Objective To evaluate perioperative, functional, and oncologic outcomes of laparoscopic (LPN) and robotic-assisted partial nephrectomy (RAPN) in a large single-institution Romanian cohort during a 14-year implementation period. Methods We retrospectively analyzed 327 patients who underwent minimally invasive partial nephrectomy (2011–2025). Clinical, perioperative, functional, and oncologic outcomes were assessed. Propensity score inverse probability weighting was used to adjust for baseline differences between LPN and RAPN. Primary endpoints included trifecta achievement, major complications (Clavien ≥ III), renal functional outcomes, and oncologic control. Results Of 327 patients, 251 (76.8%) underwent LPN and 76 (23.2%) RAPN. Median tumor size was 34 mm, with 68.8% cT1a tumors. Overall trifecta achievement was 74.6% (59.4% LPN vs 78.9% RAPN, p = 0.49 after weighting). Major complications occurred in 3.1% of patients. Positive surgical margins were observed in 4.6% (5.4% LPN vs 1.7% RAPN). Acute kidney injury occurred in 15.3%, with 79.4% recovering ≥90% baseline renal function during follow-up. Among patients with ≥5-year follow-up (n = 71), 5-year overall survival was 95.8% and cancer-free survival was 92.7%. After propensity score adjustment, no significant differences were observed between approaches in perioperative or functional outcomes. Conclusion Minimally invasive partial nephrectomy, performed within a mature tertiary program, provides excellent perioperative safety and durable oncologic control. After adjustment for baseline characteristics, surgical platform alone did not independently influence functional or oncologic outcomes.

Background/Objectives: Relationship quality is closely tied to sexual health. This study compared the effects of tadalafil cream and oral tadalafil on Dyadic Adjustment Scale (DAS) subscales and assessed the influence of age on treatment outcomes. Methods: This study includes a secondary analysis of data collected during a previously published randomized controlled crossover trial, but they were not published at that time. The participants (n = 35) completed both tadalafil cream and oral tadalafil interventions in a crossover design. Dyadic Adjustment, including DAS subscales, was assessed at baseline and after each intervention. Improvements across all DAS subscales were greater in the tadalafil cream group compared to the oral tadalafil group. Statistically significant differences were observed for Affective Expression (5.45, 95% CI: 0.22–10.67, p = 0.041) in the multivariate model. Notable gains were observed in Affective Expression and Dyadic Cohesion for the cream route. Within-group analysis showed statistically significant improvements in Affective Expression for both treatments and in Dyadic Cohesion for the cream route. The results show that younger participants benefited more from treatment, particularly in Affective Expression, Consensus subscales, and overall for Dyadic Adjustment. Conclusion: This study provides evidence that tadalafil intervention had a favorable impact on relationship dynamics, particularly in Affective Expression and Dyadic Cohesion.

Background and Objectives: This study aimed to evaluate the association between relationship dynamics as measured by dyadic adjustment and factors such as erectile function and lower urinary tract symptoms, adjusting for relevant clinical characteristics. Materials and Methods: This cross-sectional study collected data from 94 males in relationships of at least 6 months and with a prostate volume equal to or higher than 30 cc. Lower urinary tract symptoms, erectile function, and relationship dynamics were assessed with the International Prostate Symptom Score (I-PSS), International Index of Erectile Function (IIEF), Dyadic Adjustment Scale (DAS). Results: We found significant positive correlations between DAS affective expressions (AEs) and erectile dysfunction duration; between IIEF general satisfaction and DAS dyadic adjustment (DA), dyadic consensus (DC), and dyadic cohesion (DH); and between prostate width and DAS DA and DC (all ρ ≈ 0.2–0.3, p < 0.05). Further multiple regression analyses adjusting for age, prostate width, and comorbidities showed that the associations between IIEF general satisfaction and DAS DA (p = 0.013) and DH (p = 0.008) remained significant, while the relationship with DAS DC (p = 0.051) was borderline. Conclusions: Our findings highlight that general sexual satisfaction, as measured with the IIEF, had a small but independent association with higher affective expressions, dyadic cohesion, and dyadic consensus in couples, which are key domains of dyadic adjustment, regardless of relationship duration, prostate width, and comorbidities. These results emphasize the importance of considering sexual satisfaction in the context of relationship quality and, therefore, involving the female partner in the assessment and treatment of erectile dysfunction.

