Hasil untuk "Diseases of the genitourinary system. Urology"

Kajaree Giri, Richard J. Glassock, Fernando C. Fervenza

L. Di Gianfrancesco, F. Marino, D. De Marchi et al.

Nishi Patel, Ridham Patel, Himanshu Patel et al.

Edwar Jassir Rozo Ortiz, Paula Andrea Guerrero Peña, Ledmar Jovanny Vargas Rodríguez et al.

Introducción: el síndrome cardiorrenal se define como la coexistencia de desórdenes entre el corazón y el riñón en la que la alteración de uno causa la disfunción del otro, de forma aguda o crónica. Objetivo: determinar la frecuencia de síndrome cardiorrenal y las características sociodemográficas y clínicas en pacientes hospitalizados con falla cardiaca. Metodología: se realizó un estudio observacional y descriptivo que incluyó pacientes con falla cardiaca que fueron hospitalizados entre el 2018 y el 2021 en un hospital en Boyacá, Colombia. Se incluyeron las variables demográficas, clínicas, diagnósticas y los antecedentes, para la evaluación y el análisis de la información. Resultados: se incluyó a 347 pacientes, donde la frecuencia del síndrome cardiorrenal fue del 10?%, 20,17?% de zona urbana, 16,13?% de sexo masculino, 21,61?% con hipertensión arterial, 9,79?% con diabetes mellitus y 8,64?% con enfermedad pulmonar obstructiva crónica. Las características clínicas fueron: 12,10?% cursaron con insuficiencia cardiaca preservada, 10,08?% con insuficiencia cardiaca reducida y 12,68?% eran del cuadrante de Stevenson estadio C, todos con síndrome cardiorrenal. Conclusiones: el síndrome cardiorrenal es una afectación de origen multicausal, la presentación clínica depende del órgano causante de la disfunción y, típicamente, los pacientes con esta entidad clínica han cursado con alguna descompensación que genera ingresos a hospitalización, cambios en la calidad de vida, peor pronóstico y mortalidad.

Kenji Tsuji, Hiroyuki Nakanoh, Kensaku Takahashi et al.

Rationale & Objective: Assessment of kidney biopsies provides crucial information for diagnosis and disease activity, as well as prognostic value. Kidney-biopsy specimens occasionally contain veno-muscular complex (VMC), which consists of muscle tissues around the kidney venous system in the corticomedullary region. However, the role of VMC and the clinical significance of VMC variants are poorly understood. In the present study, we investigated kidney prognostic values of VMC variants. Study Design: Retrospective cohort study. Setting & Participants: Among 808 patients who underwent a kidney biopsy from 2011 to 2019, 246 patients whose kidney biopsy specimens contained VMC were enrolled. Predictors: VMC variants; inflammatory-VMC (an infiltration of ≥80 inflammatory cells/mm2-VMC area) and VMC hypertrophy (hyper-VMC, a VMC average width ≥850 μm), and the interstitial fibrosis/tubular atrophy (IFTA) score. Outcomes: A decline in estimated glomerular filtration rate (eGFR) ≥40% from the baseline or commencement of kidney replacement therapy. Analytical Approach: Cox proportional hazards model. Results: Among 246 patients with data on VMC, mean baseline eGFR was 56.0±25.6 ml/min per 1.73 m2; 80 had high inflammatory-VMC, and 62 had VMC hypertrophy. There were 51 kidney events over median follow-up of 2.5 years. We analyzed 2 VMC variants. Multivariable logistic regression analysis revealed that eGFR negatively correlated with the presence of both inflammatory-VMC and hyper-VMC. A Cox proportional hazards analysis revealed that inflammatory-VMC (but not hyper-VMC) was independently associated with the primary outcome after adjustments for known risk factors of progression, including proteinuria, eGFR, and the interstitial fibrosis/tubular atrophy (IFTA) score (hazard ratio, 1.97; 95% confidence interval, 1.00-3.91). Limitations: Single-center study and small sample size. Conclusions: Assessment of inflammatory-VMC provides additional kidney prognostic information to known indicators of kidney disease progression in patients who undergo kidney biopsy. Plain-Language Summary: Assessment of kidney biopsies provides crucial information for diagnosis, disease activity, and prognostic value. Kidney-biopsy specimens occasionally contain veno-muscular complex (VMC), which consists of muscle tissues around the kidney venous system. Currently, the role of VMC in kidney health and diseases and the clinical significance of VMC variants are poorly understood. In the present study, we have shown that an infiltration of ≥80 inflammatory cells/mm2-VMC area (inflammatory-VMC) is independently associated with kidney disease progression after adjustments for known risk factors of progression. Therefore, assessment of inflammatory-VMC provides additional kidney prognostic information to known indicators of kidney disease progression in patients who undergo kidney biopsy.

