Robotic sealing devices, such as SynchroSeal and Vessel Sealer Extend, have shown that parenchymal transection is possible without using laparoscopic instruments Finotti (Hepatobiliary Surg Nutr. 12:56-68, 2023), Palucci (J Robot Surg 19(1):36, 2024), Birgin (Lancet Reg Health Eur 43, 2024). However, there is still a need for detailed procedural guidance to ensure that these techniques can be applied effectively and consistently. We describe the Sealer and Moisture-Based Approach (SAMBA) hepatectomy technique a standardized purely robotic approach for hepatic parenchymal transection that combines robotic vessel-sealing tools with targeted saline irrigation. Between February 2021 and October 2024, a total of 72 consecutive robotic hepatectomies were performed using the SAMBA hepatectomy technique at Ulm University Hospital. The Da Vinci Xi-system was used for all hepatectomies. Parenchymal transection was performed with the SynchroSeal in 55 and the Vessel Sealer Extend in 17 cases. Of these, 27 resections were nonanatomical, and 45 resections were anatomical hepatectomies with a median operative time of 174 minutes (interquartile range [IQR] 134-236), and blood loss of 200 mL (IQR 100-400). No cases of posthepatectomy hemorrhage or mortality were observed within 90 days after surgery. SAMBA hepatectomy technique is an effective method for robotic liver parenchymal transection. Incorporating moisture during sealing improves tissue handling, minimizes carbonization, and enhances visualization. Prospective studies are warranted to compare the SAMBA technique with other techniques of parenchymal transection.

This study aimed to investigate the incidence, characteristics, risk factors, and prognostic implications of myocardial injury after non-cardiac surgery (MINS) in patients with lung cancer undergoing pulmonary resection. We conducted a retrospective analysis of 1314 consecutive patients with lung cancer undergoing elective pulmonary resection between June and November 2023 at a tertiary cancer referral center. Univariate and multivariate logistic regression analyses were used to identify independent risk factors. Kaplan-Meier survival analysis with log-rank tests were adopted to evaluate the 30day mortality and major adverse cardiovascular events (MACE). Subgroup analyses according to the extent of lung resection were also conducted. The overall incidence of MINS following lung cancer surgery was 10.4%. The majority of cases (92.7%) occurred within the first postoperative day and demonstrated predominantly asymptomatic presentation (78.1%). Independent preoperative risk factors for MINS included male sex, coronary artery disease, creatinine, high-sensitivity cardiac troponin T, thoracotomy, lobectomy, and duration of tachycardia. Although MINS showed no association with 30day postoperative mortality, it significantly increased the risk of MACE at 30 days in the overall (7.3% vs. 0.2%, p < 0.001), lobectomy (7.0% vs. 0.3%, p < 0.001), and sublobar resection (9.1% vs. 0, p = 0.002) cohorts. MINS is a common postoperative complication following lung cancer surgery, and typically occurs in the early postoperative period. Although it is predominantly asymptomatic, it was significantly associated with increased 30day MACE.

The guidelines recommend kidney-sparing surgery as the primary treatment for selected patients with low-risk upper urinary tract urothelial carcinoma (UTUC). An important issue with ureteroscopic laser ablation (ULA) is the high rate of surgical-site recurrence, largely attributable to residual lesions at the initial ULA. This trial aimed to investigate the efficacy and safety of oral 5-aminolevulinic acid hydrochloride-mediated photodynamic diagnosis (ALA-PDD)-assisted ULA for UTUC. The study evaluated 20 patients with cTa-1N0M0 UTUC who underwent ALA-PDD-assisted ULA using thulium-holmium:YAG dual lasers. The primary endpoint was the 2-year progression-free survival rate. Treatment-related adverse events (AEs), usefulness of the UroVysion test combined with conventional urinary cytology for detecting recurrent tumors, and longitudinal changes in patient-reported health-related quality of life (HRQoL) after ULA were evaluated. Of the 20 patients, 3 (15 %) experienced disease progression, and the 2-year progression-free survival rate was 82 % (95 % confidence interval [CI], 54-93 %). The lower limit of the 95 % CI for the 2-year PFS rate was less than the prespecified threshold survival rate of 58 %. The most common AEs were transient urinary-related symptoms. No grade ≥3 AEs were observed throughout the trial. Due to the low positivity rate of pretreatment UroVysion testing, the study could not evaluate its usefulness for monitoring post-ULA recurrence. Most domains and scales of HRQoL showed acceptable changes during treatment and follow-up evaluation. In particular, the intervention positively affected mental and emotional conditions. This study provided evidence for the potential benefits and efficacy of this treatment option for selected patients with UTUC.

Primary aldosteronism (PA) can be treated surgically or medically depending on disease lateralization and surgical candidacy. There is a dearth of data directly comparing antihypertensive medication trajectories and costs between these strategies. We performed a retrospective cohort study of patients with new PA diagnoses and adrenal vein sampling to assess antihypertensive medication outcomes and treatment costs using Optum's de-identified Clinformatics® Data Mart Database (2004-2022). Patients were stratified by receipt of adrenalectomy versus medical management alone. The index time point was defined as adrenal vein sampling (AVS) for medically managed and adrenalectomy for surgically managed patients. Outcomes were assessed using regression models. Of 911 patients, 52% underwent adrenalectomy and 48% medical therapy. Adrenalectomy patients were younger, with higher Elixhauser scores. Antihypertensive medication use (2.9 versus 2.8, p = 0.636) and costs did not differ at index. After 1 year, adrenalectomy patients used fewer antihypertensive medications (1.5 ± 1.4) than medically managed patients (2.5±1.5, p < 0.001). On regression, age (β = 0.02, p = 0.002), male sex (β = 0.40, p < 0.001), and baseline antihypertensive medications (β = 0.43, p < 0.001) were associated with higher antihypertensive medication requirement. Adrenalectomy patients were prescribed 1.11 fewer antihypertensive medications at one year (p < 0.001). In the resistant hypertension subcohort, adrenalectomy reduced antihypertensive medications by 1.35 (p < 0.001). Adrenalectomy was associated with US $908 lower antihypertensive medication prescription costs (p < 0.001) and 87% lower odds of potassium supplementation (p < 0.001). Patients with PA who undergo adrenalectomy demonstrate a significant reduction in antihypertensive medications compared with medically managed patients. While there is significant upfront cost to surgical intervention, reduced long-term prescription costs are realized.