Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database.

PURPOSE: To evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery. MATERIALS AND METHODS: From the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016-2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed. RESULTS: The 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN. CONCLUSIONS: Conservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of stay.

Effectiveness of a vision-based handle trajectory monitoring system in studying robotic suture operation.

Data on surgical robots are not openly accessible, limiting further study of the operation trajectory of surgeons' hands. Therefore, a trajectory monitoring system should be developed to examine objective indicators reflecting the characteristic parameters of operations. 20 robotic experts and 20 first-year residents without robotic experience were included in this study. A dry-lab suture task was used to acquire relevant hand performance data. Novices completed training on the simulator and then performed the task, while the expert team completed the task after warm-up. Stitching errors were measured using a visual recognition method. Videos of operations were obtained using the camera array mounted on the robot, and the hand trajectory of the surgeons was reconstructed. The stitching accuracy, robotic control parameters, balance and dexterity parameters, and operation efficiency parameters were compared. Experts had smaller center distance (p < 0.001) and larger proximal distance between the hands (p < 0.001) compared with novices. The path and volume ratios between the left and right hands of novices were larger than those of experts (both p < 0.001) and the total volume of the operation range of experts was smaller (p < 0.001). The surgeon trajectory optical monitoring system is an effective and non-subjective method to distinguish skill differences. This demonstrates the potential of pan-platform use to evaluate task completion and help surgeons improve their robotic learning curve.

Comparison of surgical procedures for benign prostatic hyperplasia of medium-volume prostates: evaluation of the causes of rehospitalization from the French National Hospital Database (PMSI-MCO).

PURPOSE: In France, transurethral resection of the prostate (TURP) is still the most commonly used surgical treatment for medium sized benign prostatic hyperplasia (BPH), but the Holmium Laser Enucleation of the Prostate (HoLEP) and laser vaporization procedures are becoming more common. For these three surgical procedures, we evaluate the initial complications, the short term (3 months) and the 4-12-month postoperative complications necessitating re-hospitalization. METHODS: From the French national hospital data base (PMSI-MCO), all hospitalizations for BPH treatment in 2018 were extracted. We document the complications during the initial hospitalization and any subsequent rehospitalizations during the one-year postoperative period. RESULTS: In 2018, 67,220 patients were treated for BPH: 46,242 TURP, 13,509 HoLEP and 7469 laser vaporization. Age and anticoagulation medications were similar for men treated by the three procedures, but TURP patients were more often hypertensive. Infections and hemorrhagic complications were the most common complications at the initial hospitalization: 17%, 10%, 13% for infections and 15%, 8.1%, 11% for hemorrhagic complications respectively, and TURP performed worse than the other two procedures at the initial hospitalization. During the first three months and then the subsequent nine months, there were fewer complications than initially, with little difference between the three procedures, all differences being less than 1%. CONCLUSION: Laser vaporization techniques led to fewer complications. However, the PMSI-MCO only registers complications during hospitalizations. This study should be extended to non-hospitalized, more minor complications.

Evaluation of continuous wound infusion with local analgesics in postoperative renal transplantation patients: A retrospective study.

Objectives: The objective is to evaluate the efficacy of the continuous wound infusion (CWI) with Ropivacaine (naropeine 2 mg/ml) on postoperative pain, analgesics consumption, and bowel function in renal transplantation patients. Materials and Methods: A retrospective study trial including 79 patients who underwent renal transplantation. Patients were separated into two groups (catheter or without catheter). We identified 52 (65.8%) patients who received catheter wound infusion during the first 48 h postoperatively. On the other hand, 27 (34.1%) patients received standard without catheter anesthetic technique. Catheter wound infusion was achieved through a 12 cm catheter, inserted subcutaneously after abdominal closure. The catheter was placed above the external oblique aponeurosis. All postoperative data were examined to evaluate the first postoperative 48 h. This study aims to assess three variables: postoperative pain analysis through a visual analog scale, analgesics consumption, and bowel function. Results: The overall score of the three variables was studied. Regarding pain assessment, we have determined that the group of patients with catheter scored better than patients without catheter with borderline significance (66.3 vs. 61.2 consecutively; P = 0.0843). An early bowel function was noted in patients with catheters on the 2nd postoperative day (P = 0.0209). Moreover, patients without catheter consumed more painkillers with nonsignificant difference (P = 0.2499). Conclusion: Patients with catheter showed earlier bowel function than the noncatheter group on the 2nd postoperative day. The catheter group had better pain evaluation.

