Robot-assisted laparoscopic ureterolysis: case report and literature review of the minimally invasive surgical approach.

OBJECTIVES: To evaluate our case of robot-assisted ureterolysis (RU), describe our surgical technique, and review the literature on minimally invasive ureterolysis. METHODS: One patient managed with robot-assisted ureterolysis for idiopathic retroperitoneal fibrosis was identified. The chart was analyzed for demographics, operative parameters, and immediate postoperative outcome. The surgical technique was assessed and modified. Lastly, a review of the published literature on ureterolysis managed with minimally invasive surgery was performed. RESULTS: One patient underwent robot-assisted ureterolysis at our institution in 2 separate settings. Operative time (OR) decreased from 279 minutes to 191 minutes. Estimated blood loss (EBL) was less than 50 mL. The patient has been free of symptoms and both renal units are unobstructed. According to the published literature, 302 renal units underwent successful laparoscopic ureterolysis (LU), and 6 renal units underwent RU. There were 9 open conversions (all in LU). Mean OR in LU was 248 minutes for unilateral and 386 minutes for bilateral cases. In RU, mean OR was 220 minutes for unilateral and 390 minutes for bilateral cases. EBL averaged 200 mL in LU and 30 mL in RU. CONCLUSIONS: Our data reveal that robot-assisted ureterolysis is safe and feasible. Published data demonstrate the advantages of minimally invasive surgery.

Status of robot-assisted radical cystectomy.

PURPOSE: Robot-assisted radical cystectomy (RARC) is an alternative approach for treatment of bladder cancer. We provide a critical review of the current status of RARC and pelvic lymph node dissection with a focus on feasibility, safety and oncological efficacy of the procedure. MATERIALS AND METHODS: The PubMed literature database was reviewed for RARC series that have been reported in the English language until the present time. Surgical technique, operative parameters, pathologic outcome, complications and quality of life were examined. RESULTS: RARC is progressing steadily. With nearly 500 published cases worldwide, RARC proves to be technically feasible and oncologically effective. It is associated with less blood loss, shorter hospital stay, and improved postoperative quality of life. Intracorporeal urinary diversion is still in the experimental phase, and effort is needed to make it technically easier and widely accepted. CONCLUSIONS: With the worldwide rapid spread of robot-assisted surgeries, RARC is evolving as a reliable minimally invasive alternative to standard open surgery. Awaiting long term oncological results, adequately powered prospective randomized trials comparing open, laparoscopic and robotic approaches are urgently needed.

Characterization of GPIT-1 and GPIT-2, two auxiliary components of the Neurospora crassa GPI transamidase complex.

The glycosylphosphatidylinositol (GPI) transamidase contains five known subunits and functions in the lumen of the ER to produce GPI-anchored proteins. The transamidase cleaves proteins containing a GPI anchor attachment signal at their C terminus and generates an amide bond between the newly generated carboxyl terminus of the protein and a GPI anchor. We have identified and characterized GPIT-1 and GPIT-2, two of the transamidase subunits from Neurospora crassa. GPIT-1 and GPIT-2 are homologs of the human PIG-T and PIG-U transamidase subunits respectively. We demonstrated that GPIT-2 is required for the addition of GPI anchors onto GPI-anchored proteins. We employed the Neurospora RIP (repeat-induced point mutation) phenomenon to generate 106 "noncritical" amino acid changes in GPIT-1 and 84 "noncritical" amino acid changes in GPIT-2. We used the data to evaluate three-dimensional models for the structures of GPIT-1 and GPIT-2. The mutational data for GPIT-1 is consistent with a multiple-blade propeller structure containing a central channel. The mutational analysis for GPIT-2 supports a structural model based on the karyopherin alpha subunit.