Infection and Inflammation of the Genitourinary Tract Re : Formalin Disinfection of Prostate Biopsy Needles May Reduce Post-Biopsy Infectious Complications

available at http://www.ncbi. nlm.nih. gov/pubmed/28117384 Editorial Comment: It is interesting when you share notes around the country about ways to decrease prostate biopsy complications. Both of the institutions I have worked at dipped the biopsy needle into formalin directly and swirled the needle in the formalin to remove the core. It is just how we did it. When comparing notes to other groups, I found that many other groups never took this approach, and rather they would remove the core directly onto a nonadherent gauze (Telfa ) pad and never directly expose the needle to formalin. One could hypothesize that dipping the needle into formalin would act to sterilize or reduce colony counts on the needle. This article compares a single surgeon experience using both approaches in a contemporary population. The authors observed fewer infections in the group where the needle was disinfected with formalin compared to the nonformalin disinfected group. This association was strongly noted on univariate analysis and had emerging significance on multivariable analysis. I suspect with more numbers we would see this association reach significance. My experience using this technique has been that it is safe and does not slow down prostate biopsy times. Edward M. Schaeffer, MD, PhD Laparoscopy/New Technology Re: Domestically Produced Chinese Minimally Invasive Surgical Robot System “Micro Hand S” is Applied to Clinical Surgery Preliminarily in China B. Yi, G. Wang, J. Li, J. Jiang, Z. Son, H. Su, S. Zhu and S. Wang Department of General Surgery, Third Xiangya Hospital, Central South University, Hunan and Tianjin University, Tianjin, People’s Republic of China Surg Endosc 2017; 31: 487e493. doi: 10.1007/s00464-016-4945-3 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/27194259 LAPAROSCOPY/NEW TECHNOLOGY 465 Editorial Comment: Development of potential alternatives to the only commercially available surgical robotic system is ongoing. I have previously highlighted a European system. Now the first clinical experience with a system developed in China is reported. This system, which consists of 3 slave manipulators, a 3-dimensional image viewer and wristed instrumentation, was successfully used by the authors to complete a limited number of cholecystectomies and appendectomies and a right colectomy, without complication. Additional large-scale studies are required to confirm safety and demonstrate reliability. The authors estimate that the cost of the Micro Hand S (Tianjin University, Tianjin, China) will be a tenth of the current commercially available system. Jeffrey A. Cadeddu, MD Re: Warmed and Humidified Carbon Dioxide for Abdominal Laparoscopic Surgery: Meta-Analysis of the Current Literature D. Balayssac, B. Pereira, J. E. Bazin, B. Le Roy, D. Pezet and J. Gagni ere Délégation a la Recherche Clinique et a l’Innovation, Anesthésie Réanimation and Chirurgie Digestive, CHU de Clermont-Ferrand, Faculté de Médecine et de Pharmacie, Clermont Université and Unité INSERM 1107, Clermont-Ferrand Cedex, France Surg Endosc 2017; 31: 1e12. doi: 10.1007/s00464-016-4866-1 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/27005288 Editorial Comment: Warming and humidifying the insufflated carbon dioxide during laparoscopy may decrease pain and hypothermia, creating a recovery advantage for the patient. In a metaanalysis of 17 clinical trials the authors conclude that a small beneficial effect compared to standard laparoscopy has been shown on immediate postoperative pain and body temperature. These data have been used to claim that the technology can shorten the postanesthesia care stay. However, no advantage for subsequent shoulder pain, morphine equivalent usage, postanesthesia care or hospital stay, or procedure duration were identified in this analysis. The cost/benefit ratio of warmed humidified carbon dioxide gas appears marginal at best. Jeffrey A. Cadeddu, MD Re: Improvement in Renal Function and Symptoms of Patients Treated with Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction with Less than 20% Split Renal Function M. Nishi, K. Matsumoto, T. Fujita and M. Iwamura Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan J Endourol 2016; 30: 1214e1218. doi: 10.1089/end.2016. 0553 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/27626128 Editorial Comment: Small series are emerging demonstrating a clinical benefit to laparoscopic/ robotic pyeloplasty for patients with poor ipsilateral renal function where nephrectomy had been the “standard” recommendation. In this series of 15 patients with split renal function of less than 20% (median 16.5%) all but 1 underwent successful surgery (resolved pain at 1 year postoperatively) with improvement in split function (24%) as well. Although long-term success in these patients remains poorly defined, offering pyeloplasty to patients with poor renal function should be considered. Jeffrey A. Cadeddu, MD