Purpose
Robot-assisted partial nephrectomy (RAPN) is a difficult procedure with risk of significant perioperative complications. The objective was to evaluate the impact of preoperative planning and ...intraoperative guidance with 3D model reconstructions on perioperative outcomes of RAPN.
Methods
We conducted a retrospective analysis of all patients who underwent RAPN for kidney tumor by three high-volume expert surgeons from academic centers. Clinical data were collected prospectively after written consent into the French kidney cancer network database UroCCR (CNIL-DR 2013-206; NCT03293563). Our cohort was divided into two groups: 3D-Image guided RAPN group (3D-IGRAPN) and control group. A propensity score according to age, pre-operative renal function and RENAL tumor complexity score was used. Both surgical techniques were compared in terms of perioperative outcomes.
Results
The initial study cohort included 230 3D-IGRAPN and 415 control RAPN. Before propensity-score matching, patients in the 3D-IGRAPN group had a larger tumor (4.3 cm vs. 3.5 cm,
P
< 0.001) and higher RENAL complexity score (9 vs. 8,
P
< 0.001). Following propensity-score matching, there were 157 patients in both groups. The rate of major complications was lower for patients in the 3D-IGRAPN group (3.8% vs. 9.5%,
P
= 0.04). The median percentage of eGFR variation recorded at first follow-up was lower in the 3D-IGRAPN group (− 5.6% vs. − 10.5%,
P
= 0.002). The trifecta achievement rate was higher in the 3D-IGRAPN group (55.7% vs. 45.1%;
P
= 0.005).
Conclusion
Three-dimensional kidney reconstructions use for pre-operative planning and intraoperative surgical guidance lowers the risk of complications and improve perioperative clinical outcomes of RAPN.
To evaluate the impact of virtual injection software (VIS) use during cone-beam computed tomography (CT)-guided prostatic artery embolization (PAE) on both patient radiation exposure and procedural ...time.
This institutional review board (IRB)-approved comparative retrospective study analyzed the treatment at a single institution of 131 consecutive patients from January 2020 to May 2022. Cone-beam CT was used with (Group 1, 77/131; 58.8%) or without VIS (Group 2, 54/131, 41.2%). Radiation exposure (number of digital subtraction angiography DSA procedures), dose area product (DAP), total air kerma (AK), peak skin dose (PSD), fluoroscopy time (FT), and procedure time (PT) were recorded. The influences of age, body mass index, radial access, and use of VIS were assessed.
In bivariate analysis, VIS use (Group 1) showed reduction in the number of DSA procedures (8.6 ± 3.7 vs 16.8 ± 4.3; P < .001), DAP (110.4 Gy·cm
± 46.8 vs 140.5 Gy·cm
± 61; P < .01), AK (642 mGy ± 451 vs 1,150 mGy ± 637; P = .01), PSD (358 mGy ± 251 vs 860 mGy ± 510; P = .001), FT (35.6 minutes ± 15.4 vs 46.6 minutes ± 20; P = .001), and PT (94.6 minutes ± 41.3 vs 115.2 minutes ± 39.6, P = .005) compared to those in Group 2. In multivariate analysis, AK, PSD, FT, and PT reductions were associated with VIS use (P < .001, P < .001, P = .001, and P = .006, respectively).
The use of VIS during PAE performed under cone-beam CT guidance led to significant reduction in patient radiation exposure and procedural time.
Objectives
To compare the outcomes of percutaneous image-guided cryoablation of symptomatic abdominal wall endometriosis (AWE) versus surgery alone.
Methods
From 2004 to 2016, cryoablation or surgery ...alone was performed under local (
n
= 5) or general anaesthesia (
n
= 15) for AWE in a single institution in 7 (mean age, 36.1 years) and 13 (mean age, 31.9 years) patients, respectively. Fifteen lesions were treated by cryoablation (mean size, 2.3 cm; range, 0.5-7 cm) and 16 by surgery (2.5 cm; 1.1-3.4 cm). Tolerance, efficacy and patient and procedural characteristics were compared.
Results
Median follow-up was 22.5 (range, 6-42) months after cryoablation and 54 (14-149) after surgery. The median procedure and hospitalisation durations were 41.5 min (24-66) and 0.8 days (0-1) after cryoablation, and 73.5 min (35-160) and 2.8 days (1-12 days) after surgery (both
P
= 0.01). Three patients (23.1%) had severe complications and nine aesthetic sequels (69.2%) after surgery, none after cryoablation (
P
= 0.05). The median 12- and 24-month symptom free-survival rates were 100% and 66.7% (95% CI, 5.4; 94.5) after cryoablation and 92% (55.3; 98.9) after surgery at both time points (
P
= 0.45).
