Introduction: The treatment of large renal stones in children can be challenging often requiring combination therapy and multiple procedures. The purpose of this video is to describe our technique of robotic nephrolithotomy and pyelolithotomy for complex renal stone disease in children, and to demonstrate the utility of the robotic ultrasound probe to aid with stone localization. Materials and Methods: Robotic nephrolithotomy/pyelolithotomy was carried out in four consecutive patients. A robotic ultrasound probe (Hitachi-Aloka, Tokyo, Japan) under console surgeon control was used in all cases. Results: Two patients underwent robotic pyelolithotomy, one patient underwent robotic nephrolithotomy, whilst the fourth patient underwent robotic pyelolithotomy and nephrolithotomy along with Y-V pyeloplasty for concurrent ureteropelvic junction obstruction. Mean operative time, blood loss and hospital stay was 216 minutes, 37.5 mL and 2 days, respectively. The robotic ultrasound probe aided identification of calculi within the kidney in all cases. For nephrolithotomy it was helpful in planning the incision for nephrotomy. After nephrotomy or pyelotomy, stones were removed using a combination of robotic Maryland forceps, fenestrated grasper or Prograsp. Antegrade nephroscopy introduced through a laparoscopic port was used in all patients for confirmation of residual stone status. Two patients did not require a ureteral stent in the post-operative period. One patient had a minor complication (Clavien Grade 2 - dislodged malecot catheter). All patients were stone free at last follow-up. Conclusions: Robotic nephrolithotomy and pyelolithotomy with utilization of the robotic ultrasound probe offers a one-stop solution for complex renal stones with excellent stone-free rates.

Objectives To examine the effect of surgical approach on perioperative morbidity and mortality after partial nephrectomy. Materials and Methods Within the Nationwide Inpatient Sample, patients who underwent RAPN or LPN between October 2008 and December 2009 were identified. Propensity-based matching was performed to adjust for potential baseline differences between the two groups. The rates of intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality, stratified according to RAPN vs. LPN, were compared. Results Overall, 851 (72.5%) patients underwent RAPN and 323 (27.5%) underwent LPN. For RAPN and LPN respectively, the following rates were recorded in the propensity-score matched cohort: blood transfusions, 4.5 vs. 6.8% (p = 0.223); intraoperative complications, 5.2 vs. 2.6% (p = 0.096); postoperative complications, 10.6 vs. 13.5% (p = 0.268); prolonged length of stay, 6.8 vs. 9.4% (p = 0.238); in-hospital mortality, 0.0 vs. 0.0%. Conclusions RAPN has supplanted LPN as the predominant minimally invasive surgical approach for renal masses. Perioperative outcomes after RAPN and LPN are comparable. Interpretation of these findings needs to take into account the lack of adjustment for case complexity and surgical expertise.

Objectives: To describe a technique of Robot Assisted Radical Prostatectomy (RAP) for localized carcinoma of the prostate, the Vattikuti Institute Prostatectomy (VIP) and an innovative incremental nerve preservation technique, the Veil of Aphrodite. We also report complications, oncolgical and functional outcomes in a cohort of the patient operated during 2001-2006. Methods: 2.652 patients with localiced carcinoma of prostate underwent VIP at our centre between 2001- 2006. Our current technique involves: early division of the bladder neck, preservation of the lateral pelvic fascia and control of the dorsal vein complex after apical dissection of the prostate. Oncological, functional and follow-up information was obtained through "ROBOSURG"® data base, which is managed by an independent group not involved in the patient care. VIP, as it has evolved in our hands over a period of 5 years, has given excellent outcomes in terms of cancer control, continence and erectile function. Our modifications of the surgical technique had a singular focus on consistent improvement of the so called "Trifecta", taking radical retropubic prostatectomy (RRP) published data as a reference standard. We present our current technique of VIP with preservation of the lateral prostatic fascia ("Veil of Aphrodite"). Results: In this report we include 2077 patients with follow-up ranging from 4 weeks to 260 weeks (median 68 weeks). We have a low incidence (1.5%) of perioperative complications. 97.6% of our patients had a hospital stay of less than 48 hours. There were 5.8% unscheduled postoperative visits. With the PSA cut-off limit of 0.4ng/ml, the overall biochemical recurrence rate was 3.9%. Median duration of incontinence was 4 weeks; 0.8% patients had total incontinence at 12 months. The intercourse rate was 93% in men with no pre-operative erectile dysfunction undergoing veil nerve-sparing surgery, although only 51% returned to baseline function. Conclusion: Vattikuti Institute Prostatectomy offers excellent patient recovery with significant reduction in first 30 days morbidity and provides excellent oncological and functional outcomes. The preservation of the "Veil of Aphrodite" helps in postoperative return of erectile function in patients with normal preoperative erectile function.

Objetivos: Describir nuestra técnica de Prostatectomía Radical Asistida por Robot (PRAR) (VIP) como tratamiento del cáncer localizado de próstata, y nuestra reciente innovación en la preservación nerviosa conocida como "Velo de Afrodita". Asimismo se describen las complicaciones, resultados oncológicos y funcionales en una cohorte de pacientes operados entre 2001 y 2006. Métodos: Un total de 2.652 pacientes con carcinoma localizado de próstata se sometieron a PRAR en nuestro centro entre 2001 y 2006. Nuestra técnica actual incluye: división precoz del cuello de la vejiga, preservación de la fascia pélvica lateral y control del complejo venoso dorsal después de la disección apical de la próstata. La información oncológica, funcional y de seguimiento se obtuvo a través de la base de datos "ROBOSURG"®, que es controlada por un grupo independiente no involucrado en el cuidado al paciente. La técnica VIP, como tal, ha sido desarrollada en nuestras manos en un período de 5 años, y ha dado excelentes resultados en cuanto al control del cáncer, continencia y función eréctil. Nuestras modificaciones de la técnica quirúrgica se enfocaron para conseguir el objetivo "Trifecta", tomando la información publicada de la prostatectomía radical retropúbica (PRR), como referencia estándar. Presentamos nuestra técnica VIP actual con preservación de la fascia lateral prostática (Velo de Afrodita). Resultados: En este trabajo, incluimos 2077 pacientes con un seguimiento que varía desde 4 a 260 meses (media 68 meses). Tenemos una incidencia de complicaciones perioperativas (1.5%) muy baja. El 97.6% de nuestros pacientes tuvo una estancia hospitalaria de menos de 48 horas. Hubo un 5.8% de ingresos postoperatorios no programadas. Con un punto de corte de PSA de 0.4ng/ml, el índice de recurrencia global fue del 3.9%. El promedio de duración de la incontinencia fue de 4 semanas; el 0.8% de los pacientes tuvo incontinencia total a los 12 meses. El índice de relaciones sexuales (coito) fue del 93% en hombres con función sexual previa normal que se sometieron a cirugía de preservación nerviosa con conservación el "Velo de Afrodita", a pesar de que sólo el 51% recuperaron la función basal completa. Conclusión: La técnica VIP ofrece una excelente recuperación del paciente con reducción importante de la morbilidad en los primeros 30 días y proporciona unos resultados oncológicos y funcionales excelentes. La preservación del "Velo de Afrodita" ayuda al retorno postoperativo de la función sexual en pacientes con función eréctil preoperatoria normal.