Adenoid cystic carcinoma of the breast (ACC) is a rare tumor, comprising <0.1% of all breast cancers. It has a unique dual-cell pattern and is indistinguishable from ACC arising from salivary tissue. It is a low-grade tumor with favorable prognosis, and rare metastasis, with unique features. It is more commonly seen in older women with a mean age at diagnosis of 63, with Caucasian women being at greatest risk. Most cases present as a painful, palpable mass in the outer quadrants of the breast, and must be diagnosed via core needle biopsy or surgical excisional biopsy. Although few other cancers resemble ACC it is commonly misdiagnosed. Given the rarity of this cancer, treatment guidelines have yet to be well established. Current treatment is focused around surgical resection, however, there are not specific recommendations for the extent of resection due to the lack of cases to draw from.
The da Vinci single port surgical system (SP) is the newest iteration of robotic technology, which combines the camera and all instruments into a single port. Robotic assisted radical cystectomy (RARC) with intracorporeal urinary diversion has classically been a difficult operation. Here we describe our technique for RARC with the SP and review our initial outcomes and data in the literature. Four patients at our institution underwent single port robotic assisted radical cystectomy with intracorporeal ileal conduit using the da Vinci SP surgical system. Operative steps were performed as described. Perioperative outcomes were reviewed. All patients successfully underwent the procedure without intraoperative complications. The average operative time was 270 minutes with an EBL of 250 cc. The average nodal harvest was 12.5. The average length of stay was 5.5 days. There was one 30-day Clavien Grade II complication and no additional 90-day complications.With our initial experience with the da Vinci surgical system, radical cystectomy with intracorporeal urinary diversion can be performed safely and quickly with the right technique. Our outcomes are similar to other initially published data. Further study is necessary to determine the additional benefits and clinical outcomes.
Mini-percutaneous nephrolithotomy (mini-PCNL) has been described as a safe and effective technique to eliminate stones in patients in whom a less-invasive approach is desired. It was originally developed to treat stones in the pediatric population, but has since been adapted to serve a role in the adult urologic community. This approach has been reported to result in less blood loss and postoperative pain when compared with traditional PCNL. Herein, we present a case in which a recurrent caliceal diverticulum containing stones was managed using a mini-PCNL technique in a patient who previously failed multiple other retrograde endoscopic approaches.
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