Conclusions
Cryoablation presents similar effectiveness to surgery alone for local control of AWE while reducing hospitalisation duration and complications. Any aesthetic sequels were associated with the cryoablation treatment.
Key points
•
Hospitalisation is shorter after cryoablation than after surgery of abdominal wall endometriosis.
•
A significantly lower rate of complications is observed after cryoablation compared to surgery.
•
Cryoablation of abdominal wall endometriosis presents similar effectiveness to surgery alone.
•
A significant reduction of pain is observed 6 months after treatment.
•
A significant reduction of abdominal wall endometriosis is observed at 6 months.
The purpose of this retrospective review was to evaluate SpineJack implantation in cancer-related vertebral compression fractures in 13 consecutive patients (mean age, 62.8 years ± 18.8). A total of ...36 devices were inserted at 20 levels (13 65% lumbar and 7 35% thoracic vertebrae), with a mean Spinal Instability Neoplastic Score of 9.1 ± 2.1. Vertebral height restoration was observed in 10 levels (50%), with a mean height restoration of 5.6 mm ± 2.2 (interquartile range IQR, 4-7.5). A total of 6 cement leakages were observed in 3 (23%) patients without clinical consequences. No severe adverse events were observed. One adjacent fracture occurred. Average pain scores on the visual analog scale significantly improved from 5.5 ± 1.8 (IQR, 4-7) preoperatively to 1.5 ± 2.2 (IQR, 0-3.3) at 1 month (P < .01) and to 1.5 ± 1.3 (IQR, 0.3-2.8) at 6 months (P < .01). In this small cohort, SpineJack offered pain relief in cancer-related fractures without an observed increase in adverse events.
•Rapid and acute ATP loss during IRE promotes necrotic cell death.•Cell death from IRE progresses even during caspase signaling inhibition.•IRE can be immunostimulatory and effective in cancers with ...mutant apoptosis genes.
Irreversible electroporation (IRE) has been reported to variably cause apoptosis, necrosis, oncosis or pyroptosis. Intracellular ATP is a key substrate for apoptosis which is rapidly depleted during IRE, we sought to understand whether intracellular ATP levels is a determinant of the mode of cell death following IRE. A mouse bladder cancer cell line (MB49) was treated with electric fields while increasing the number of pulses at a fixed electric field strength, and pulse width. Cell proliferation and viability and ATP levels were measured at different timepoints post-treatment. Cell death was quantified with Annexin-V/Propidium Iodide staining. Caspase activity was measure with a fluorometric kit and western blotting. A pan-caspase (Z-VAD-FMK) inhibitor was used to assess the impact of signal inhibition. We found cell death following IRE was insensitive to caspase inhibition and was correlated with ATP loss. These findings were confirmed by cell death assays and measurement of changes in caspase expression on immunoblotting. This effect could not be rescued by ATP supplementation. Rapid and acute ATP loss during IRE interferes with caspase signaling, promoting necrosis. Cell necrosis from IRE is expected to be immunostimulatory and may be effective in cancer cells that carry mutated or defective apoptosis genes.
Patients suffering from bone metastasis are at high risk for pathological fractures and especially hip fractures. Osteolytic metastases can induce a high morbidity rate (i.e., pain, facture risk, ...mobility impairment), and operation on them can be difficult in this frail population having a reduced life expectancy. Several medical devices have been investigated for the prevention of these pathological hip fractures.
To investigate these solutions, a literature review and a meta-analysis of primary studies was performed. Data sources included electronic databases (PubMed, CENTRAL and ClinicalTrials.gov) from 1990 until 1 January 2019. Titles, abstracts and full-text articles were reviewed in order to select only studies evaluating the performance of the studied solution to prevent osteoporotic and/or pathological hip fracture. The main outcomes were the occurrence of hip fracture, pain evaluation (VAS score) and adverse events occurrence (including severe adverse events and deaths). All randomised controlled trials (RCTs) and cohort studies were considered. A Bayesian cumulative meta-analysis was undertaken on the primary studies conducted in patients with bone metastasis.
A total of 12 primary studies were identified, all were cohort studies without a control group, and one compared two devices, and were thereafter considered separately. In those 12 samples, 255 patients were included, mean age 61.7 years. After implantation, the cumulative risk of fracture was 5.5% (95% confidence interval, 3.0% to 8.6%), and adverse event occurrence was 17.4% (95%CI, 12.6 to 22.8%), with a median follow-up of 10 months. The posterior probability of a fracture rate below 5% was 40.3%.
The literature about medical devices evaluation for preventing hip fractures in metastatic patients is poor and mostly based on studies with a limited level of evidence. However, this systematic review shows promising results in terms of efficacy and tolerance of these devices in patients with bone metastases. This treatment strategy requires further investigations.
