Novel Technologies in Urologic Surgery: a Rapidly Changing Scenario

Primary tumor ablation in metastatic renal cell carcinoma

BACKGROUND

The role of primary tumor ablation (pTA) in metastatic renal cell carcinoma (mRCC) is unknown. We compared pTA-treated mRCC patients to patients who underwent no local treatment (NLT), as well as patients who underwent cytoreductive nephrectomy (CN).

METHODS

Within the Surveillance, Epidemiology, and End Results database (SEER, 2004-2020), we identified mRCC patients who underwent either pTA, NLT or CN. Endpoints consisted of overall survival (OM) and other-cause mortality (OCM). Propensity score 1:1 matching (PSM), multivariable cox regression models (OM), as well as, multivariable competing risk regressions (CRR) models (OCM) were used.

RESULTS

We identified 27,087 mRCC patients, of whom 82 (0.3%) underwent pTA, 17,266 (64%) NLT and 9,739 (36%) CN. In comparisons of pTA vs. NLT mRCC patients addressing OM, after 1:1 PSM, median survival was 19 months for pTA vs. 4 months for NLT patients (multivariable HR 0.3, 95% CI 0.22-0.47, P < 0.001). No statistically significant OCM differences were recorded in multivariable CRR (HR 1.13 95%, CI 0.52-2.44, P = 0.8). In comparisons of pTA vs. CN, after 1:1 PSM, no statistically significant differences in OM (HR 1.22, 95% CI 0.81-1.83, P = 0.32), as well as OCM (HR 1.4, 95% CI 0.56-3.48, P = 0.5) were recorded.

CONCLUSION

In mRCC patients, pTA is associated with significantly lower mortality compared to NLT. Interestingly, OM rates between pTA and CN mRCC patients do not exhibit statistically significant differences. This preliminary report may suggest that pTA may provide a comparable survival benefit to CN in highly selected mRCC patients.

A Systematic Review of New Imaging Technologies for Robotic Prostatectomy: From Molecular Imaging to Augmented Reality

New imaging technologies play a pivotal role in the current management of patients with prostate cancer. Robotic assisted radical prostatectomy (RARP) is a standard of care for localized disease and through the already imaging-based console subject of research towards combinations of imaging technologies and RARP as well as their impact on surgical outcomes. Therefore, we aimed to provide a comprehensive analysis of the currently available literature for new imaging technologies for RARP. On 24 January 2023, we performed a systematic review of the current literature on Pubmed, Scopus and Web of Science according to the PRISMA guidelines and Oxford levels of evidence. A total of 46 studies were identified of which 19 studies focus on imaging of the primary tumor, 12 studies on the intraoperative tumor detection of lymph nodes and 15 studies on the training of surgeons. While the feasibility of combined approaches using new imaging technologies including MRI, PSMA-PET CT or intraoperatively applied radioactive and fluorescent dyes has been demonstrated, the prospective confirmation of improvements in surgical outcomes is currently ongoing.

Preclinical optimization of a diode laser-based clamp-free partial nephrectomy in a large animal model

Kidney cancer is a common urologic malignancy with either laparoscopic (LPN) or robotic partial nephrectomy as therapeutic options of choice for localized tumors. However, renal resection and suturing are challenging steps of the procedure that can lead to complications such as prolonged warm ischemia, bleeding, and urinary fistulas. LPN with a diode laser is an efficient technique due to its cutting and/or coagulation attributes. Surprisingly, key laser features such as wavelength and power remain undefined. Using a large porcine model, we evaluated the laser range of wavelength and power in a clamp-free LPN and compared it to the established gold-standard LPN technique (i.e., cold-cutting and suturing). By analyzing surgery duration, bleeding, presence of urine leak, tissue damage related to the resected renal fragment and the remaining organ, hemoglobin levels, and renal function, we show that an optimized experimental diode laser clamp-free LPN (wavelength, 980 nm; power, 15 W) had shorter surgery time with less bleeding, and better postoperative renal function recovery when compared to the well-established technique. Together, our data indicate that partial nephrectomy with a diode laser clamp-free LPN technique is an improved alternative to the gold-standard technique. Therefore, translational clinical trials towards human patient applications are readily feasible.

Spectral imaging enables contrast agent-free real-time ischemia monitoring in laparoscopic surgery

Laparoscopic surgery has evolved as a key technique for cancer diagnosis and therapy. While characterization of the tissue perfusion is crucial in various procedures, such as partial nephrectomy, doing so by means of visual inspection remains highly challenging. We developed a laparoscopic real-time multispectral imaging system featuring a compact and lightweight multispectral camera and the possibility to complement the conventional surgical view of the patient with functional information at a video rate of 25 Hz. To enable contrast agent-free ischemia monitoring during laparoscopic partial nephrectomy, we phrase the problem of ischemia detection as an out-of-distribution detection problem that does not rely on data from any other patient and uses an ensemble of invertible neural networks at its core. An in-human trial demonstrates the feasibility of our approach and highlights the potential of spectral imaging combined with advanced deep learning-based analysis tools for fast, efficient, reliable, and safe functional laparoscopic imaging.

