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PurposeThe aim of this review was to collate current evidence wherein digitalisation, through the incorporation of video technology and artificial intelligence (AI), is being applied to the practice of surgery. Applications are vast, and the literature investigating the utility of surgical video and its synergy with AI has steadily increased over the last 2 decades. This type of technology is widespread in other industries, such as autonomy in transportation and manufacturing.MethodsArticles were identified primarily using the PubMed and MEDLINE databases. The MeSH terms used were “surgical education”, “surgical video”, “video labelling”, “surgery”, “surgical workflow”, “telementoring”, “telemedicine”, “machine learning”, “deep learning” and “operating room”. Given the breadth of the subject and the scarcity of high-level data in certain areas, a narrative synthesis was selected over a meta-analysis or systematic review to allow for a focussed discussion of the topic.ResultsThree main themes were identified and analysed throughout this review, (1) the multifaceted utility of surgical video recording, (2) teleconferencing/telemedicine and (3) artificial intelligence in the operating room.ConclusionsEvidence suggests the routine collection of intraoperative data will be beneficial in the advancement of surgery, by driving standardised, evidence-based surgical care and personalised training of future surgeons. However, many barriers stand in the way of widespread implementation, necessitating close collaboration between surgeons, data scientists, medicolegal personnel and hospital policy makers.

Novice users of telesurgery could be limited by their experience and technical ability. The impact of the COVID-19 pandemic on health care systems is unprecedented, and telehealth allowed care providers and patients a safety margin. An indirect impact of redeployment of hospital staff during COVID-19 management has been on the reduced educational opportunities for residents. Proximie can be considered as a virtual teaching platform or classroom for any user. Twenty-one students voluntarily participated in utilizing a da Vinci ® skills simulator (dVSS) to carry out surgical training simulation tasks. Our study focuses on digital native’s adaptation to utilizing Proximie’s augmented reality platform to direct task performance, to gauge its feasibility by this unique cohort.

The da Vinci ® single-port (SP) and multiport (Xi) approaches to robotic-assisted radical prostatectomy (RARP) are described by different authors in the literature, primarily comparing short-term outcomes of both modalities. To our knowledge, this is the first article comparing the surgical perspective and satisfaction of patients who underwent RARP with the SP and Xi platforms. To determine the patient surgical perspective and satisfaction in terms of pain control, return to normal activity, and overall results of surgery for two groups who underwent SP and Xi radical prostatectomy. The data from 71 consecutive patients who underwent SP RARP in a single center from June 2019 to April 2020 was compared to 875 patients who underwent Xi RARP in the same period. A single surgeon performed all procedures with a transperitoneal technique. After a propensity score match, two groups of 71 patients (SP and Xi) were selected and compared in the study. Patients were contacted by phone by two interviewers and a questionnaire was administered in English or Spanish. Patients were instructed not to disclose the type of robotic surgery they underwent, as interviewers were blinded to that information. A validated Surgical Satisfaction Questionnaire (SSQ-8) was used, along with an additional question from our institution asking about the satisfaction with the number of incision sites (GRI-1). Data were analyzed as continuous and discrete variables to compare the differences between the Xi and SP cohorts. A response rate of 85.9% ( n  = 61) in the Xi group and 73.2% ( n  = 52) in the SP group was captured. Overall satisfaction with surgical results was 80% and 88% in the Xi and SP cohorts, respectively. No statistical difference in responses was found between the Xi and SP cohorts for SSQ-8. However, GRI-1 demonstrated a statistically significant difference ( P  < 0.001) in terms of number of scars that favors the SP approach. Limitations of this study are the small sample size and recall bias. We found no statistical difference between the groups regarding the answers for SSQ-8 questionnaire; both groups were very satisfied. When assessing the number of incision sites with the GRI-1 question, patients who underwent MP had lower satisfaction rates compared to SP. These patients perceived the number of scars and their appearance as reason for lower satisfaction. We believe that future studies should consider patient’s postoperative perspective when adopting new platforms in order to combine adequate treatment with patient expectations. We performed a study assessing the postoperative satisfaction and perspectives of two groups of patients who underwent radical prostatectomy with two different robots (SP and Xi). There was no difference in patient satisfaction with the results of either the da Vinci ® SP or Xi RARP except for the patients’ perception on their number of scars, which favored the SP group.