M. Tantari, S. Bogliolo, M. Morotti et al.

Simple Summary The prognosis of cervical cancer is significantly influenced by lymph node involvement. The lymphatic system is the primary way of metastasis for cervical carcinoma, and lymph-vascular space invasion (LVSI) is considered the most important risk factor for pelvic lymph node metastasis (PLNM). Previous studies have not clarified the correlation between lymphangiogenesis and an increased risk of metastasis and tumor recurrence. The evaluation and identification of several markers of lymphangiogenesis may identify patients with high risk of PLNM. Our findings suggest that the lymphatic spread does not required the proliferation of new lymphatic endothelial cells. These results emphasize the importance of pre-existing peritumoral lymphatic vessels in the metastatic process in early cervical cancer. Abstract Background: In patients with cervical cancer, the presence of tumoral lymph-vascular space invasion (LVSI) is the main risk factor for pelvic lymph node metastasis (PLNM). The objective of this study was to evaluate the presence of several markers of lymphangiogenesis in early-stage cervical cancer and their correlation with PLNM and tumoral recurrence. Materials and Methods: Seventy-five patients with early-stage cervical carcinoma underwent sentinel lymph node (SLN) sampling in association with complete pelvic lymph node dissection. Primary tumors were stained with the following markers: Ki67, D2-40, CD31 and VEGF-C. A 3-year follow-up was performed to evaluate the disease-free survival. Results: Overall, 14 patients (18.6%) had PLNM. Positive LVSI was seen in 29 patients (38.6%). There was a significant correlation between LVSI evidenced by H/E staining and PLNM (p < 0.001). There was no correlation between high Ki67, CD31, D2-40, and VEGF-C staining with PLNM or tumor recurrence. Conclusions: Our data support that lymphatic spread does not require the proliferation of new lymphatic endothelial cells in early-stage cervical cancer. These results emphasize the importance of pre-existing peritumoral lymphatic vessels in the metastatic process in early cervical cancer. None of the markers of lymphangiogenesis and proliferation assessed in this study were predictive of PLNM or recurrence.

D. Dona’, C. Montagnani, C. di Chiara et al.

Compared to adults, severe or fatal COVID-19 disease is much less common in children. However, a higher risk for progression has been reported in infants. Different pediatric COVID-19 severity scores are reported in the literature. Methods: Subjects under 90 days of age admitted to 35 Italian institutions for COVID-19 were included. The severity of COVID-19 was scored as mild/moderate or severe/critical following the classification reported in the literature by Venturini, Dong, Kanburoglu, and Gale. To assess the diagnostic accuracy of each classification system, we stratified all enrolled patients developing a posteriori severity score based on clinical presentation and outcomes and then compared all different scores analyzed. Results: We included 216 infants below 90 days of age. The most common symptom was fever, followed by coryza, poor feeding, cough, and gastrointestinal manifestations. According to Venturini, Dong, Kanburoglu, and Gale’s severity scores, 18%, 6%, 4.2%, and 29.6% of infants presented with severe/critical disease, respectively. A correlation analysis between these four scores and the a posteriori severity score assigned to all enrolled subjects was performed, and a crescent strength of correlation from Gale (R = 0.355, p < 0.001) to Venturini (R = 0.425, p < 0.001), Dong (R = 0.734, p < 0.001), and Kanburoglu (R = 0.859, p < 0.001) was observed. Conclusions: The percentage of infants with severe COVID-19 varies widely according to the score systems. A unique clinical score should be designed for neonates and infants with COVID-19.

