% vs . 2.22%, p<0.0001) in the meat and lower protein content (22.02% vs . 18.98%, p=0.0002). Glucose level was 19% higher in the local population than in the synthetic line. CONCLUSION: The synthetic line is well adapted to the local conditions of Algeria. This line has shown better growth, daily gain, and feed conversion, due to its better intestinal absorption surface.

Multicenter transversal two-phase study to determine a national prevalence of epilepsy in Algeria.

BACKGROUND/AIMS: The prevalence of epilepsy in Algeria is unknown. The aims of this multicenter transversal study were to determine the national prevalence and clinical characteristics of epilepsy in the Algerian population. METHODS: This two-phase study was conducted in 5 circumscriptions and included 8,046 subjects aged over 2 months who attended the randomly selected public and private primary care clinics. In the phase 1 study, a questionnaire was submitted to the sample of patients. In the phase 2 study, all potentially epileptic people were examined by neurologists and a second questionnaire was submitted, eventually assessed by appropriate investigations. RESULTS: Sixty-seven patients were identified as having active epilepsy, giving a crude prevalence ratio of 8.32 per 1,000 (95% CI, 6.34-10.3) and an age-adjusted prevalence ratio of 8.9 per 1,000. The highest age-specific ratio was found in patients aged 10-19 years (16.92 per 1,000). Generalized seizures (68.7%) were more common than partial seizures (29.8%). Perinatal injuries were the major leading putative causes (11.9%). CONCLUSION: The prevalence of epilepsy of 8.32 determined in this study is relatively high. These results provide new epidemiological data and suggest that epilepsy remains an important public health issue to consider in Algeria.