Purpose: To analyze the perioperative factors that influence the risk of biochemical recurrence (BCR) in patients with localized PCa undergoing radical prostatectomy Materials and Methods: A total of 457 patients, operated by 2 surgeons in our high -volume oncological center were included in the initial database. Patients who underwent RP for clinically localized PCa in our clinic from 2016 to 2021 were included in the study. Perioperative data were retrospectively reviewed for this study. Follow-up data including post -operative PSA and adjuvant treatment was prospectively gathered by contacting the patients or from the follow-up consultation. Final database was composed of 366 patients who underwent open or 3D laparoscopic RP. Statistical analysis was performed to emphasize the most powerful parameters that influence the BCR. Results: Accounting for multivariable analysis, 4 parameters were statistically significant: initial PSA (iPSA), Gleason score, vascular involvement and positive surgical margins. For the group of patients with no positive margins, 3 parameters were statistically significant: iPSA above 10,98 ng/mL (AUC=0,71); lymph node involvement and Gleason score. Multivariable Cox regression showed that positive margins and iPSA had a significant impact on the time to BCR. Patients who received adjuvant therapy were excluded from the study. Out of the whole cohort, 27,3% of patients presented BCR. Conclusion: Perioperative factors need to be carefully analyzed and a detailed follow-up needs to be conducted in order to assess the risk of biochemical recurrence, resulting in the optimal time for adjuvant treatment implementation.

Background/Objectives: The objective of this study is to explore potential correlations between prostate volume, LUTS, and IIEF, with a particular emphasis on the relationship between prostate dimensions—width, height, and length—and both LUTS and IIEF and to assess patients based on risk factors such as hypertension, diabetes, cardiovascular disease, smoking, alcohol consumption, and PSA levels. Methods: A retrospective multicenter study was conducted between January 2007 and December 2023, focusing on male patients over the age of 40. The study evaluated hypertension, diabetes, cardiovascular diseases, smoking, alcohol consumption, and lower urinary tract symptoms (LUTS) through the completion of the IPSS and QoL questionnaires, sexual function using the IIEF-15, and PSA levels. Abdominal ultrasound was performed to determine prostate volume and its dimensions (width, height, and length). Results: A total of 943 patients were included in the study, with a mean age of 61.89 ± 8.51 years. From the 40–49 age group to the 80–90 age group, IPSS increased from 10.29 to 14.26 points, PSA from 1.1 ng/mL to 3.05 ng/mL, and prostate volume from 23.79 mL to 41.16 mL. Meanwhile, over the same age intervals, IIEF showed a decline from 52.57 to 24.76 points. The IPSS demonstrated a statistically significant positive correlation (p < 0.05) with prostate volume and patient age, while showing an inverse correlation with IIEF. The only statistically significant correlation between IPSS and prostate dimensions was with the length diameter of the prostate (p = 0.011). The severity of sexual symptoms was inversely correlated with both prostate volume and age. Additionally, IIEF was negatively correlated with the width and length diameters of the prostate. Hypertension (p = 0.57), diabetes (p = 0.57), smoking (p = 0.76), and alcohol consumption (p = 0.27) did not have a statistically significant impact on IPSS, and IIEF except for cardiovascular diseases, which showed a significant correlation with IPSS in patients experiencing moderate to severe symptoms (p = 0.0001). The statistically significant correlation between cardiovascular diseases and IIEF was observed only in patients with severe symptoms (p = 0.0001). Conclusions: There is a correlation between prostate volume, IPSS, and IIEF. Only length of the prostate shows a statistically significant correlation with both IPSS and IIEF. PSA levels increase progressively with each decade of age. Hypertension, diabetes, smoking, and alcohol consumption do not have a statistically significant impact on LUTS and erectile function. Cardiovascular diseases show a correlation with patients experiencing moderate to severe LUTS, as well as with those who have severe symptoms according to the IIEF evaluation.

This review aimed to bring a comprehensive analysis of key clinical strategies for enhancing reproductive efficiency in buffaloes, a species that exhibit low reproductive performance under conventional reproductive management compared to that exhibited by cattle. It considers key ART techniques including estrus synchronization for artificial insemination, and ovulation induction, highlighting their role in improving fertility and overall herd productivity. However, it also addresses common postpartum inflammatory and functional reproductive disorders, discussing their diagnosis and treatment protocols, stressing their impact on the overall reproductive outcome in buffalo farming.