I. Criado, Wendy G Nieto, Guillermo Oliva-Ariza et al.

Simple Summary Assessment of the status of the immune system in both health and disease requires robust and reliable reference ranges for the different blood leukocyte (sub)populations that take into consideration factors that might influence their distribution, such as age, sex, ethnicity and the presence vs. absence of low-count monoclonal B-cell lymphocytosis with a chronic-lymphocytic-leukemia-like phenotype (MBLlo). It should be noted that despite MBLlo being highly prevalent in the general population and being associated with immune impairment, MBLlo individuals have not been previously excluded in the definition of normal leukocyte ranges. Here, we provide reference cell-count ranges for the major leukocyte populations identified in blood using an optimized and fully validated 8-color flow-cytometry antibody combination based on the largest (n = 706) cohort reported to date of Caucasian adult donors from the general population, grouped by age and sex, and highlight the altered immune profiles associated with MBLlo (622 non-MBL and 84 MBLlo subjects). Abstract Reference ranges of blood-circulating leukocyte populations by, e.g., age and sex, are required for monitoring immune-cell kinetics. Most previous reports in which flow cytometry has been used to define the reference ranges for leukocyte counts included a limited number of donors and/or cell populations and/or did not consider age and sex simultaneously. Moreover, other factors not previously considered in the definition of normal ranges, such as the presence of chronic-lymphocytic-leukemia (CLL)-like low-count monoclonal B-cell lymphocytosis (MBLlo), might also be associated with an altered distribution of leukocytes in blood in association with an immunodeficiency and increased risk of infection and cancer. Here, we established reference cell-count ranges for the major populations of leukocytes in blood of non-MBL and MBLlo adult Caucasians matched by age and sex using the EuroFlow Lymphocyte Screening Tube (LST). A total of 706 Caucasian adult donors—622 non-MBL and 84 MBLlo—were recruited from the general population. Among non-MBL donors, the total leukocyte, neutrophil, basophil dendritic cell and monocyte counts remained stable through adulthood, while the absolute numbers of T- and B-cell populations and plasma cells decreased with age. The number of eosinophils and NK-cell increased over time, with clear differences according to sex for certain age ranges. In MBLlo subjects, few differences in the absolute cell counts by age (vs. non-MBL) were observed, and MBLlo men and women showed similar trends to non-MBL subjects except for the B-cell count drop observed in >70 y-men, which was more pronounced in MBLlo vs. non-MBL controls. Building robust age- and sex-matched reference ranges for the most relevant immune-cell populations in the blood of non-MBL donors is essential to appropriately identify an altered immune status in different clinical settings and highlight the altered immune-cell profiles of MBLlo subjects.

S. Siddi, I. Giné-Vázquez, R. Bailón et al.

Background: Changes in lifestyle, finances and work status during COVID-19 lockdowns may have led to biopsychosocial changes in people with pre-existing vulnerabilities such as Major Depressive Disorders (MDD) and Multiple Sclerosis (MS). Methods: Data were collected as a part of the RADAR-CNS (Remote Assessment of Disease and Relapse Central Nervous System) programme. We analyzed the following data from long-term participants in a decentralized multinational study: symptoms of depression, heart rate (HR) during the day and night; social activity; sedentary state, steps and physical activity of varying intensity. Linear mixed-effects regression analyses with repeated measures were fitted to assess the changes among three time periods (pre, during and post-lockdown) across the groups, adjusting for depression severity before the pandemic and gender. Results. Participants with MDD (N=255) and MS (N=214) were included in the analyses. Overall, depressive symptoms remained stable across the three periods in both groups. Lower mean HR and HR variation were observed between pre and during lockdown during the day for MDD and during the night for MS. HR variation during rest periods also decreased between pre-and post-lockdown in both clinical conditions. We observed a reduction of physical activity for MDD and MS upon the introduction of lockdowns. The group with MDD exhibited a net increase in social interaction via social network apps over the three periods. Conclusions: Behavioral response to the lockdown measured by social activity, physical activity and HR may reflect changes in stress in people with MDD and MS.