A 57-year-old woman developed portomesenteric vaccine-associated immune thrombosis and thrombocytopenia (VITT) 12 days after a second administration of AstraZeneca (AZ) (ChAdOx1 nCov-19, UK) COVID-19 ...vaccine. Abdominal computed tomography (CT) demonstrated the absence of contrast filling of the portal trunk and portal branches and bilateral kidney corticomedullary triangular hypodensity corresponding to a complete thrombosis of the portal trunk and branches with bilateral segmental kidney infarcts (Fig. 1A).
Objective
To assess the influence of patient characteristics, anatomical conditions, and technical factors on radiation exposure during prostatic arteries embolization (PAE) performed for benign ...prostatic hyperplasia.
Materials and methods
Patient characteristics (age, body mass index (BMI)), anatomical conditions (number of prostatic arteries, anastomosis), and technical factors (use of cone beam computed tomography (CBCT), large display monitor (LDM), and magnification) were recorded as well as total air kerma (AK), dose area product (DAP), fluoroscopy time (FT), and number of acquisitions (NAcq). Associations between potential dose-influencing factors and AK using univariate analysis and a multiple linear regression model were assessed.
Results
Forty-one consecutive men (68 ± 8 years, min–max: 40–76) were included. LDM and CBCT decreased the use of small field of view with 13.9 and 3.8% respectively, both
p
< 0.001. The use of a LDM significantly reduced AK (1006.6 ± 471.7 vs. 1412 ± 754.6 mGy,
p
= 0.02), DAP (119.4 ± 64.4 vs. 167.9 ± 99.2,
p
= 0.04), FT (40.4 ± 11.5 vs. 53.6 ± 25.5 min,
p
= 0.01), and NAcq (16.3 ± 6.3 vs. 18.2 ± 7,
p
= 0.04). In multivariate analysis, AK reduction was associated with lower patient BMI (
β
= 0.359,
p
= 0.002), shorter FT (
β
= 0.664,
p
< 0.001) and CBCT use (
β
= − 0.223,
p
= 0.03), and decreased NAcq (
β
= 0.229,
p
= 0.04).
Conclusion
LDM and CBCT are important technical dose-related factors to help reduce radiation exposure during PAE, and should be considered in standard practice.
Key Points
• The use of large display monitor (LDM) and cone beam computed tomography (CBCT) both decreased the need for magnification during prostatic arteries embolization (PAE).
• The use of LDM reduces radiation exposure during PAE.
• Total air kerma is associated with patient’s body mass index, fluoroscopy time, CBCT, and the number of acquisitions.
Purpose
To compare the safety and efficacy of n-butyl cyanoacrylate glue (NBCA) versus microspheres for prostatic artery embolization (PAE) in patients with benign prostatic obstruction (BPO).
...Materials and Methods
This institutional review board-approved, single-centre, retrospective study included consecutive patients undergoing PAE from September 2017 to July 2020. Age, medical history, previous treatment, pre- and post-PAE prostatic volumes and International Prostate Symptom Scores (IPSSs) were systematically analysed. Procedural duration, dosimetry, immediate and delayed complications were recorded. Patients at the beginning of the study were treated with microspheres and patients at the end of the study with NBCA. The main outcome measures were the absolute and relative changes in IPSS at 3 months. Statistical analyses comprised unpaired
t
-tests, Wilcoxon tests, Chi-2 tests, uni- and multivariate linear regressions.
Results
Sixty-two patients were included (median age: 65.9 years). Thirty-two patients were treated with microspheres and 30 with NBCA. There were no significant baseline differences between the two groups except for the baseline PSA (
P
= 0.0251). Average procedural and fluoroscopy times, and radiation exposure were significantly lower in the NBCA group versus the microspheres group (80.7 ± 22.5 versus 112 ± 42.1 min
P
= 0.0011, 24.2 ± 9.6 min versus 42.1 ± 20.2 min
P
= 0.0001, 12,004.6 ± 6702 uGy.m
2
versus 25,614.9 ± 15,749.2 uGy.m
2
P
= 0.0001, respectively). Immediate complications were all minor, and there were no significant differences between the two groups (4/32 12.5% with microspheres versus 7/30 23.3% with NBCA,
P
= 0.4335), nor for delayed complications (
P
= 1). No association was found between the PAE techniques and the absolute change in IPSS at 3 months (−10.2 ± 7.9 with microspheres versus −9.5 ± 7.6 with NBCA,
P
= 0.7157).
Conclusion
PAE using NBCA was safe and effective for symptomatic BPO, with faster procedures, lower radiation exposure and similar safety and efficacy compared to microspheres. Operator learning curve could have biased the procedural times and radiation exposure between groups favouring NBCA.
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