Introduction dHACM is a source of factors including cytokines that allow anti-inflammatory and proliferative elements to be utilized for wound and ulcer management. We present our experience of using dHACM in a cohort of patients undergoing nerve-sparing (NS) robot-assisted laparoscopic prostatectomy (RALP). Our objective is to investigate the functional and oncological outcomes of NS after placing amniotic or dehydrated human amnion/chorion membrane (dHACM) on preserved neurovascular bundles (NVBs). From 2013 to 2019, our institution performed transperitoneal multi-port da Vinci robotic prostatectomy. The NVBs are spared by releasing their fascial planes posteriorly, followed by an anterior release of the plane at a similar level. Once the retrograde release of the NVB is performed then 599 patients underwent placement of dHACM graft (AmnioFix by MiMedx, Marietta, GA, USA). The graft was cut into two 4 × 1 cm pieces and laid over the NVB as a wrap. In order to inform the urological community of oncological and functional outcomes, we excluded patients with less than 12 months follow up ( n  = 64), benign prostatic hyperplasia ( n  = 5), and unilateral NS ( n  = 1). 529 (88%) patients were included in this study who underwent a partial or full bilateral NS with dHACM. 529 patients were followed-up for a median (IQR) of 42 months (25–89). Demographics include median (IQR) age 57 years (52–62), median preoperative SHIM score of 24 (21–15), and AUASS of 5 (2–11). Full NS was performed in 74% (391/529). Pathological staging was pT2 = 399 (75%), pT3a = 107 (20%), pT3b = 19 (4%) and pT4 = 4 (1%) with N1 = 3 (0.6%). The number of patients with PSM was 86 (16%), and the overall BCR in the entire cohort was 10%. Postoperatively, 434 (82%) were sexually active. Median time to potency was 119 (37–420) days and time to continence was 42 (23–91) days. Regarding full vs partial NS: median post op SHIM score 18 (13–20) vs 15 (6–20), median time to potency 92 (35–365) days vs 184 (42–560) days, and median time to continence 42 (23–91) days vs 44 (30–92) days. Age > 55 vs ≤ 55 years: median post op SHIM score 18 (12–20) vs 15 (10–20), median time to potency 167 days (42–549) vs 80 (35–288) days, and median time to continence 42 (25–116) days vs 42 (29–76) days. In our series the application of amniotic membrane/dHACM has led to acceptable post RALP outcomes. The BCR rate of 10% in addition to the recovery of potency at a median time of 3 months and continence at 6 weeks is an encouraging result of dHACM. Our findings indicate that dHACM allowed for an even faster period for continence recovery which was independent of grade of NS. Future comparative studies may further assess the impact of new amniotic membrane types on the functional and oncological outcomes after RALP.

Post radical prostatectomy (RP) erectile dysfunction and incontinence impacts quality of life for patients. In an objective to hasten the recovery of these functional outcomes, human placental derived allografts laid on neurovascular bundles (NVB) have been investigated. These grafts include amniotic membranes (AM) chorionic membranes (CM) or umbilical cord (UC) allografts. A literature review performed using the MeSH terms “AMNION” OR “CHORION” OR “AMNIOTIC MEMBRANE” OR “UMBILICAL CORD” AND “PROSTATE CANCER” from no specified start date, to April 2022. 163 articles were retrieved, with 149 articles excluded. 14 articles were eligible and analysed. 5 articles were included in this review for an analysis on comparative outcomes. The average return to potency was statistically significant in the intervention groups. Positive surgical margin (PSM) rates showed a higher rate in the control groups. BCR was observed at a lower rate in the interventional group. This review reveals a benefit from human placental allograft's ability to hasten post RP functional recovery, without impacting oncological control.