Laura Trives-Folguera, David A. Isenberg

DEAR EDITOR, Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis that affects small and medium-sized vessels and is often associated with cytoplasmic ANCA. It usually affects the upper and lower respiratory tract and the kidneys, which, if left untreated, can cause life-threatening organ damage [1]. Although they are the most commonly affected systems, GPA can also involve other organs, including the bladder or skin. Early diagnosis, based on clinical features, laboratory data with ANCA levels and subtype, and histopathology, is important for the timely initiation of immunosuppressive treatment [2]. We describe the rare case of a 66-year-old male diagnosed with GPA because of prostatitis, granulomatosis and cutaneous lesions. A 66-year-old male was referred to the urology service in a community hospital in 2005 because he developed a bladder outflow obstruction and microscopic haematuria. Prostate biopsies revealed ‘inflammatory tissue’, hence he was prescribed CS treatment and was referred to an academic hospital for a second opinion. The biopsies were reviewed and showed ‘extensive ulcerative granulomatous tissue formation and acute and chronic inflammation; areas of microabscesses and foci of granulomatous inflammation with some appearing to be centred on vessel’. He developed an unusual cutaneous lesion on the proximal component of his fourth right finger, which was evaluated by dermatologist. In the letter of referral to our rheumatology department, we were told that the local pathologists had reviewed the biopsy and concluded that it showed evidence of vasculitis. A PR3 ANCA level of 29 UI/ml (normal: <2 UI/ml) was recorded. He was diagnosed with GPA and started immunosuppressive treatment with i.v. methylprednisolone and weekly MTX. He improved rapidly, going into remission from the skin involvement within 3 months. The cANCA became normal during the next 5 years. Given that he was in clinical and serological remission, MTX was stopped in 2012. A few months later, he developed urethral bleeding, and a new biopsy showed activity of the vasculitis that required immunosuppressive treatment with CSs and induction with i.v. CYC. MTX was subsequently reinitiated as maintenance treatment. He remained well during the next 7 years and was able to reduce both MTX and prednisone doses gradually until their cessation in June 2019 and February 2020, respectively. There was a delay in follow-up owing to the coronavirus disease 2019 pandemic, but he was seen again in our clinic in July 2021. Although feeling well in general, he had developed a lesion on his left temple since May 2021 (Fig. 1). An initial biopsy was reported to show non-specific inflammatory changes only, but a deeper one in September 2021 reported chronic inflammation and granulomatous inflammation. In addition, his cANCA increased from 0.6 to 3.1 UI/ml (normal now <2.9 UI/ml). Treatment with prednisone and AZA was prescribed, but he had to stop the latter because of intolerance, and he received two doses of rituximab in October 2021. When reviewed in the clinic in November 2021, he was feeling well and had partial resolution of the temple lesion, without any new symptoms. He has maintained his prednisolone but with a decreasing dose. This report describes a case of GPA presenting with prostatic involvement, which is unusual. The incidence of genitourinary symptoms in this disease is <1%, with few cases described in the literature [3, 4]. It is usually observed at disease onset and as part of generalized systemic disease, with isolated involvement of the urogenital tract being rare [5, 6]. Up to 18% of the cases described had isolated urogenital symptoms with a prior suspicion of malignancy, but later developed signs of generalized GPA. Prostatitis is the most common presentation ( 37% of cases), and the main symptoms are macroscopic haematuria, dysuria and obstructive symptoms [7]. The bladder is the second organ most affected (25% of cases), in which cytoscopy reveals a diffusely thickened bladder, with ulcerations and fibrosis [6, 7]. Furthermore, the skin involvement in our patient is not characteristic of GPA. As described by Micheletti et al. [8], the most frequent cutaneous manifestations in ANCA-associated vasculitis are petechiae/purpura, painful skin lesions and maculopapular rash. Skin involvement is correlated with systemic disease and cANCA positivity [8]. The combination of a single skin lesion and bladder involvement is most unusual in patients with GPA. Prostatic involvement is also rare, but in patients with unexplained prostatitis the possibility of this disease should be considered. Histopathological examination will often be the key to establish a diagnosis of GPA in patients with atypical organ involvement. Key message