Exploring the use of driving simulation to improve robotic surgery simulator training: an observational case-control study.

The correlation between driving skills and the ability to perform robotic surgery have not yet been discussed. Therefore, this study aimed to investigate the impact of driving skills on learning robotic surgery using a driving simulator and a robotic simulator. Sixty robot- and simulator-naïve participants were recruited: 30 with a driver's license and 30 without a driver's license. All participants completed a test on the driving simulator and learned four tasks using a robotic surgical simulator (dV-Trainer). On the driving simulator, the lap time in the driver's license group (D-Group) was significantly lower than that in the non-driver's license group (ND-Group) [217.93 ± 42.79 s vs. 271.24 ± 46.63 s, P < 0.001]. The average number of tires off track in the D-Group was lower than that in the ND-Group (0.13 ± 0.35 vs. 0.57 ± 0.63, P = 0.002). The baseline score of the D-Group on the robotic simulator was higher than that of the ND-Group (467.53 ± 107.62 vs. 385.53 ± 136.30, P = 0.022). In the Pick-and-Place-Clutching, Peg-Board-2, and Thread-the-Rings-1 tasks, the learning curve of the D-Group was steeper than that of the ND-Group. However, no significant difference was observed in the Match-Board-2 task. According to the lap time ranking, participants in the top tertile had a steeper learning curve than those in the bottom tertile, especially for the Pick-and-Place-Clutching and Peg-Board-2 tasks (P < 0.05). Significant differences were also found in the baseline and final stages of the Thread-the-Rings-1 task and in the initial stage of the Match-Board-2 task (P < 0.05). Students with a driver's license or better performance in racing games had more success in learning robotic surgery. Driving simulators may promote robotic surgery training.

Robot-assisted vesicovaginal fistula repair: comparison of the extravesical and transvesical techniques.

INTRODUCTION AND OBJECTIVES: Almost two decades after the description of robotic vesicovaginal fistula repair (R-VVF), the literature remains limited. The aims of this study are to report the outcomes of R-VVF and to compare the transvesical versus extravesical techniques. METHODS: We performed an observational, retrospective, multicenter study, including all patients who underwent R-VVF from March 2017 to September 2021 at four academic institutions. All abdominal VVF repair over the study period were performed using a robotic approach. The success of R-VVF was defined as the absence of clinical recurrence. The outcomes of the extravesical versus transvesical techniques were compared. RESULTS: Twenty-two patients were included. The median age was 43 years old (IQR 38-50). Fistulas were supratrigonal and trigonal in 18 and 4 cases respectively. Five patients had undergone previous attempts of fistula repair (22.7%). The fistulous tract was systematically excised, and an interposition flap was used in all but two cases (90.9%). The transvesical and extravesical techniques were used in 13 and 9 cases respectively. There were four postoperative complications, three minor and one major. None of the patients had vesicovaginal fistula recurrence after a median follow-up of 15 months. CONCLUSIONS: The present series, one of the largest R-VVF reported to date, is consistent with the few series already published with a 100% cure rate. Systematic excision of the fistulous tract and the high rate of flap interposition may explain the high success rate. The transvesical and extravesical approaches yielded similar outcomes.

Cost-effectiveness of robotic-assisted surgery vs open surgery in the context of partial nephrectomy for small kidney tumors.

