NLRP3 is a cytosolic sensor triggered by different pathogen- and self-derived signals that plays a central role in a variety of pathological conditions, including sterile inflammation. The leucine-rich repeat domain is present in several innate immune receptors, where it is frequently responsible for sensing danger signals and regulation of activation. Here we show by reconstitution of truncated and chimeric variants intoNlrp3^−/−macrophages that the leucine-rich repeat domain is dispensable for activation and self-regulation of NLRP3 by several different triggers. The pyrin domain on the other hand is required to maintain NLRP3 in the inactive conformation. A fully responsive minimal NLRP3 truncation variant reconstitutes peritonitis inNlrp3^−/−mice. We demonstrate that in contrast to pathogen-activated NLRC4, the constitutively active NLRP3 molecule cannot engage wild-type NLRP3 molecules in a self-catalytic oligomerization. This lack of signal amplification is likely a protective mechanism to decrease sensitivity to endogenous triggers to impede autoinflammation.

Combined liver–kidney transplantation (CLKT) has evolved as a therapeutic option for patients with concurrent end-stage liver and renal diseases. This study evaluates the perioperative and long-term outcomes of CLKT at a single center in Slovenia, highlighting the challenges and successes of simultaneous organ transplantation. We retrospectively analyzed all patients undergoing simultaneous CLKT at the University Medical Centre Ljubljana from April 2014 to June 2023. Data on demographics, cause of liver and kidney disease, operative details, postoperative complications, patient and graft survival, and follow-up were collected and analyzed. Five patients aged 27 to 60 years underwent CLKT within the study period. All transplants involved deceased donors with whole-liver grafts. Indications for CLKT were polycystic liver disease (n = 3), Caroli’s disease (n = 1), and alcoholic cirrhosis (n = 1). The mean follow-up duration was 45.2 months, with a 100% survival rate. The incidence of surgical and postoperative complications was low. This pioneering series of simultaneous CLKTs in Slovenia demonstrates the feasibility and effectiveness of the procedure in smaller transplant centers. Despite challenges, including T cell-mediated kidney rejection and surgical complications, the study emphasizes the importance of comprehensive postoperative care and management in optimizing outcomes for CLKT recipients.

Background: Robot-assisted radical prostatectomy (RARP) is the predominant surgical approach for localized prostate cancer in high-volume centers worldwide. However, comprehensive real-world data describing complete institutional transition from open to robotic surgery remain limited. This study evaluated perioperative and early oncological outcomes of a contemporary RARP cohort and characterized the transition from open radical prostatectomy (ORP) to RARP in a European center. Methods: We analyzed 520 consecutive patients who underwent RARP between January 2023 and December 2025. Perioperative, pathological, and biochemical outcomes were assessed. Biochemical recurrence was defined as prostate-specific antigen ≥0.2 ng/mL. Institutional data from 2011 to 2025 were reviewed to evaluate procedural trends and the transition from ORP to RARP. Surgeon-specific and institutional learning curves were analyzed using operative time and linear regression models. Results: Following the introduction of robotic surgery in 2018, annual RARP volume increased from 37 procedures to 205 in 2025. Since 2023, RARP accounted for more than 99% of all radical prostatectomies. Median operative time decreased from 185 min in 2023 to 165 min in 2025, with consistent downward trends observed across all surgeons. Linear regression confirmed progressive improvement in operative efficiency, with learning rates ranging from −0.22 to −0.92 min per case. Estimated blood loss was minimal, no patients required transfusion, and major complications occurred in four patients (0.8%). Hospital stay decreased from 2 days to predominantly 1 day. During follow-up, 36 patients developed biochemical recurrence or PSA persistence. Biochemical recurrence-free survival differed significantly according to pathological stage (log-rank p < 0.001), with 24-month estimates of 93.7%, 91.5%, and 82.1% for pT2, pT3a, and pT3b disease, respectively. Conclusions: RARP provides favorable perioperative safety, minimal morbidity, and favorable early oncological outcomes in a high-volume setting. The complete institutional transition from ORP to RARP, together with demonstrated surgeon-specific and institutional learning effects, supports the feasibility and safety of implementing RARP as the institutional standard within a structured robotic program.

Minimally invasive surgical therapies (MISTs), such as Rezūm™ Water Vapor Therapy, are emerging treatment options for benign prostatic obstruction (BPO). When prostate cancer is subsequently diagnosed, radical prostatectomy may still be indicated. However, evidence regarding intraoperative challenges and the surgical and functional outcomes of robot-assisted radical prostatectomy (RARP) following Rezūm remains limited. We report the first documented case of RARP following Rezūm in a 68-year-old man. He initially underwent Rezūm for symptomatic BPO. Due to rising PSA, a suspicious lesion on MRI, and a biopsy-confirmed high-risk prostate carcinoma, radical surgery was performed. Intraoperatively, dense fibrosis and altered tissue planes required precise dissection and a level 2 bilateral nerve-sparing approach. A systematic review revealed no previously published cases of RARP after Rezūm. On the other hand, RARP after transurethral resection of the prostate (TURP) is associated with increased operative time, blood loss, and bladder neck reconstruction, though late continence and biochemical recurrence rates are similar to those in treatment-naïve patients. In conclusion, RARP after ablative BPO therapies is feasible but may present unique technical challenges. Larger prospective studies are needed to develop standardized management strategies.

Background/Objectives: Robot-assisted partial nephrectomy (RAPN) has increasingly replaced laparoscopic partial nephrectomy (LPN) in the management of localized renal tumours. This study aimed to evaluate perioperative, functional and surgical margin outcomes during an institutional transition from LPN to RAPN in a high-volume centre. Methods: We performed a retrospective single-centre analysis of 100 consecutive patients undergoing minimally invasive partial nephrectomy. The last 50 LPN cases (August 2014–May 2018) were compared with the first 50 RAPN cases (June 2018–February 2020). Baseline characteristics, perioperative outcomes, early functional parameters and surgical margin status were analysed. Complications were classified according to the Clavien–Dindo system. Results: Tumours treated in the RAPN group were significantly larger (3.4 vs. 2.5 cm) and more complex (RENAL score of 6 vs. 5; p < 0.001). Operative time was longer in the RAPN group (143 vs. 122 min; p < 0.01), while warm ischaemia time did not differ significantly (16 vs. 15 min; p = 0.37). Estimated blood loss was lower (0 vs. 10 mL; p = 0.049) and the hospital stay was shorter (3 vs. 4 days; p < 0.001) in the RAPN group. Haemoglobin decrease and postoperative creatinine change were comparable between groups. Positive surgical margins were observed less frequently in the RAPN group (2.3% vs. 7.7%), but this difference was not statistically significant (p = 0.34). Complication rates were significantly lower in the RAPN group (4% vs. 22%; p < 0.05), with no major complications observed in the robotic cohort. Conclusions: In this institutional experience, RAPN was associated with favourable perioperative outcomes during the transition period, despite the treatment of larger and more complex renal tumours. The slightly longer operative and warm ischaemia times likely reflect a more comprehensive reconstruction strategy, which may contribute to improved haemostatic control and lower complication rates. Further studies with extended follow-up are required to evaluate oncological and renal functional outcomes.