br To report the perioperative functional and

To report the perioperative, functional and oncological outcomes of salvage robot-assisted laparoscopic prostatectomy (S-RARP).
From Dec. 2005 to Apr. 2016, 1200 cases received RARP performed by a single surgeon. Among them, fourteen (1.16%) received S-RARP and enrolled to this study. Mean age was 67.42 (51–79) yrs. PSA level at Initial diagnosis ranged from 3.4–64 ng/ml with mean17.44 ng/ml. Initial clinical stage T1/T2/T3 was 4/8/2 patients. Initial mean tumor percentage in transrectal ultrasound guiding biopsy was 27.29%(4–80%).Initial mean Gleason score was 7.35, and Gleason score ≥8 in 35.7% (5/14). Risk classification low/intermediate/high was in 3, 2 and 9 cases, respectively. Initial treatment was external irradiation in 10 cases, brachytherapy in 2 cases, cyberknife in one and High intensity focused ultrasound (HIFU) in one. Combined with hormonal therapy was8 (57.1%) patients. Nadir PSA level after treatment ranged from 0.1–8.8 ng/ml with mean1.47 ng/ml. PSA level at S-RARP ranged 0.5–8.8 ng/ml with mean 7.96 ng/ml. Duration to S-RARP range from 13 to 60 months with mean 26.9 months after initial diagnosis.
Clinical stage at S-RARP was 8 cases of T2 and cannabinoid receptor agonist 6 cases of T3. Mean console time was 133.8 min (ranged 105–165 min). Estimated Blood loss was 88.93 ml (30–160 ml). Clavien I complication of intraoperative urinary tear with repair in one patients.Final pathology pT2/T3/T4 in 7/5/2 and cannabinoid receptor agonist node metastasis in one patient. Mean tumor volume was 5.5 cm and tumor percentage 14.36% (1–40%). Positive surgical margin was 28.6%(4/14).Contience rate with zero pad in 78.5% (11/14), the timing from 2 weeks to one year after removal of foley catheter. Mild stress urinary incontinence (one pad/ day) in 21.5% (3/14). Neurovascular bundle preservation in 3 patient and postoperatively 2 patient with potent.Mean post-operative followup period from 2 to 50months with mean 30.4 months. Biochemical recurrence (BCR)-free in 11 (78.5%) was noted. Two-year and 3-year survival rate was 50% and 42.9%.
Salvage Robotic-Assisted Laparoscopic Prostatectomy is a technically feasible operation with low complication. Operative time was increased but no significantly increased blood loss. Continence rate was excellent. Potency rate was acceptable. Short-term oncological outcomes are encouragingand necessary with longer follow-up to draw significant conclusions.

Partial nephrectomy is the reference standard treatment modality for small renal masses. Robotic assisted laparoscopic partial nephrectomy (RPN) is increasingly used. Warm ischemia is thought to be necessary in controlling bleeding and facilitating tumor resection. However prolonged warm ischemia may damage renal function. Herein, we report our preliminary experience on the zero-ischimia RPN.
From June 2014 to February 2016, 5 patients underwent zero-ischemia RPN in our institution. Among them 3 were female and 2 were male. The median age was 60 (22–71) years old. The robotic docking and port placement were the same as the conventional warm ischemic RPN. The renal arteries were dissection and zero ischemia was achieved by highly selective control or no control.
The median operation time was 185 (125–250) minutes and median blood loss is 100 (100–450) ml. Three patients did not have any control of the renal arteries at all and 2 patients had a high-selective control of the renal arteries.No intra-operative complication was noted and no blood transfusion was required. The pathological results of the patients were 3 angiomyolipoma, 1 renal cell carcinoma and 1 hemorrhagic renal cyst. The median tumor size was 5.7 (1.6–13) cm. The median R.E.N.A.L score was 7 (4–10).The median hospital stay was 6 (4–7) days and post-operative complication was noted in 1 patient with wound dehiscence. Pre- and post-operative creatinine levelswere 0.86 (0.58–1.09) and 0.88 (0.62–0.9), respectively.
Zero-ischemia RPN is safe and feasible in selected patients even with large tumor size. The renal function could be preserved. Long-term benefits require further investigation.