Treatment of testicular cancer has made significant progress in the past decades in terms of reduction of treatment-associated morbidity and preventing over-treatment. At the forefront of this progression is utilization of the da Vinci robot to perform retroperitoneal lymph node dissections (RPLNDs) via a minimally invasive approach. The robot offers multiple potential advantages such as smaller incisions, improved 3D visualization, more precise dissection, and faster convalescence, leading to its increased usage the past several years. In this chapter, we summarize the recent progress made in robotic surgery for testicular cancer and its potential in the future. Promising preliminary data has also renewed interest in defining the role of primary RPLND in patients with seminoma, potentially sparing patients of the harmful long-term radiation and cisplatin-based chemotherapy. SEMS and PRIMETEST trials are ongoing trials that will provide significant insight into this area and potentially expand the role of robotic RPLND.
Despite technical refinements in urologic oncologic surgery, complications are inevitable and often carry significant morbidity. Similar to oncologic surgery, reconstructive surgery has realized a paradigm shift from mainly open to an increasingly minimally invasive approach. Robotic assisted surgery has facilitated this transition as it mitigates some of the limitations of traditional laparoscopy. With continued technological advances in robotic technology along with improved training and experience, the breadth and complexity of cases expand annually. Few head to head trials exist and data is overall heterogeneous. Herein, we review and summarize the currently available literature describing robotic assisted reconstruction for complications following urologic oncologic procedures.
Conclusions: As expected with 100 N compared to 50 N, our results show increased strain, contact stress, apparent moduli and tangential force. Our data suggest that the sliding speeds we applied do not have en effect on the mechanical response of the tissue. However, we still found a relationship between sliding speed and gene expression when the tissue was loaded with 100 N normal force. This indicates that differences in hydrostatic pressures and osmotic changes, induced by sliding, might account for an alteration in gene expression, as already proposed in other studies. By interpreting this data we furthermore need to take into account, that different sliding speeds changed the number of cycles and could affect gene regulation. In conclusion, this study demonstrates the importance of applying migrating contact loads to cartilage explants for studying the biological responses of the tissue. Even if higher sliding speeds do not necessarily change mechanical parameters, they can still evoke a biological response in terms of altered gene expression.
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