Marcio Covas Moschovas, Vipul Patel

ABSTRACT Despite the neuroanatomy knowledge of the prostate described initially in the 1980's and the robotic surgery advantages in terms of operative view magnification, potency outcomes following robotic-assisted radical prostatectomy still challenge surgeons and patients due to its multifactorial etiology. Recent studies performed in our center have described that, in addition to the surgical technique, some important factors are associated with erectile dysfunction (ED) following robotic-assisted radical prostatectomy (RARP). These include preoperative Sexual Health Inventory for Men (SHIM) score, age, preoperative Gleason score, and Charlson Comorbidity Index (CCI). After performing 15,000 cases, in this article we described our current Robotic-assisted Radical Prostatectomy technique with details and considerations regarding the optimal approach to neurovascular bundle preservation.

Sivashankar Meganathan, MBBS, MD Surgery, MRCS (Glasgow), Kanchana Edirisinghe, MBBS, MS Surgery, Agalawatta Asmgbb, (MBBS, MD Surgery)

A 55-year-old healthy lady underwent left side PCNL for a 1.5cm upper ureteric stone. The surgery was straightforward, and the stone was removed by pneumatic lithotripsy. We diagnosed bowel perforation while we were withdrawing the scope at the end of the procedure. Subsequently, she underwent exploratory laparotomy and jejunal perforation was identified, which was repaired primarily. To our knowledge, there were few similar case scenarios in the English literature, therefore we are sharing our experience on diagnosis and management of bowel perforation during PCNLs.

Ruoxin Chen, Liuping Zhang, Mengyan Zhang et al.

Objective Sarcopenia is a common complication in patients with end-stage kidney disease. Insulin resistance is present in non-diabetic patients undergoing maintenance hemodialysis (MHD) and is an important factor leading to sarcopenia. The triglyceride–glucose (TyG) index, a reliable indicator for evaluating insulin resistance, is widely used in clinical practice. The present study investigated the association between the TyG index and sarcopenia in non-diabetic patients undergoing MHD.Methods Relevant clinical data of non-diabetic patients undergoing MHD at our center were collected. The TyG index was calculated using the following formula: ln(fasting triglycerides(mg/dL)×fasting blood glucose(mg/dL)/2). Multivariate logistic regression analyses were used to evaluate the associations. The receiver-operating characteristic curve was used to analyze the predictive value of the TyG index in sarcopenia.Results Of the 142 patients undergoing MHD who were included, 75 (52.82%) were men, the mean age was 54.05 ± 13.97 years, and 40 (28.17%) patients satisfied the diagnostic criteria for sarcopenia. The TyG index of participants with sarcopenia was higher compared with those without sarcopenia (8.83 ± 0.45 vs. 8.49 ± 0.50, p < 0.001). The prevalence of sarcopenia increased with increasing TyG index tertile (T1, 8.51%; T2, 31.91%; T3, 43.75%; p = 0.001). Logistic regression analysis indicated that the TyG index was an independent risk factor for sarcopenia (odds ratio, 4.21 [95% confidence interval, 1.85–9.59], p = 0.001).Conclusion A higher TyG index was associated with an increased risk of sarcopenia in non-diabetic patients undergoing MHD; it may be used as a novel marker to reflect the presence of sarcopenia.

