Shirai M, et al. World J Mens Health. 2020 Jan;38:e54. https://doi.org/10.5534/wjmh.200129

Introduction: Complications unique to laparoscopic surgery have been reported, including port site hernia. We experienced a case of port site hernia in the robotic right‐hand port site measuring 8 mm in diameter after robotic‐assisted laparoscopic radical prostatectomy.Case presentation: A 56‐year‐old man was indicated a high prostate–specific antigen level of 37.8 ng/ml. Subsequent prostate biopsy revealed adenocarcinoma with a Gleason score of 4 + 4. The patient underwent robotic‐assisted laparoscopic radical prostatectomy in Juntendo Hospital. Although his postoperative recovery was generally good, the patient complained of sudden nausea and acute abdominal pain. A contrast computed tomography scan showed an ileus due to a hernia occurring at the robotic right‐hand port, the da Vinci Arm I port. We released incarceration under laparoscopic procedure.Conclusion: Since the port diameter is relatively small in robot‐assisted surgery, port site hernias are expected to be rare. However, careful attention should be paid to the positional deviation of the remote center.

Background: Robot-assisted partial nephrectomy (RAPN) is a standard approach for localized renal cell carcinoma (RCC), emphasizing renal functional preservation. The Minimum Layer Resection (MLR) method, guided by 3D virtual partial nephrectomy (3DvPN) planning, was developed to balance oncological safety with parenchymal preservation. This study evaluated functional and oncological outcomes of RAPN with MLR and identified predictors of renal functional decline. Methods: We retrospectively analyzed 237 patients (after screening 312 cases) who underwent RAPN between 2012 and 2022 with ≥36-month follow-up. 3DvPN planning was used to guide MLR when feasible; both MLR and non-MLR were available and applied throughout the study period according to predefined indications. The primary endpoint was the percentage of estimated glomerular filtration rate (eGFR) preservation at 36 months; a ≥10% decline was clinically significant. Secondary endpoints included perioperative outcomes, acute kidney injury (AKI), and oncological outcomes such as margin involvement and recurrence. Results: The median age was 60 years, tumor size 29 mm, and warm ischemia time 21 min, with selective or superselective clamping achieved in 62.8% of cases. Postoperative AKI occurred in 25.0% (no patient required dialysis). At 3 years, the median eGFR preservation rate was 84.4%, and 28.5% of patients experienced a ≥10% decline. Independent predictors of short-term decline (14 days) were BMI > 25 kg/m², AKI, and WIT > 25 min, whereas long-term decline (36 months) was associated with tumor size > 30 mm and WIT > 25 min. Margin involvement was 1.7%, recurrence 3.8%, and major complications (Clavien–Dindo ≥IV) occurred in 1.7%. Conclusions: In conclusion, RAPN with the MLR technique under 3DvPN guidance demonstrated favorable perioperative outcomes, acceptable oncologic safety, and good mid-term renal functional preservation (up to 36 months). The approach provides a reproducible surgical strategy that maximizes parenchymal preservation while maintaining negative surgical margins. Prospective multicenter studies with longer follow-up are warranted to confirm long-term durability and to define the role of MLR in routine practice.

Taiki Ogasa, Yuki Nakagawa, Shuji Isotani, Kenta Futamura, Manabu Okada, Takahisa Hiramitsu, Norihiko Goto, Shunji Narumi, Yoshihiko Watarai. Korean J Transplant 2022;36:281. https://doi.org/10.4285/ATW2022.F-4242

Taiki Ogasa, Yuki Nakagawa, Tomoki Kimura, Mai Yamazaki, Kazuhiko Mizushima, Taiji Nozaki, Yoshihiko Watarai, Shuji Narumi, Shigeo Horie. Korean J Transplant 2023;37:308. https://doi.org/10.4285/ATW2023.F-9171