To evaluate the cost-effectiveness of robotic-assisted surgery compared to open surgery in the context of partial nephrectomy for small kidney tumor management. This is a retrospective study using data from 395 patients operated on by either robot-assisted surgery (RAPN) or by open partial nephrectomy (OPN); one hospital performed RAPN exclusively and the second hospital, OPN exclusively. Cost-effectiveness analysis was conducted from the perspective of the National Health Insurance System (NHIS) by considering the costs of the initial hospital stay and the cost of complications. Clinical outcome was defined by the avoidance of major complications during the 12 months postoperatively. Major complications were absent in 82% of patients in the OPN group and 93% of patients in the RAPN group, with 11% in favor of robotic assistance (p < 0.001). The average cost per patient, including the costs of complications, were, respectively, 9637 € and 8305 € for the OPN and RAPN groups. Robotic assistance was associated with a 1332 € lower cost (p < 0.001). The incremental cost-effectiveness ratio (ICER) is estimated at - 12,039 €. From the perspective of the public payer, robotic assistance was associated with a lower rate of postoperative complications and a lower average cost per patient. Robotic-assisted surgery was an efficient alternative to open surgery in partial nephrectomy. Trial registration number: NCT05089006 (October 22, 2021).

Impact of paternal age on assisted reproductive technology outcomes and offspring health: a systematic review.

BACKGROUND: The increase in paternal age and the percentage of births after assisted reproductive technologies (ART) may have consequences on offspring and society's position regarding access to ART must be questioned. Most countries recommend limiting ART to men under 60 years. What is the rationale for this threshold? OBJECTIVE: This systematic review assesses scientific arguments to establish links between paternal age, male fertility, and offspring health. MATERIAL AND METHODS: Using the PRISMA guidelines, this systematic review of the literature analyzed 111 articles selected after screening PubMed, ScienceDirect, and Web of Science for articles published between January 1, 1995 and December 31, 2021. RESULTS: A strong correlation was highlighted between advanced paternal age and a decrease of some sperm parameters (semen volume and sperm motility) and infant morbidity (exponentially increased incidence of achondroplasia and Apert syndrome, and more moderately increased incidence of autism and schizophrenia). The impact of paternal age on pregnancy and fetal aneuploidy rates is more controversial. No association was found with spontaneous abortion rates. DISCUSSION AND CONCLUSION: The scientific parameters should be explained to older parents undergoing ART. And for countries that discuss a limit on paternal age for access to ART, the debate requires consideration of social and ethical arguments.

Clinical and oncological outcomes of open partial nephrectomy versus robot assisted partial nephrectomy over 15 years.

Partial nephrectomy (PN) is the gold standard surgical treatment for localized kidney cancer. The objective of our study was to compare clinical and perioperative outcomes of open partial nephrectomy (OPN) and robotic-assisted partial nephrectomy (RAPN). We retrospectively collected all patients who underwent PN for kidney cancer between 2007 and 2019 at two French academic urology departments. Clinical and perioperative outcomes and complications were compared between the OPN group and the RAPN group. Recurrence-free survival (RFS) and overall survival (OS) were compared using the log-rank test. We included 405 patients. The maximum follow-up time was 13.6 years in the OPN group and 7.1 years in the RAPN group. The OPN group was associated with more blood loss and longer hospital stay (respectively, 287 ml vs. 62.1 ml; p < 0.001 and 8.54 days vs. 4.96 days; p < 0.001). Ischemia time was shorter in the OPN group (11.4 min vs. 16.9 min; p < 0.001). The rate of complications during hospitalization and after discharge from hospital was higher in the OPN group (respectively, n = 51 vs. 30; p = 0.031 and n = 31 vs. 14; p < 0.001). RFS and OS were similar in both groups. In our study, RAPN has better perioperative outcomes with shorter hospital stay and less blood loss but also fewer early and late complications. However, we did not find any difference in terms of RFS and OS.

Updated National Study of Functional Graft Renal Cell Carcinomas: Are They a Different Entity?