Purpose: This study aimed to evaluate the indirect effect of the Coronavirus Disease 2019 (COVID-19) pandemic on the surgical outcomes and oncological results of patients who underwent surgery during the lockdown period. Methods: We analysed data from 423 patients who underwent radical prostatectomy between 2016 and 2022, with a cut-off date of March 16, 2020. Patients were categorised into two groups, namely, pre-lockdown (n = 289) and during lockdown (n = 134). Perioperative variables, histopathological findings and oncological outcomes, including prostate-specific antigen (PSA) levels and biochemical recurrence (BCR), were assessed. Results: The number of radical prostatectomy increased by 24.26% during lockdown. The study included patients with a mean follow-up of 21 months. A nonsignificant trend towards a higher PSA level at presentation was found (14.22 vs. 12.53 ng/dL, p = 0.216). The International Society of Urological Pathology grade was not significantly different among radical prostatectomy specimens (p = 0.669). Lymph node involvement increased during the COVID-19 period (p = 0.046). The pT classification in prostatectomy specimens increased during the pandemic, but the difference from the pre-pandemic value was not statistically significant. The BCR rates were 24.6% pre-lockdown and 29.9% during lockdown (p = 0.136). Conclusions: The COVID-19 pandemic led to poor postoperative results. Through a 2-year follow-up, this research investigated the effect of the pandemic on the oncological outcomes, particularly BCR, of patients who underwent radical prostatectomy. Further extended investigations and multi-institutional studies should be conducted to quantify the effect of the pandemic on various cancer outcomes and inform crisis management strategies.

Introduction: Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achieMaterials and methods: We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3 D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or Results: The mean operative time was 269.85 minutes (range 145-360). The mean hemoglobin 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal Conclusion: Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons. (c) 2024 AEU. Published by Elsevier Espa & ntilde;a, S.L.U. All rights reserved.

Background/Objectives: An electric wire inserted into the bladder or urethra presents a specific challenge that is frequently encountered in such cases: the potential formation of a tight knot, making extraction nearly impossible. The primary objective of this study was to share our personal experience with patients who had intravesical electric cable insertions and to provide an extensive literature review, offering detailed insights into the various strategies reported for managing such foreign body cases. Methods: Of the four cases with a foreign body in the lower urinary tract, two involved patients aged 19 and 53, respectively, who had inserted an electric cable. During their attempt at self-removal, they developed an intravesical knot, as confirmed by radiographic imaging. Results: In the first case, a bipolar approach was used: a cystoscope was inserted transurethrally into the bladder alongside the cable, while a laparoscopic trocar was introduced suprapubically. Using laparoscopic scissors, the cable was successfully cut and removed. In the second case, due to the cable’s size, a direct cystotomy was performed. At the 3-month follow-up, the uroflowmetry results were normal for both patients. A psychiatric evaluation revealed no abnormalities in the first patient, while the second patient was diagnosed with polyembolokoilamania. Conclusions: The removal of self-inserted electric cables from the urethra and bladder is a challenging procedure, often requiring the urologist’s creativity to prevent potential complications. Many cases can be resolved endoscopically; however, even this minimally invasive approach must be tailored to each case to provide the most suitable solution for the patient.

The ImageCLEF evaluation campaign was integrated with CLEF (Conference and Labs of the Evaluation Forum) for more than 20 years and represents a Multimedia Retrieval challenge aimed at evaluating the technologies for annotation, indexing, and retrieval of multimodal data. Thus, it provides information access to large data collections in usage scenarios and domains such as medicine, argumentation and content recommendation. ImageCLEF 2024 has four main tasks: (i) a Medical task targeting automatic image captioning for radiology images, synthetic medical images created with Generative Adversarial Networks (GANs), Visual Question Answering and medical image generation based on text input, and multimodal dermatology response generation; (ii) a joint ImageCLEF-Touché task Image Retrieval/Generation for Arguments to convey the premise of an argument, (iii) a Recommending task addressing cultural heritage content-recommendation, and (iv) a joint ImageCLEF-ToPicto task aiming to provide a translation in pictograms from natural language. In 2023, participation increased by 67% with respect to 2022 which reveals its impact on the community.

