ObjectiveTo compare the renal functional outcomes, with >1 year of follow-up, of patients who underwent robot-assisted partial nephrectomy (RAPN) performed with different clamping techniques. Patients and MethodsThe peri-operative data of patients undergoing RAPN performed with different clamping techniques were retrospectively analysed (group 1: off-clamp, n = 23; group 2: selective clamp, n = 25; group 3: main artery clamp, n = 114). The main outcome measures were postoperative serum creatinine level, estimated glomerular filtration rate (eGFR) and percentage change in eGFR, the data for which were collected at periodic intervals during the first 12 months and annually thereafter, in addition to late eGFR value. Only patients with >1 year of follow-up were included in the analysis. ResultsThe baseline characteristics of groups 2 and 3 were similar, while patients in group 1 had smaller sized tumours and lower tumour complexity. The median follow-up periods were 45 (group 1), 20 (group 2) and 47 (group 3) months. The median clamping times were 24.8 min in the main artery clamp and 18 min in the selective artery clamp groups. Group 2 had greater median blood loss volume (100 vs 500 vs 200 mL for groups 1, 2 and 3, respectively; P < 0.01) and a longer length of hospital stay (3 vs 4 vs 3 days for groups 1, 2 and 3, respectively; P = 0.02). No significant differences were found among the groups with regard to transfusion rates, positive surgical margin rates, complications, recurrence or mortality rates. Groups 1 and 2 had significantly less deterioration of postoperative renal function during the first 3 months after surgery (P = 0.04; percent change in eGFR À1.5, À2 and À8% for groups 1, 2 and 3, respectively), but this beneficial outcome was not observed after 6 months or for the latest eGFR measurement (P = 0.48; latest percent change in eGFR À3, À6 and À3.5% for groups 1, 2 and 3, respectively). In regression analysis, baseline eGFR, type of clamp procedure and tumour complexity score were predictive of normal renal function 7 days after surgery, while only baseline eGFR and age could predict it 1 year postoperatively. ConclusionsOff-clamp and selective artery clamp techniques result in superior short-term renal functional outcomes compared with the main artery clamp approach; however, after the 6th postoperative month, there were no significant differences regarding the functional outcome among the above surgical techniques, as long as the warm ischaemia time was 20-30 min.

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PurposeTo evaluate the impact of high body mass index (BMI) on outcomes following robotic laparoendoscopic single-site surgery (R-LESS) robotic-assisted laparoscopic partial nephrectomy (RPN).Materials and MethodsData from 83 Korean patients who had undergone robotic partial nephrectomy from 2006 to 2014 were retrospectively analyzed. The subjects were stratified into two groups according to WHO definitions for the Asian population, consisting of 56 normal range (BMI=18.5-24.99 kg/m2) and 27 obese (≥25 kg/m2) patients. Outcome measurements included Trifecta achievement and the perioperative and postoperative comparison between high and normal BMI series. The measurements were estimated and analyzed with SPSS version 17.ResultsTumor's complexity characteristics (R.E.N.A.L. score, tumor size) of both groups were similar. No significant differences existed between the two groups with regard to operative time (p=0.27), warm ischemia time (p=0.35) estimated blood loss (p=0.42), transfusion rate (p=0.48) renal function following up for 1 year, positive margins (p=0.24) and postoperative complication rate (p=0.34). Trifecta was achieved in 5 (18.5%) obese and 19 (33.9%) normal weight patients, respectively (p=0.14). In multivariable analysis, only tumor size was significantly correlated with the possibility of Trifecta accomplishment.ConclusionOur findings suggest that R-LESS RPN can be effectively and safely performed in patients with increased BMI, since Trifecta rate, and perioperative and postoperative outcomes are not significantly different in comparison to normal weight subjects.

BackgroundThe presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population.MethodsData were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR).ResultsOf the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8–10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP.ConclusionsThere was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0070-1) contains supplementary material, which is available to authorized users.

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Résumé Les Confessions de Jean-Jacques Rousseau prétendent écarter tout précédent mais le modèle, pour être refusé, est bien là : celles d’Augustin relatent déjà les premières rencontres avec le Mal. Ces rencontres doivent, pour Rousseau, aboutir à sa disculpation, cela au prix de la tâche impossible et sans cesse réitérée d’être, en l’absence de Dieu, tant l’instance qui juge que celui qui est jugé.

L’un des textes les plus traduits au monde, Robinson Crusoé , a suscité une multitude de successeurs comme le travail indéfini du commentaire. L’histoire s’est élevée au niveau d’un mythe moderne, au prix de l’oubli de ses origines et de son sens. Il est alors utile de la confronter à un modèle inavoué, Le philosophe autodidacte d’Ibn Tufayl, pour restituer au texte sa dimension religieuse (effacée par l’incursion de Rousseau sur l’île de Robinson) qui guide le progrès du lecteur et commande une exigence d’auto-éducation du sujet, qui était bien plus radicale dans le conte arabe.