Single-Port vs Multiport Robot-Assisted Partial Nephrectomy: A Meta-Analysis.

Background: Several centers have reported their experience with single-port robot-assisted partial nephrectomy (SP-RAPN); however, it is uncertain if utilization of this platform represents an improvement in outcomes compared to multiport robot-assisted partial nephrectomy (MP-RAPN). To evaluate this, we performed a meta-analysis to compare the perioperative, oncological, and functional outcomes between SP-RAPN and MP-RAPN. Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until January 1, 2023. A meta-analysis has been reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and assessing the methodological quality of systematic reviews (AMSTAR) guidelines. The odds ratio (OR) and weighted mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). Results: Of the 374 retrieved abstracts, 29 underwent full-text review, and 8 studies were included in the final analysis, comprising a total cohort of 1007 cases of RAPN (453 SP-RAPN cases and 554 MP-RAPN cases). Compared to MP-RAPN, the SP-RAPN group had a significantly longer ischemia time (MD = 4.6 minutes, 95% CI 2.8 to 6.3, p < 0.001), less estimated blood loss (MD = -12.4 mL, 95% CI -24.6 to -0.3, p = 0.045), higher blood transfusion rate (OR = 2.97, 95% CI 1.33 to 6.65, p = 0.008), and higher postoperative estimated glomerular filtration rate (eGFR) at 6 months (MD = 4.9 mL/min, 95% CI 0.2 to 9.7, p = 0.04). There was no significant difference in other outcomes between the two approaches, including the intraoperative complication, overall postoperative complication, minor postoperative complication (Clavien-Dindo I - II), major postoperative complication (Clavien-Dindo III-V), conversion to radical nephrectomy, pain score on day #1, pain score on discharge, morphine milligram equivalent usage, hospital stay, positive surgical margins, and postoperative eGFR. Conclusions: SP-RAPN represents an emerging technique using a novel platform. Initial studies have demonstrated that SP-RAPN is a safe and feasible approach to performing partial nephrectomy, although with inferior outcomes for ischemia time and blood transfusion rates. Further studies will be necessary to define the best usage of SP-RAPN within the surgeon's armamentarium.

Vascularized fibular transfer in longstanding and infected large bone defects.

The reconstruction of large bone defects in the infectious environment is still a big challenge for limb salvage because of disturbance in bacterial flora, bacterial resistance and limitation of blood supply at scarred tissue. This retrospective study was to evaluate long-term outcomes in patients who were performed vascularized fibular transfers for treatment of large bone defects in the infectious environment. The review included 26 patients with an average age of 27 years old. Bone defects were located at the arm in 1 patient, the forearm in 2 patients, the thigh in 6 patients and the leg in 17 patients. The cause of the bone defects included high-energy trauma in 14 cases, chronic osteomyelitis in 7 cases, infected non-union in 5 cases. All patients had had several previous operative procedures. The average length of fibular vascularized graft was 16.6 cm (range, 10-22 cm), and the average size of the associated fasciocutaneous component in 16 patients was 3.6 x 8.5 cm. Three patients had partial necrosis of skin paddle. Three patients, who were stabilized by screw and external fixator, had an infection at the distal part of the fibular graft and pin tracts. 25 fibular grafts (96%) showed complete bone union. This review has showed that the vascularized fibular transfer can be effective for management of large segmental bone defects in the infectious environment.