Technical features and the demonstrated advantages of the Retzius sparing robotic prostatectomy

OBJECTIVE

Robot-assisted laparoscopic  radical prostatectomy (RARP) is nowadays considered  the main surgical option for localized prostate cancer (PCa). We recently developed a new approach for RARP  avoiding all the Retzius structures involved in continence  and potency preservation, the so called Retzius-sparing  technique (RSP). The objective of the paper is to report technical aspects and functional results of RSP.  METHODS: We evaluated our data and available literature  regarding RSP, functional results and advantages.  RESULTS: RSP is oncologically safe and guarantee high early continence rates.

CONCLUSION

Long-term, prospective, comparative,  and possibly randomized studies are needed but RSP is  now spreading all over the world thanks to the different advantages that offers to patients. The most recognized benefit is surely the achievement of early continence, as well documented in multiple studies and papers, without compromising the oncological outcomes.

Analysis of pedestrian-to-ground impact injury risk in vehicle-to-pedestrian collisions based on rotation angles

INTRODUCTION

Due to the diversity of pedestrian-to-ground impact (secondary impact) mechanisms, secondary impacts always result in more unpredictable injuries as compared to the vehicle-to-pedestrian collisions (primary impact). The purpose of this study is to investigate the effects of vehicle frontal structure, vehicle impact velocity, and pedestrian size and gait on pedestrian-to-ground impact injury risk.

METHOD

A total of 600 simulations were performed using the MADYMO multi-body system and four different sizes of pedestrians and six types initial gait were considered and impacted by five vehicle types at five impact velocities, respectively. The pedestrian rotation angle ranges (PRARs) (a, b, c, d) were defined to identify and classify the pedestrian rotation angles during the ground impact.

RESULTS

The PRARs a, b, and c were the ranges primarily observed during the pedestrian landing. The PRAR has a significant influence on pedestrian-to-ground impact injuries. However, there was no correlation between the vehicle velocity and head injury criterion (HIC) caused by the secondary impact. In low velocity collisions (20, 30km/h), the severity of pedestrian head injury risk caused by the secondary impact was higher than that resulting from the primary impact.

CONCLUSIONS

The PRARs defined in this study are highly correlated with the pedestrian-to-ground impact mechanism, and can be used to further analyze the pedestrian secondary impact and to predict the head injury risk.

PRACTICAL APPLICATIONS

To reduce the pedestrian secondary impact injury risk, passive and active safety countermeasures should be considered together to prevent the pedestrian's head-to-ground impacts, particularly in the low-velocity collisions.

Oncologic results, functional outcomes, and complication rates of transperitoneal robotic assisted radical prostatectomy: single centre's experience

BACKGROUND

We report the operative details and short term oncologic and functional outcome of the first 334 Robotic-assisted radical prostatectomy experiences for organ confined prostate cancer

METHODS

From August 2009 to December 2012, details of 334 consecutive patients were retrospectively analyzed. The analyzed parameters included: preoperative, per-operative characteristics, postoperative minor and major complications, positive surgical margin continence, potency, and biochemical progression at the follow-up period.

RESULTS

The classical extrafascial, interfascial, intrafascial and fascia sparing radical prostatectomy were performed in 31, 41, 200, and 62 cases, respectively. The mean operation time was 213.8±90.1minutes, and the mean estimated blood loss was 116.1±58.9cc during operation. A nerve-sparing procedure was performed bilaterally in 198 (59.3%) cases and unilaterally in 126 (37.7%) cases. The catheter was removed on postoperative day 9, 1±1.9. Surgical margin was positive in 36 (10.7%) patients. The overall, pT2, pT3a and pT3b PSM rates were 8 (2.4%), 12 (3.6%), 16 (4.8%) respectively and PSM and BCR rates were not statistically different among four approach (P>.05). At the follow-up period, the continence rates were 74.4%, 80.4%, 80.5%, and 96.7% (P<.001), and previously potent patients' potency rates were 64.3%, 66.6%, 68.1%, and 74.5% (P>.05), in classic extrafascial, interfascial, intrafascial, and fascia sparing intrafascial prostatectomy, respectively.

CONCLUSION

RARP is a safe and feasible technique in treatment of localized prostate cancer. Fascia sparing approach has better continence rate. This results need to be supported by new prospective, randomized studies.