MicroRNAs (miRNAs) are a class of small non-coding RNAs that may function as tumor suppressors or oncogenes. Alteration of their expression levels has been linked to a range of human malignancies, including cancer. The objective of this investigation is to assess the relative expression levels of certain miRNAs to distinguish between prostate cancer (PCa) from benign prostatic hyperplasia (BPH). Blood plasma was collected from 66 patients diagnosed with BPH and 58 patients with PCa. Real-time PCR technology was used to evaluate the relative expression among the two groups for miR-106a-5p and miR-148a-3p. The significant downregulation of both miRNAs in plasma from PCa versus BPH patients suggests their potential utility as diagnostic biomarkers for distinguishing between these conditions. The concurrent utilization of these two miRNAs slightly enhanced the sensitivity for discrimination among the two analyzed groups, as shown in ROC curve analysis. Further validation of these miRNAs in larger patient cohorts and across different stages of PCa may strengthen their candidacy as clinically relevant biomarkers for diagnosis and prognosis.

Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (−0.3 versus −0.6, p < 0.001) and median sodium drop (−0.3 versus −0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique.

BACKGROUND:Prostate cancer (PCa) remains a significant global health issue, exhibiting a spectrum of clinical behaviours from indolent to aggressive. Biomarkers are crucial for risk assessment, treatment selection and prognosis prediction. Despite their importance, accurately evaluating PCa aggressiveness and guiding personalised treatment strategies present challenges. This review aims to evaluate biomarkers for assessing recurrence risk following radical prostatectomy, with a focus on personalised follow-up and timely intervention for high-risk patients. This review assesses the clinical significance of immunohistochemical biomarkers, including LIM domain kinase 1 (LIMK1), Antigen Kiel 67 (Ki67), PTEN and ERG, in PCa management. A comprehensive literature review examined the correlation between these biomarkers and biochemical recurrence (BCR) in patients undergoing radical prostatectomy. Our search included articles published between 2019 and 2024, yielding 87 articles, with 7 focused on the correlation between LIMK1 and BCR, 46 on Ki67 and 34 on PTEN/ERG biomarkers. After applying the exclusion criteria, 36 articles were included for review. LIMK1, a serine/threonine kinase, is highly expressed in cancers like PCa. It influences cell survival and motility through actin cytoskeleton reorganisation, correlating with poor prognosis, aggressive tumour behaviour and BCR. Similarly, Ki67, a marker of cell proliferation, predicts high-risk PCa and worse prognosis, particularly in castration-resistant cases, although its association with recurrence risk remains debated. PTEN loss and ERG fusion are prevalent genetic alterations in PCa, with PTEN loss linked to poor prognosis and ERG fusion associated with increased disease progression and BCR post-prostatectomy. Integrating these biomarkers into clinical practice can enhance risk stratification and inform personalised treatment strategies for patients with PCa. Despite promising findings, further validation studies and standardisation of detection methods are needed to ensure the clinical utility of these biomarkers. Continued research is essential to validate and optimise the clinical utility of these biomarkers, paving the way for more effective PCa management strategies and improved patient outcomes and quality of life.

Introduction Infective endocarditis(IE) has a low incidence, but it remains a serious disease with high mortality rates. Only 5 % of these patients will develop a splenic abscess, and the number of patients that have IE and a splenic abscess requiring surgery is low. The current guidelines recommend that splenectomy should be performed prior to valve replacement, but there is no strong evidence to support this statement and no evidence to clearly endorse the order in which the surgical interventions should be performed. The objective of this review and case series is to establish the proper treatment strategy, to assess the adequate order of the surgical interventions and to clarify the role of percutaneous drainage in the management of these patients. Material and Methods All patients with infective endocarditis and splenic abscess who underwent surgery in our institution, between January 2008 and December 2020 were included in this study, excluding patients which had cardiac device related endocarditis. Literature review on the matter included a number of 30 studies which were selected from the PubMed database. Results Assessing the literature and case series no reinfection was reported for simultaneously performing splenectomy(S) and valvular surgery(VS) nor for VS followed by S. Conclusion Percutaneous drainage of the splenic abscesses is a feasible solution as definitive therapy in high-risk patients or as bridge therapy. Additional studies are needed, even though they are difficult to conduct, therefore a national/international infectious endocarditis register may be of use to clarify these challenges.

