Objective: To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. Patient and Methods: The MEDLINE , EMBASE and PsycINFO databases were systematically searched for studies published up to D ecember 2011. Studies pertaining to learning curves of urological procedures were included. Two reviewers independently identified potentially relevant articles. Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed. Results: Forty‐four studies described the learning curve for different urological procedures. The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases. The learning curve for robot‐assisted laparoscopic prostatectomy ( RALP ) has been reported to be 40 procedures as a minimum number. Robot‐assisted radical cystectomy has a documented learning curve of 16–30 cases, depending on which outcome variable is measured. Irrespective of previous laparoscopic experience, there is a significant reduction in operating time ( P = 0.008), estimated blood loss ( P = 0.008) and complication rates ( P = 0.042) after 100 RALPs . Conclusions: The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency. The complexities associated with defining procedural competence are vast. The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures.

Calcium is the most abundant mineral in the human body and is central to many physiological processes, including immune system activation and maintenance. Studies continue to reveal the intricacies of calcium signalling within the immune system. Perhaps the most well-understood mechanism of calcium influx into cells is store-operated calcium entry (SOCE), which occurs via calcium release-activated channels (CRACs). SOCE is central to the activation of immune system cells; however, more recent studies have demonstrated the crucial role of other calcium channels, including transient receptor potential (TRP) channels. In this review, we describe the expression and function of TRP channels within the immune system and outline associations with murine models of disease and human conditions. Therefore, highlighting the importance of TRP channels in disease and reviewing potential. The TRP channel family is significant, and its members have a continually growing number of cellular processes. Within the immune system, TRP channels are involved in a diverse range of functions including T and B cell receptor signalling and activation, antigen presentation by dendritic cells, neutrophil and macrophage bactericidal activity, and mast cell degranulation. Not surprisingly, these channels have been linked to many pathological conditions such as inflammatory bowel disease, chronic fatigue syndrome and myalgic encephalomyelitis, atherosclerosis, hypertension and atopy.

Artificial liver systems are used to bridge between transplantation or to allow a patient's liver to recover. They are used in patients with acute liver failure (ALF) and acute‐on‐chronic liver failure. There are five artificial systems currently in use: molecular adsorbent recirculating system (MARS), single‐pass albumin dialysis (SPAD), Prometheus, selective plasma filtration therapy, and hemodiafiltration. The aim is to compare existing data on the efficiency of these devices. A literature search was conducted using online libraries. Inclusion criteria included randomized control trials or comparative human studies published after the year 2000. A systematic review was conducted for the five individual devices with a more detailed comparison of the biochemistry for the SPAD and MARS systems. Eighty‐nine patients were involved in the review comparing SPAD and MARS. Results showed that there was an average reduction in bilirubin (−53 μmol/L in MARS and −50 μmol/L in SPAD), creatinine (−19.5 μmol/L in MARS and −7.5 μmol/L in SPAD), urea (−0.9 mmol/L in MARS and −0.75 mmol/L in SPAD), and gamma‐glutamyl transferase (−0.215 μmol/L·s in MARS and −0.295 μmol/L·s in SPAD) in both SPAD and MARS. However, there was no significant difference between the changes in the two systems. This review demonstrated that both MARS and SPAD aid recovery of ALF. There is no difference between the efficiency of MARS and SPAD. Because of the limited data, there is a need for more randomized control trials. Evaluating cost and patient preference would aid in differentiating the systems.

Objective: To compare laparoscopic partial nephrectomy ( LPN ) with robotic PN ( RPN ) using meta‐analytical techniques, since there has been a rise in the incidence of small renal masses ( SRM ; <4 cm) minimally invasive approaches are becoming more popular in dealing with such pathologies. Materials and Methods: A systematic review of the literature was performed to identify studies comparing LPN and RPN . Comparative studies evaluating RPN and LPN that fulfilled the inclusion criteria were selected. Data on preoperative, operative (operative time, estimated blood loss [ EBL ], and warm ischaemia time [ WIT ]), postoperative (length of stay [ LOS ]) variables and complications were collected. A meta‐analysis using random effect model was performed. A further Bland–Altman analysis of some of the operative variables was done to compare their reproducibility and mean difference in techniques. Results: Six studies matched the selection criteria. In all, 256 patients were analysed (40% RPN and 60% LPN ). There was no significant different in EBL ( P = 0.12, 95% confidence interval [ CI ] –12.01 to 104.26). Similarly, there was no significant different in WIT between the groups ( P = 0.23, 95% CI –15.22 to 3.70). Also, LOS ( P = 0.22, 95% CI –0.38 to 0.09) and overall postoperative complication rates were not significantly different between the groups ( P = 0.84, 95% CI –0.05 to 0.06). Conclusions: Despite multiple studies reporting better perioperative variables for RPN , the present study found no significant differences between RPN and LPN . This has implications for both the surgeon and the patient. Lack of randomised controlled trials in addition to a lack of long‐term oncological data for RPN are current limitations.

Background: The learning curve of new surgical procedures has implications for the education, evaluation and subsequent adoption. There is currently no standardised surgical training for those willing to make their first attempts at minimally invasive pancreatic surgery. This study aims to ascertain the learning curve in minimally invasive pancreatic surgery. Methods: A systematic search of PubMed, Embase and Web of Science was performed up to March 2021. Studies investigating the number of cases needed to achieve author-declared competency in minimally invasive pancreatic surgery were included. Results: In total, 31 original studies fulfilled the inclusion criteria with 2682 patient outcomes being analysed. From these studies, the median learning curve for distal pancreatectomy was reported to have been achieved in 17 cases (10–30) and 23.5 cases (7–40) for laparoscopic and robotic approach respectively. The median learning curve for pancreaticoduodenectomy was reported to have been achieved at 30 cases (4–60) and 36.5 cases (20–80) for a laparoscopic and robotic approach respectively. Mean operative times and estimated blood loss improved in all four surgical procedural groups. Heterogeneity was demonstrated when factoring in the level of surgeon’s experience and patient’s demographic. Conclusions: There is currently no gold standard in the evaluation of a learning curve. As a result, derivations are difficult to utilise clinically. Existing literature can serve as a guide for current trainees. More work needs to be done to standardise learning curve assessment in a patient-centred manner.