OBJECTIVE: To analyze de novo graft carcinoma characteristics from our updated national multicentric retrospective cohort. METHODS: Thirty-two transplant centers have retrospectively completed the database. This database concerns all kidney graft tumors including urothelial, and others type but excludes renal lymphomas over 31 years. RESULTS: One hundred and fifty twokidney graft carcinomas were diagnosed in functional grafts. Among them 130 tumors were Renal Cell Carcinomas. The calculated incidence was 0.18%. Median age of the allograft at diagnosis was 45.4 years old. The median time between transplantation and diagnosis was 147.1 months. 60 tumors were papillary carcinomas and 64 were clear cell carcinomas. Median tumor size was 25 mm. 18, 64, 21 and 1 tumors were respectively Fuhrman grade 1, 2, 3 and 4. Nephron sparing surgery (NSS) was performed on 68 (52.3%) recipients. Ablative therapy was performed in 23 cases (17.7%). Specific survival rate was 96.8%. CONCLUSION: This study confirmed that renal graft carcinomas are a different entity: with a younger age of diagnosis; a lower stage at diagnosis; a higher incidence of papillary subtypes.

Evaluation and understanding of automated urinary stone recognition methods.

OBJECTIVE: To assess the potential of automated machine-learning methods for recognizing urinary stones in endoscopy. MATERIALS AND METHODS: Surface and section images of 123 urinary calculi (109 ex vivo and 14 in vivo stones) were acquired using ureteroscopes. The stones were more than 85% 'pure'. Six classes of urolithiasis were represented: Groups I (calcium oxalate monohydrate, whewellite), II (calcium oxalate dihydrate, weddellite), III (uric acid), IV (brushite and struvite stones), and V (cystine). The automated stone recognition methods that were developed for this study followed two types of approach: shallow classification methods and deep-learning-based methods. Their sensitivity, specificity and positive predictive value (PPV) were evaluated by simultaneously using stone surface and section images to classify them into one of the main morphological groups (subgroups were not considered in this study). RESULTS: Using shallow methods (based on texture and colour criteria), relatively high sensitivity, specificity and PPV for the six classes were attained: 91%, 90% and 89%, respectively, for whewellite; 99%, 98% and 99% for weddellite; 88%, 89% and 88% for uric acid; 91%, 89% and 90% for struvite; 99%, 99% and 99% for cystine; and 94%, 98% and 99% for brushite. Using deep-learning methods, the sensitivity, specificity and PPV for each of the classes were as follows: 99%, 98% and 97% for whewellite; 98%, 98% and 98% for weddellite; 97%, 98% and 98% for uric acid; 97%, 97% and 96% for struvite; 99%, 99% and 99% for cystine; and 94%, 97% and 98% for brushite. CONCLUSION: Endoscopic stone recognition is challenging, and few urologists have sufficient expertise to achieve a diagnosis performance comparable to morpho-constitutional analysis. This work is a proof of concept that artificial intelligence could be a solution, with promising results achieved for pure stones. Further studies on a larger panel of stones (pure and mixed) are needed to further develop these methods.

Minimally Invasive and Open Donor Nephrectomy: Lessons Learned From a French Multicenter Experience.

BACKGROUND: We evaluated different techniques of donor nephrectomy. METHODS: Outcomes of 4 surgical approaches (open surgery [OS], standard laparoscopy [SL], hand-assisted laparoscopy [HAL], and robot-assisted la`paroscopy [RAL]) were compared. RESULTS: A total of 264 nephrectomies were performed: 65 in the OS group, 65 in the SL group, 65 in the HAL group, and 69 in RAL group. Operative time was longer for the RAL group (P < .001) with a mean time of 202 minutes (RAL), 182 minutes (OS), 173 minutes (SL), and 157 minutes (HAL). Complications (P = .002) and consumption of morphine derivates (P = .31) were lower for the RAL group (P = .0002). The visual analog scale pain scores (P = .002), hospital stay (P = .023), and time to return to full activities (P = .79) were higher for OS. CONCLUSIONS: The 4 different nephrectomy surgical approaches had similar favorable results. The robot-assisted technique presented as an alternative option, with low incidence of complications, less pain, and results comparable to the other techniques.

Robot-assisted radical prostatectomy training: Description of a canine cadaveric model.