Background and aims:To evaluate the quality of life in patients treated for prostate cancer in detail, an accessible, extensive, and easy-to-administer questionnaire is needed. The self-administered 50-item "Expanded Prostate Cancer Index Composite" (EPIC) is an instrument used for this purpose, but it is not officially translated into Romanian. The aim of the study was to translate and validate the Romanian version of the EPIC. Methods:We translated and culturally adapted the EPIC into Romanian. For validation, we included a retrospective analysis of 112 patients who underwent robotic radical prostatectomy and a prospective study including 120 consecutive patients hospitalized before surgical treatment. Baseline and follow-up assessments took place before and at six months, two, and five years post-surgery, between January 2014 and December 2015. We performed cross-sectional correlations between the EPIC, AUASI, and SF-12 at baseline, factor analysis, and calculated the internal consistency. Results:For most EPIC domains and subscales, our a priori-defined criteria for reliability were fulfilled (Cronbach's alpha 0.7-0.9). Cross-sectional correlations between EPIC scales and AUASI domain ranged from 0.23-0.69, and SF-12 domains ranged from 0.21-0.53 and 0.22-0.61, respectively. The retrospective analysis showed a medium acceptability and understanding of the EPIC questionnaire. In the prospective study, the revised EPIC draft showed an overall higher acceptability with a responding rate of 66% at a 5-year follow-up. All domains exhibited good internal consistency except for the hormonal section (Cronbach's α = 0.67) at the 6-month follow-up. Conclusion:The Romanian version of the EPIC is reliable, responsive and valid for measuring HRQL in prostate cancer patients. The EPIC questionnaire proved to be an exhaustive and reproducible instrument for evaluating the quality of life in Romanian prostate cancer patients.

Background and aims:To evaluate a novel multimodal treatment (TLP) that integrates the use of a thulium laser, bipolar transurethral resection of the prostate (TURP), and "button-type" bipolar plasma vaporization for the endoscopic treatment of benign prostatic hyperplasia (BPH). Methods:From March 2018 to December 2021, we prospectively evaluated 220 patients with symptomatic BPH who underwent TLP. Patients were assessed based on the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). Perioperative and postoperative follow-up data were analyzed. Results:The mean age at surgery was 66.74 years (SD 8.21). The median prostate size was 80 (IQR 70 - 110). The median operative time was 45 (IQR 35 - 55) minutes and the hospital stay was 2 (IQR 1 - 2) days. Patients were discharged with the urinary catheter in place, which was removed approximately 7 days after surgery when the histopathological result was discussed with the patient. Postoperatively, IPSS, QoL, Qmax and PVR showed a significant improvement starting at 3 months and continued through the postoperative follow-up visits (6-12-24-36-48-60 months). Urethral stricture and bladder neck contracture occurred in 1 (0.45%) and 2 (0.91%) patients, respectively. Recurrence of BPH occurred in 2 patients (0.91%) who underwent a second procedure. Conclusions:In conclusion, we report that the multimodal surgical treatment of BPH consisting of combining Thulium laser vaporization, bipolar TURP and plasma vaporization (TLP) represents an efficient and durable therapeutic method for BPH patients with low a complication rate at 5-year follow-up.

Introducción: La pielonefritis xantogranulomatosa (PXG) es una forma rara de inflamación renal crónica, causada por una obstrucción prolongada de las vías urinarias. La pionefrosis es una complicación supurativa grave de la pielonefritis aguda obstructiva. Aunque el abordaje mínimamente invasivo tiene muchas ventajas, no siempre es viable realizar una disección segura del riñón.Materiales y métodos: Revisamos 27 casos de pacientes diagnosticados con PXG o pionefrosis sometidos a nefrectomía total laparoscópica en nuestro servicio entre octubre de 2016 y marzo de 2022. Todas las intervenciones se realizaron con el sistema laparoscópico 3D de Karl Storz. El abordaje quirúrgico para la mayoría de los casos de PXG consistió en una nefrectomía transperitoneal estándar, mientras que los casos de pionefrosis se trataron por vía retroperitoneal. Todos los procedimientos fueron realizados o supervisados por el mismo cirujano.Resultados: El tiempo quirúrgico medio fue de 269,85 minutos (rango 145-360). El descenso medio de hemoglobina tras la intervención fue de 1,41 g/dl (rango 0,3-2,3 g/dl). La disección fue difícil en 13 de los casos (48,14%). Nueve de las 13 intervenciones se realizaron mediante abordaje intracorpóreo exclusivamente, y en los 4 casos restantes se requirió conversión a cirugía abierta. Las complicaciones vasculares que afectaron los vasos sanguíneos principales incluyeron un caso de rotura de la vena cava inferior (VCI). Las complicaciones digestivas fueron dos fístulas en el colon descendente y una brecha peritoneal. En 6 casos se realizó resección multiorgánica.Conclusiones: La nefrectomía radical constituye un procedimiento difícil en casos de PXG y pionefrosis. El abordaje laparoscópico es viable, ya que la mayoría de las complicaciones se resuelven de manera intracorpórea. Sin embargo, puede reservarse para centros con un volumen alto de pacientes, que cuenten con cirujanos experimentados.