Top 50 Most Cited Articles About OAB: A Bibliometric Analysis

OBJECTIVE

To identify key articles about overactive bladder (OAB) using citation number and bibliometric analysis.

METHODS

We searched for articles in the Web of Science Core Collection between 1900 and 2022 using terms specific to OAB. We identified relevant OAB articles and selected the top 50 most cited. A bibliometric analysis was performed to collect and analyze data about authorship, title, publication year, total citations, journal, journal impact factor, country, institution, study type, citation index, conflict of interest (COI), and conclusions.

RESULTS

A total of 12,200 records were identified. The top 50 most cited articles were published between 1997 and 2015 in nine countries, across over 30 different institutions, and in 19 journals. The country, institution, and journal which produced the greatest number of articles were the USA, Southmead General Hospital in England, and BJU International, respectively. The mean number of citations per article was 365.66. Observational studies and clinical trials were the most common. Most articles were published in 2006 and were sponsored. The most cited article also had the most citations per year. This study is limited by using a single database and a single parameter as a proxy for paper importance.

CONCLUSION

Bibliometric analyses are an important resource for clinicians to understand the body of knowledge of OAB by identifying landmark papers. This objective approach to literature review can facilitate future research and scholarly efforts.

Development of Simulation Methods in Biomedical Sciences - From Phantoms to Virtual Patients

Simulation is an imitation of the operation of a real process or system over time that is applied for a variety of purposes, including entertainment, education, training, system evaluation, and research. Medical simulation is an artificial presentation of real clinical situations, which is applied in education. Medical simulation allows the acquisition of clinical skills without the risk of harming the patient. Medical simulations have been developed and refined over the years-simulation models, cadavers, actors and robots have found wide application in medical training. Of more sophisticated simulation technologies, Virtual and Augmented Realities are used. The presence of science in the digital world is necessary in order to market the proven knowledge acquired in an adequate manner. The traditional teaching process, despite serious and thorough research, seems non-inspirational, and it is important that educators and teachers keep up with the times and provide students with the latest teaching and work methods.

Effect of augmented reality simulation on administration of local anaesthesia in paediatric patients

BACKGROUND

Augmented reality (AR) is a simulation of a three-dimensional environment created using hardware and software that provides the user with realistic experiences and ability to interact. The aim of the study was to evaluate the impact of AR simulator on the perception of learning and acute stress level in students administering local anaesthesia to paediatric patients relative to standard teaching methods.

MATERIAL AND METHODS

The prospective study included 21 fourth- and fifth-year students enrolled in 5-year dental programme. In addition to conventional training, the students of the study group used the augmented reality simulator in a dental office 2 hours weekly in 2 weeks. The level of salivary cortisol was measured before and after the anaesthetic procedure as one of the indicators of acute stress.

RESULTS

A statistically significant shorter time to perform infiltrative anaesthesia technique for the anterior superior alveolar nerve was observed in students using the AR technique (28.91 ± 9.06 seconds in the study group and 39.80 ± 9.29 seconds in the control group). The level of cortisol before and after anaesthesia was statistically significant in all subjects (cortisol concentration was 0.53 μg/dL before anaesthesia and 2.44 μg/dL after the procedure); however, there was no statistically significant difference between the groups.

CONCLUSION

The AR concept may influence better manipulation and control of the syringe in students administering their first anaesthetic injection to paediatric patients, but may not reduce acute stress.

The 100 most-cited articles in urological surgery: A bibliometric analysis

BACKGROUND

The purpose of this bibliometric analysis was to identify and assess the 100 most-cited articles (T100 articles) on urological surgery.

METHODS

The Web of Science (WoS) Core Collection database was used to investigate the T100 articles in the field of urological surgery. Different aspects of the T100 articles, including the countries, journals, authors, and topics, were analyzed.

RESULTS

The number of citations of T100 articles published between 1989 and 2016 ranged from 334 to 2189. The T100 articles originated from 28 countries, with more than half originating from the USA (n = 80). Professor Bill-Axelson A from Uppsala University Hospital published the largest number of T100 articles as the first author (4) and as a coauthor (1). The Memorial Sloan Kettering Cancer Center from the USA is the top institution with the most T100 articles in the field of urological surgery. The special journal Journal of Urology published 41 of the T100 articles, which had a total of 19780 citations.

CONCLUSIONS

Our study analyzed the 100 most-cited articles in the field of urological surgery. The USA is the dominant country in terms of the number of T100 articles, scientists and institutions. Surgery related to urological cancer has garnered the most academic attention, especially prostate cancer and renal cancer.

Augmented reality in dentistry: a current perspective

Augmentation reality technology offers virtual information in addition to that of the real environment and thus opens new possibilities in various fields. The medical applications of augmentation reality are generally concentrated on surgery types, including neurosurgery, laparoscopic surgery and plastic surgery. Augmentation reality technology is also widely used in medical education and training. In dentistry, oral and maxillofacial surgery is the primary area of use, where dental implant placement and orthognathic surgery are the most frequent applications. Recent technological advancements are enabling new applications of restorative dentistry, orthodontics and endodontics. This review briefly summarizes the history, definitions, features, and components of augmented reality technology and discusses its applications and future perspectives in dentistry.