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Our initial experience showed that RARC with complete intracorporeal urinary diversion is feasible based on perioperative data and oncologic features. However, in this small case series, we observed no definite benefits associated with intracorporeal urinary diversion over extracorporeal urinary diversion except for better cosmesis. Long-term, large-scale, prospective comparative studies will be needed to demonstrate the benefit of intracorporeal urinary diversion.

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MicroRNAs (miRs) are small noncoding RNAs that have been reported to be promising diagnostic tools. We used quantitative real-time reverse transcription PCR (RT-qPCR) to analyze differentially expressed miRNAs in prostate tumor samples to determine its prognostic value. From 2007 to 2009, tumor tissues were obtained from 73 radical prostatectomy specimens. Differentially expressed miR-96, -145 and -221 were validated by TaqMan RT-qPCR using all 73 tissues. The prognostic value was assessed in terms of biochemical recurrence using Kaplan-Meier and Cox regression analyses. For our patient cohort, the mean age was 64.7 years (50-76 years) and the mean prostate-specific antigen (PSA) was 7.5 ng ml 21 . During the follow-up period (mean, 19.4 months), 14 of 73 (19.2%) patients developed biochemical recurrence. Expression of miR-96, -145 and -221 correlated strongly with each other, but there were no correlations between miRNA expression and clinicopathologic parameters. Kaplan-Meier survival curves using the log-rank test showed a decreased biochemical recurrence-free interval with pathologic stage (P,0.001). In addition, patients with Gleason scores over 8, compared with those with a Gleason score of 6, showed a decreased biochemical recurrence-free interval in Kaplan-Meier analysis (P50.001). However, expression of miR-96, -145 and -221 did not correlate with the biochemical recurrence interval in Kaplan-Meier survival curves or by multivariate analysis using the Cox proportional hazard regression model, either. In conclusion, we did not observe a significant correlation between the expression of miR-96, -145 and -221 and clinicopathologic parameters. To utilize miRNA as a diagnostic tool in clinical practice, more research is needed to understand miRNA mechanisms, identify miRNA targets, and further characterize miRNA function.

Objectives To investigate the oncological significance of a robot‐assisted radical cystectomy (RARC)‐related pentafecta in patients with bladder cancer. Patients and Methods Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien–Dindo grade 3–5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer‐specific survival (CSS) using multivariate Cox proportional analysis was then carried out. Results Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow‐up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non‐attainment group (10‐year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10‐year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038). Conclusions Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.

Our study showed that the robotic virtual reality simulator (dV-Trainer) can yield sufficient improvement in technical performance in the "Tube 2" task within 4 hours. The simulator improves the technical surgical performance, but the development of more applications to reflect actual surgical situations is needed to improve and maximize the usefulness of the simulator.

Robotic radical prostatectomy (RARP) is a standardized treatment for localized prostate cancer, which provides better functional outcomes and similar oncological outcomes compared to open approaches. Here, we share our experience of 12,000 RARPs by describing the outcomes of the procedure in terms of positive surgical margin (PSM), continence, and potency as well as by presenting our detailed surgical technique with recent modifications. On cancer control, the PSM rates were 5.8% and 26.1% in T2 and T3, respectively. On the premise of not compromising oncologic outcomes, a tailored approach to individual patients is essential. Even if an extracapsular extension is suspected, neurovascular bundle (NVB) tailoring can be applied using an anatomical landmark to preserve maximal nerve tissue with a negative margin. We developed a nomogram as a useful tool for deciding the degree of tailoring. For improvements of functional outcomes, we used athermal retrograde early release with a toggling technique, wherein the nerve dissection from the bottom helps with blood loss and allows for smooth NVB releasing. Additionally, we recently performed a new minimal apical dissection/lateral prostatic fascia preservation technique. As a result, our 1-week continence rate was 37% and the 6-week rate was 77.6%. In addition, the potency rates in our study were 69%, 82%, and 92% at 3 months, 6 months, and 1 year, respectively (preoperative Sexual Health Inventory for Men scores >21 & bilateral full nerve spared).