OBJECTIVE To report our step-by-step technique for 3D laparoscopic radical nephrectomy and thrombectomy for a right renal tumor with level IV venous thrombus. Worldwide experience in minimally-invasive approach for such complex cases is limited. MATERIALS AND METHODSA 66-year-old male was incidentally diagnosed with a right renal tumor. He had a medical history of hypertension and benign prostatic hyperplasia. Blood test analysis showed a hemoglobin of 11.2 g/dL and creatinine of 0.92 mg/dL. Liver function and bilirubin were within normal limits. Contrast-enhanced abdominal CT scan showed an 90/77/85 mm right renal mass with a level IV inferior vena cava (IVC) tumor thrombus. Cardiac MRI showed that the tumor thrombus was extending into the right atrium, through the tricuspid valve and into the right ventricle. There was no evidence of distant metastases. After a multidisciplinary team reviewed the case, the patient was scheduled for 3D laparoscopic radical nephrectomy and thrombectomy by mini-thoracotomy approach RESULTS Retroperitoneal laparoscopic approach was used to ensure rapid access on the renal artery, with minimal mobilization of the renal vein, and to better isolate the posterior wall of the IVC. Surgery continued with the transperitoneal approach and the isolation of the infrarenal and infrahepatic IVC and left renal vein. Meanwhile the right femoral artery and vein and right jugular vein were cannulated. Mini-thoracotomy was performed and cardiopulmonary by-pass was started. Blood flow through the IVC and left renal vein was stopped, and the right atrium was opened to control the thrombus. Cavotomy was performed at the level of right renal hilum and the tumor thrombus was identified and sectioned. There were no signs of thrombus adherence to the IVC wall. The thoracic segment of the thrombus was completely extracted by the cardiovascular surgeons. Pringle maneuver was not necessary, as there was no retrograde bleeding. No intraoperative adverse events occurred, according to the Intraoperative Complications Assessment and Reporting with Universal Standards Criteria. The operative time was 7 hours. Blood loss was minimal, with no need of intra- or postoperative transfusions. Hospital length of stay was 8 days. Pathology revealed renal cell carcinoma, International Society of Urological Pathology 3, with negative surgical margins. At 9-months follow-up, the patient is doing well, without signs of local or distant recurrence. CONCLUSION 3D laparoscopy is a feasible alternative to open surgery for the most complex cases, enabling very precise dissection and suturing. We have shown a case of successful 3D laparoscopic radical nephrectomy with IVC thrombectomy combined with mini-thoracotomy achieving complete intracardiac thrombus removal.

In this paper, we provide an overview of the upcoming ImageCLEF campaign. ImageCLEF is part of the CLEF Conference and Labs of the Evaluation Forum since 2003. ImageCLEF, the Multimedia Retrieval task in CLEF, is an ongoing evaluation initiative that promotes the evaluation of technologies for annotation, indexing, and retrieval of multimodal data with the aim of providing information access to large collections of data in various usage scenarios and domains. In its 21st edition, ImageCLEF 2023 will have four main tasks: (i) a Medical task addressing automatic image captioning, synthetic medical images created with GANs, Visual Question Answering for colonoscopy images, and medical dialogue summarization; (ii) an Aware task addressing the prediction of real-life consequences of online photo sharing; (iii) a Fusion task addressing late fusion techniques based on the expertise of a pool of classifiers; and (iv) a Recommending task addressing cultural heritage content-recommendation. In 2022, ImageCLEF received the participation of over 25 groups submitting more than 258 runs. These numbers show the impact of the campaign. With the COVID-19 pandemic now over, we expect that the interest in participating, especially at the physical CLEF sessions, will increase significantly in 2023.