The purpose is to report the United Kingdom’s largest single-centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using the neurovascular structure-adjacent frozen-section (NeuroSAFE) technique. We describe the utilisation and outcomes of this technique. This is a retrospective study from 2012 to 2019 on 520 patients undergoing NeuroSAFE RALP at our Institution. Our Institution’s database was analysed for false-positive frozen-section (FS) margins as confirmed on paraffin histopathological analysis: functional outcomes of potency, continence, and biochemical recurrence (BCR). The median (range) of console time was 145 (90–300) min. In our cohort, positive FS was seen in 30.7% (160/520) of patients, with a confirmatory paraffin analysis in 91.8% of our patients’ cohort (147/160). The neurovascular bundles (NVBs) that underwent secondary resection contained tumour in 26.8% (43/160) of the cases. Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. There were insufficient evidence of a statistical association of urinary incontinence and positive surgical margin rates according to NS or NVB resection. NeuroSAFE enables intraoperative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE can be converted to a negative surgical margin (NSM) by ipsilateral wide resection. This spared 1 in 4 men from positive margins posterolaterally in our series. Limitations are the absence of a matched contemporary cohort of NS RALP without NeuroSAFE in our centre.

The hormonal milieu influences immune tolerance and the immune response against viruses and cancer, but the direct effect of androgens on cellular immunity remains largely uncharacterized. We therefore sought to evaluate the effect of androgens on murine and human T cells in vivo and in vitro. We found that murine androgen deprivation in vivo elicited RNA expression patterns conducive to IFN signaling and T-cell differentiation. Interrogation of mechanism showed that testosterone regulates T-helper 1 (Th1) differentiation by inhibiting IL-12–induced Stat4 phosphorylation: in murine models, we determined that androgen receptor binds a conserved region within the phosphatase, Ptpn1, and consequent up-regulation of Ptpn1 then inhibits IL-12 signaling in CD4 T cells. The clinical relevance of this mechanism, whereby the androgen milieu modulates CD4 T-cell differentiation, was ascertained as we found that androgen deprivation reduced expression of Ptpn1 in CD4 cells from patients undergoing androgen deprivation therapy for prostate cancer. Our findings, which demonstrate a clinically relevant mechanism by which androgens inhibit Th1 differentiation of CD4 T cells, provide rationale for targeting androgens to enhance CD4-mediated immune responses in cancer or, conversely, for modulating androgens to mitigate CD4 responses in disorders of autoimmunity.

For a graph H , the H -recolouring problem Recol ( H ) asks, for two given homomorphisms from a given graph G to H , if one can get between them by a sequence of homomorphisms of G to H in which consecutive homomorphisms differ on only one vertex. We show that, if G and H are reflexive and H is triangle-free, then this problem can be solved in polynomial time. This shows, at the same time, that the closely related H -reconfiguration problem Recon ( H ) of deciding whether two given homomorphisms from a given graph G to H are in the same component of the Hom-graph Hom ( G , H ) , can be solved in polynomial time for triangle-free reflexive graphs H .

Let Qd denote the hypercube of dimension d. Given d ⩾ m, a spanning subgraph G of Qd is said to be (Qd , Qm )-saturated if it does not contain Qm as a subgraph but adding any edge of E(Qd )\\E(G) creates a copy of Qm in G. Answering a question of Johnson and Pinto [27], we show that for every fixed m ⩾ 2 the minimum number of edges in a (Qd , Qm )-saturated graph is Θ(2 d ). We also study weak saturation, which is a form of bootstrap percolation. A spanning subgraph of Qd is said to be weakly (Qd , Qm )-saturated if the edges of E(Qd )\\E(G) can be added to G one at a time so that each added edge creates a new copy of Qm . Answering another question of Johnson and Pinto [27], we determine the minimum number of edges in a weakly (Qd , Qm )-saturated graph for all d ⩾ m ⩾ 1. More generally, we determine the minimum number of edges in a subgraph of the d-dimensional grid Pk d which is weakly saturated with respect to ‘axis aligned’ copies of a smaller grid Pr m . We also study weak saturation of cycles in the grid.