Gülistan Maçin, Hayriye Sarıcaoğlu, Serkan Yazici et al.

Background and Design: This study aimed to investigate the effects of the comorbidities on disease severity and outcomes in pediatric psoriasis patients. Materials and Methods: A total of 366 patients enrolled to the study were &#8804;18 years old and were followed up between January 2013 and December 2017. Age, gender, family history, localization, clinical type, severity, treatments, duration of treatment/response, and comorbidities were retrieved retrospectively. Physician Global Assessment was used for psoriasis severity. All parameters were compared statistically in between groups that patients with or without comorbidities. Statistical significance was accepted p&lt;0.05. Results: Of the 366 patients 62.6% were women, and 37.4% were men. At least one comorbidity was detected in 39.3% of the patients. The most common observed comorbidity was allergic rhinitis (8.1%), and obesity (7.1%) was the second most common. The duration of treatment was higher in patients with comorbidity than in patients without comorbidities, and the duration of the disease was statistically significant (p=0.043). Scalp, face, nail, and palmoplantar involvement was more common in patients with comorbidity than in patients without comorbidity (p&gt;0.05). Those with comorbidity were generally higher in patients with moderate to severe psoriasis (p=0.165). In patients with epilepsy, asthma, allergic rhinitis, and valvular disorders, the clinical manifestation was mild. Biological agent use is statistically higher in comorbidity group (p=0.045). It was found that the rates of complete and partial remission rates were lower, and relapse was higher in the comorbidity group, but this was not statistically significant. Conclusion: In this study, a significant relationship was found between comorbidity and disease duration (p=0.043). Comorbidities in cases of moderate to severe psoriasis and accompanying cases. Our results are compatible with previous literature, which indicates that the key to managing pediatric psoriasis is investigation and recognition of comorbidities.

R. Lapidot, K. Shea, I. Yildirim et al.

Background: Although a substantial decline in vaccine-serotype invasive pneumococcal disease (IPD) incidence was observed following the introduction of pneumococcal conjugate vaccines (PCV), the estimated range of thirteen-valent conjugate vaccine (PCV13) effectiveness for serotype 3 disease is wide and includes zero. We assessed the impact of PCV13 on serotype 3 IPD incidence and disease characteristics in Massachusetts’ children. Methods: Serotype 3 IPD cases in children <18 years old were identified via enhanced passive surveillance system in Massachusetts. We compared incidence rates and characteristics of IPD cases before and after PCV13. Results: A total of 47 serotype 3 IPD cases were identified from 2002 to 2017; incidence of serotype 3 IPD in the years following PCV13 was 0.19 per 100,000 children compared to 0.21 before PCV 13, incidence rate ratio (IRR) = 0.86 (95% CI 0.47–1.57). The majority (78%) of post-PCV13 serotype 3 IPD cases occurred among fully vaccinated children. Age distribution, clinical syndrome and presence of comorbidities among serotype 3 IPD cases were similar before and after PCV13 introduction. There was no association between the date of the last PCV13 dose and time to IPD to suggest waning of immunity. Conclusions: seven years following PCV 13 we found no significant changes in serotype 3 IPD incidence or disease characteristics in children in Massachusetts.

D. Surasi, Xuemei Wang, T. Bathala et al.

The Coronavirus disease 2019 (COVID-19) pandemic has significantly affected health care systems throughout the world. A Qualtrics survey was targeted for radiologists around the world to study its effect on the operations of prostate MRI studies and biopsies. Descriptive statistics were reported. A total of 60 complete responses from five continents were included in the analysis. 70% of the responses were from academic institutions. Among all participants, the median (range) number of prostate MRI was 20 (0, 135) per week before the COVID-19 pandemic versus 10 (0, 30) during the lockdown period; the median (range) number of prostate biopsies was 4.5 (0, 60) per week before the COVID-19 versus 0 (0, 12) during the lockdown period. Among the 30% who used bowel preparation for their patients prior to MRI routinely, 11% stopped the bowel preparation due to the pandemic. 47% reported that their radiology departments faced staff disruptions, while 68% reported changes in clinic schedules in other clinical departments, particularly urology, genitourinary medical oncology, and radiation oncology. Finally, COVID-19 pandemic was found to disrupt not only the clinical prostate MRI operations but also impacted prostate MRI/biopsy research in up to 50% of institutions. The impact of this collateral damage in delaying diagnosis and treatment of prostate cancer is yet to be explored.