BACKGROUND: Assess the relevance of a canine model in robot-assisted radical prostatectomy (RARP) training. METHODS: Step-by-step RARP was performed in five dog cadavers using a Da Vinci Si® Surgical Robot (Intuitive Surgical, Inc.). The steps were defined according to the RARP score, a validated training tool describing 17 key steps and four levels of difficulty; each step was scored to reflect the anatomical and technical similarities, realism of dissection, and face validity of the canine model compared to the human procedure. RESULTS: Fourteen steps were performed during each procedure. Face validity was scored as high or very high for five of the nine steps of difficulty levels 1 and 2 as well as five of the eight steps of difficulty levels 3 and 4, especially nerve preservation, vesicourethral anastomosis and lymph node dissection. CONCLUSIONS: The cadaveric canine model seems to be a realistic and relevant training model for key steps of RARP.

Role and Training of the Bedside Surgeon in Robotic Surgery: A Survey Among French Urologists-in-Training.

INTRODUCTION: Due to the development of robotic surgery, surgeons operating at the console are physically separated from the patient. They must rely on help from an assistant, also called bedside surgeon. This study aimed to investigate the habits and practices of French urologic residents when performing this role and to determine whether they expected specific training to qualify as bedside surgeons. MATERIALS AND METHODS: A web-based survey was sent to French urology residents and fellows using the mailing-list of the French Association of Urologists in Training (AFUF). RESULTS: Over a 3-month period, 86 residents and fellows responded to the survey. Seventy-five (87.2%) thought that an experience as bedside surgeon was useful to acquire console surgeon status and, more specifically, 48.2% of them indicated that this former experience was vital. Nearly 64% considered that learning robotic surgery was essential during residency and fellowship. Overall, 91.9% believed that bedside surgeons should receive a formal training. They were 69.7% to need 5 to 10 procedures to feel confident as bedside surgeon. Almost 75% underwent laparoscopic training on simulators. Having access to a surgery school significantly increased the probability of receiving laparoscopic training on simulators (p = 0.0033). CONCLUSION: French urology residents and fellows expect a specific training program for bedside surgeons to increase their level of confidence and to get familiar with the device during their first robotic procedures. For them, a bedside surgeon program on a regional/national level would be required.

Assessing deep learning methods for the identification of kidney stones in endoscopic images.

Knowing the type (i.e., the biochemical composition) of kidney stones is crucial to prevent relapses with an appropriate treatment. During ureteroscopies, kidney stones are fragmented, extracted from the urinary tract, and their composition is determined using a morpho-constitutional analysis. This procedure is time-consuming (the morpho-constitutional analysis results are only available after several weeks) and tedious (the fragment extraction lasts up to an hour). Identifying the kidney stone type only with the in-vivo endoscopic images would allow for the dusting of the fragments and eneable early treatments, while the morpho-constitutional analysis is ready. Only few contributions dealing with the in vivo identification of kidney stones have been published. This paper discusses and compares five classification methods including deep convolutional neural networks (DCNN)-based approaches and traditional (non DCNN-based) ones. Even if the best method is a DCCN approach with a precision and recall of 98% and 97% over four classes, this contribution shows that an XGBoost classifier exploiting well-chosen feature vectors can closely approach the performances of DCNN classifiers for a medical application with a limited number of annotated data.

Robot-Assisted Cystectomy and Ileal Conduit for Neurogenic Bladder: Comparison of Extracorporeal vs Intracorporeal Urinary Diversion.

Objectives: The aim of the present study was to compare the perioperative outcomes of extracorporeal (EXTRA) vs intracorporeal (INTRA) urinary diversion in patients undergoing robotic cystectomy and ileal conduit for neurogenic bladder. Methods: All consecutive patients who underwent robot-assisted cystectomy and ileal conduit for neurogenic bladder in six centers between 2011 and 2020 were included in a retrospective study. Four centers performed exclusively INTRA urinary diversion all over the study period, one center performed exclusively EXTRA urinary diversion, and the last center performed EXTRA urinary diversion during a first period and INTRA during the subsequent period. Results: Ninety-seven patients were included: 66 in the EXTRA group and 31 in the INTRA group. There were 11 major (Clavien grade ≥3) postoperative complications in the overall population (11.3%) with no statistically significant difference between both groups (EXTRA = 12.1% vs INTRA = 9.7%; p = 0.99). The mean length of stay did not differ significantly between INTRA and EXTRA (13.1 vs 14.1 days; p = 0.44). The mean times to oral feeding and to return of bowel function were similar in the two groups (3.9 vs 3.5 days; p = 0.28 and 4.1 vs 4.1 days; p = 0.51, respectively). There was no incisional hernia in the INTRA group vs five in the EXTRA group (0% vs 7.6%; p = 0.17). Conclusion: The perioperative morbidity of robotic cystectomy and ileal conduit for neurogenic bladder appears to be relatively limited compared with the historical open series. Possibly due to the relatively small sample size, no difference was found between INTRA and EXTRA urinary diversion in terms of perioperative outcomes.

Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study.

BACKGROUND: Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery. METHODS: This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients. RESULTS: Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = - 0.92, p < 0.001) but was not correlated with the surgeon's experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics. CONCLUSION: Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.

Towards an automated classification method for ureteroscopic kidney stone images using ensemble learning.

Urolithiasis is a common disease around the world and its incidence has been growing every year. There are various diagnosis techniques based on kidney stone identification aiming to find the formation cause. However, most of them are time consuming, tedious and expensive. The accuracy of the diagnosis is crucial for the prescription of an appropriate treatment that can eliminate the stones and diminish future relapses. This paper presents two effective supervised learning methods to automate and improve the accuracy of the classification of kidney stones; as well as a dataset consisting of kidney stone images captured with ureteroscopes. In the proposed methods, the image features that are visually exploited by urologists to distinguish the type of kidney stones are analyzed and encoded as vectors. Then, the classification is performed on these feature vectors through Random Forest and ensemble K Nearest Neighbor classifiers. The overall classification accuracy obtained was 89%, outperforming previous methods by more than 10%. The details of the classifier implementation, as well as their performance and accuracy, are presented and discussed. Finally, future work and improvements are proposed.

Metal-Metal Hip Prosthesis and Kidney Cancer: Assumed Role of Chromium and Cobalt Overload.

BACKGROUND The case of a patient with bilateral renal cancers diagnosed at 94 and 120 months after metal-on-metal hip placement may serve as a warning. It suggests that there may be a need for kidney echography observation of patients with similar types of prostheses. CASE REPORT A 61-year-old woman received a metal-on-metal hip prosthesis for degenerative arthritis in January 2007. In November 2014, after bleeding from the renal tract, she was diagnosed with clear cell carcinoma of the right kidney. When she returned to her orthopaedic surgeon 1 year later, a blood test showed a serum cobalt level that exceeded the French medical agency recommendation. After the patient's metallic acetabulum was replaced in September 2015, her blood cobalt level fell. However, in February 2017, she was diagnosed with adenocarcinoma of the left kidney. Laser-induced breakdown spectroscopy (LIBS) showed cobalt, chromium, and silica overload in both the patient's kidneys despite the drop in serum levels. CONCLUSIONS In this case, exposure to a cobalt-chromium implant with high particulate wear, LIBS results showing chromium overload of the kidneys, diagnosis of renal cancer at 7 years, 10 months and 10 years in a patient with a metal-on-metal hip prosthesis suggests that there may be a causal relationship between the implant, carcinogenic chromium intoxication, and development of renal cancer.

Concurrent, face, content, and construct validity of the RobotiX Mentor simulator for robotic basic skills.

OBJECTIVES: To assess several criteria, such as concurrent, face, content, and construct validity of the RobotiX Mentor (RXM) simulator for basic robotic skills and to compare virtual and actual dry lab dome. METHODS: A prospective study was conducted from December 2017 to May 2018 using RXM and a da Vinci Si robot. 37 subjects, divided into three groups according to their initial surgical training (expert, intermediate, and novice), were evaluated in terms of six representative exercises of basic robotic specific skills as recommended by the fundamentals of robotic surgery. RESULTS: There was a correlation between the automatic data from the RXM and the subjective evaluation with the robot. The face and content validity, which were evaluated by the experts, were generally considered high (71.5% and 62.5%, respectively). Three levels (analysis of variance [ANOVA]; P = .01) and two levels (P = .001) of experience were clearly identified by the simulator. CONCLUSION: Our study proves the concurrent validity and confirms the face, content, and construct validity of the RXM.