No abstract

The instillation of Tisseel fibrin glue is safe for tubeless percutaneous nephrolithotomy. It is associated with less postoperative pain and a lower analgesic requirement. Additional prospective, randomized studies are required to better define its clinical role in the future.

RAPN was associated with a low rate of conversion. Independent predictors of conversion were BMI and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion.

Tumors of the genitourinary system are one of the most common tumors encountered in clinical practice. The associated morbidity and mortality and the significant proportion of affected middle-age individuals have a major bearing on the death-adjusted life years compared to other malignancies. Genitourinary system tumors encompass a very broad spectrum with regard to age, location, histology, and clinical outcomes. Advances in diagnostic imaging, surgical techniques, radiotherapy equipment, and generation of newer chemotherapeutic and targeted agents over the past few years have helped improving treatment outcome. Several focused groups within India have been working on a range of topics related to genitourinary system tumors, and a significant body of work from India in the recent years is being increasingly recognized throughout the world. The present article summarizes the key published work related to the epidemiology of genitourinary system tumors in the Indian setting. A PubMed search was made for locating and selecting articles relevant to the topic.

ObjectivesTo analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database. Patients and MethodsIn all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A 'trifecta' of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) of <20 min, negative surgical margins, and no complications intraoperatively or within 3 months of RAPN. ResultsAll 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75-20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of ClavienDindo grade ≤II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m 2 (11.01%). ConclusionOur findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT of <20 min, and low operative and perioperative morbidity.

Objective To predict intra‐operative (IOEs) and postoperative events (POEs) consequential to the derailment of the ideal clinical course of patient recovery. Materials and Methods The Vattikuti Collective Quality Initiative is a multi‐institutional dataset of patients who underwent robot‐assisted partial nephectomy for kidney tumours. Machine‐learning (ML) models were constructed to predict IOEs and POEs using logistic regression, random forest and neural networks. The models to predict IOEs used patient demographics and preoperative data. In addition to these, intra‐operative data were used to predict POEs. Performance on the test dataset was assessed using area under the receiver‐operating characteristic curve (AUC‐ROC) and area under the precision‐recall curve (PR‐AUC). Results The rates of IOEs and POEs were 5.62% and 20.98%, respectively. Models for predicting IOEs were constructed using data from 1690 patients and 38 variables; the best model had an AUC‐ROC of 0.858 (95% confidence interval [CI] 0.762, 0.936) and a PR‐AUC of 0.590 (95% CI 0.400, 0.759). Models for predicting POEs were trained using data from 1406 patients and 59 variables; the best model had an AUC‐ROC of 0.875 (95% CI 0.834, 0.913) and a PR‐AUC 0.706 (95% CI, 0.610, 0.790). Conclusions The performance of the ML models in the present study was encouraging. Further validation in a multi‐institutional clinical setting with larger datasets would be necessary to establish their clinical value. ML models can be used to predict significant events during and after surgery with good accuracy, paving the way for application in clinical practice to predict and intervene at an opportune time to avert complications and improve patient outcomes.

This article presents a new protection scheme for the µgrid structure is implemented on low voltage side as DC system’s protection methods are quite new when compared to the AC systems. The protection system designed in AC system faces many difficulties like frequency matching, reactive power violation, and instability. The main objective of the proposed system is to eliminate the faulty segment promptly while keeping the healthy segments functioning unaltered. In the proposed method, a unitwise controller is designed and is connected in feedback so as to maintain stability under all conditions. The unitwise controller comprises primary and secondary controllers which continually monitor all the units of DC grid comprising semiconductor bidirectional switches and snubber circuits. A primary controller is used for monitoring the complete variation in the parameters in all the units. If the observed parameter value is greater than the acceptable range, the secondary controllers receive the command so as to take the required action to eliminate the faulty segment. Both lines and ground faults are tested on all the sections separately and also simultaneously. The tested results are analyzed in all aspects and the results of the states that the designed protection scheme competent in isolating the defective segment within a short period of time. Once the defective segment is isolated, the other segments retain the stabilized voltage and current limits. The protection scheme is designed and verified using MATLAB/Simulink.

If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.