Chutatip Limkunakul, Benjawan Srisantithum, Yotin Lerdrattanasakulchai et al.

Background Worsening renal function (WRF) occurs in approximately 25% of acute heart failure patients, and both baseline characteristics and heart failure treatment may increase the risk of WRF. This study aimed to evaluate additional risk factors for WRF in acute heart failure, particularly those related to heart failure treatment. Methods This was a retrospective, observational, analytical study. The inclusion criteria were age 18 years or over, hospital admission due to acute heart failure, and having undergone at least two serum creatinine tests during admission. The eligible patients were classified into two groups: WRF and non-WRF. Predictors for WRF (including treatment parameters) were determined using logistic regression analysis. Results During the study period, there were 301 eligible patients who met the study criteria. Of those, 82 (27.24%) had WRF. There were two independent factors associated with WRF occurrence: baseline diastolic blood pressure and beta blocker treatment, with adjusted odds ratios (95% confidence interval) of 1.060 (1.008, 1.114) and 0.064 (0.006, 0.634), respectively. The Hosmer-Lemeshow Chi square for the final model was 6.11 (p = .634).   Conclusions After examining several heart failure treatments and baseline factors, we found that beta blocker treatment results improvement in kidney function.

Julie W. Cheng, Jonathan Maldonado, Ruth E. Belay et al.

Objective: To demonstrate a minimally-invasive method for excision of retrocrural masses. The patient was a 31-year-old male with mixed germ cell testicular cancer underwent left radical orchiectomy, chemotherapy, and open extraperitoneal retroperitoneal lymph node dissection (eRPLND), presented with recurrent disease two years later. Surveillance imaging demonstrated three enlarging retrocrural masses in the setting of normal tumor markers. Methods: The patient was placed in a reverse Trendelenburg position. The liver was retracted. Laparoscopic abdominal inspection demonstrated no adhesions as a benefit of his prior eRPLND. The da Vinci XI robot was docked, the gastrohepatic ligament and short gastric vessels were identified and divided. The stomach and gastro-esophageal junction were identified. The esophagus was mobilized at the level of the diaphragmatic crura before being retracted anterolaterally. The peritoneum was dissected and the diaphragmatic crura was split longitudinally. The larger mass was dissected off of the vena cava and aorta. Lumbar vessels and lymphatics were clipped. Additional inferior dissection was performed to excise the remaining two masses that were adjacent to the celiac artery. The diaphragmatic hiatus was repaired with interrupted sutures. Following closure, esophagogastroduodenoscopy identified viable esophageal mucosa without stricture or evidence of perforation. A drain was placed in the retrocrural fossa. Estimated blood loss was 50 mL. Results: Expected small bilateral pneumothoraces resolved by postoperative day (POD) 2. The drain was removed and the patient was discharged home on POD 2. Final pathology demonstrated metastatic mature teratoma in 3 of 3 nodes with the largest tumor measuring 4.4 cm. The patient has since continued surveillance with no evidence of disease. Conclusions: This video demonstrates the surgical benefits of eRPLND in facilitating reoperation in the abdomen. Furthermore, this video ultimately demonstrates an innovative, minimally-invasive method of removing teratomatous tumors from the retrocrural space through a robotic transabdominal approach.

Shamim Hossain, M. A. Salam, Muhammed Serajul Islam et al.

A. Harada, H. Ueshima, Yuki Kinoshita et al.