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Near-infrared fluorescence imaging with indocyanine green has emerging applications in urologic surgery. This technology is strongly used in robotic surgery for several ablative and reconstructive procedures. On the contrary, it is not used at all in the urological laparoscopic surgery. To date, bilateral pelvic lymph node dissection represents the most accurate and reliable staging procedure for the detection of lymph node invasion in prostate cancer and bladder cancer. However, it is not devoid of complications. In this field, indocyanine green fluorescence-guided sentinel lymph node identification is an emerging technique, as accurate staging of urologic cancer could be enhanced by an intraoperative lymphatic mapping. Our goal was to show a high spatial resolution, real-time intraoperative imaging technique to recognize the main lymphatic drainage networks, avoiding at same time lymphatic vessel damage. Furthermore, the use of such an imaging system represents an absolute novelty in the field of urological laparoscopy.

Background: Pheochromocytoma is known for its instantaneous presentation, especially in the younger population. Hemodynamic instability may be the cause of severe complications and impede patients’ ability to undergo surgical treatment. These tumours are surgically difficult to treat due to the risk of catecholamine release during their manipulations, and when they are large, the tumour size represents an additional challenge. In our report, cardiogenic shock developed due to increases in systemic vascular resistance, and the lesion’s size induced surgeons to perform open surgery. Case presentation: A 46-year-old female patient was admitted to our intensive care unit with hypertension and later cardiogenic shock. Systolic dysfunction was noted, along with severely increased systemic vascular resistance. A CT scan showed a left-sided 8.5 cm adrenal mass, which was confirmed as pheochromocytoma using meta-iodobenzylguanidine scintigraphy. Anaesthesiologists and the surgical team planned an effective strategy of treatment. Given the lesion’s size and its apparent invasion of the neighbouring organs, open adrenalectomy (after prolonged hemodynamic stabilisation) was considered safer. The surgery was successful, and the patient remains free from disease two years after the initial event. Conclusions: Large pheochromocytoma can be safely and effectively treated with open surgery by experienced hands but only by seeking to reach hemodynamic stabilisation and minimising the release of catecholamine before and during surgery.

INTRODUCTION AND OBJECTIVES: To evaluate whether splitting TURP and Hifu in two session can reduce complication rate in patients with localized prostate cancer. METHODS: From November 2004 to September 2010, 103 patients affected by localized prostate cancer underwent HIFU following TURP. In 39 patients both procedures were performed in the same session (Group A); in 64 patients HIFU was delayed (Group B). Follow up included serial PSA measurements and prostate biopsies 6 months after the treatment in all patients. Biochemical recurrence was defined as PSA nadir 2ng/ml (ASTRO 2005 criteria). We have evaluated complication rate in the Group A and B. RESULTS: The mean age, PSA and prostate volume were 73.3 ( 5.4) years, 8.2 ( 19.3) ng/ml and 29 ( 8,3) cc, respectively. Mean procedure time was 128 minutes and mean hospitalization was 3.4 days. Complications occurred in 30 patients. Complication rate was not associated with clinical stage (T1 vs T2) (p0,67), Gleason score (p0,62), age (p0,2), prostate volume (p0,06), PSA (p0,9). Complications rate was lower when HIFU has been delayed after TURP (Group B) [see table]. Complications occurred in 61% (24/39) of Group A patients and in 9,3% (6/64) of Group B patients (p 0,001). No significant differences were seen between Group A and B patients in terms of clinical stage (p0,9), Gleason score (p0,2), prostate volume (p0,3), age (p0,4) and PSA (p0,46). CONCLUSIONS: Splitting TURP and HIFU in two different sessions seems to reduce postoperative complications and improve patient tolerance of the procedure. Longer follow up and larger patient population are needed to obtain more robust evidence.