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MIM had been performed by either RM or LM. RM had been performed with the da Vinci-Si system (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Four ports, including a 12-mm camera port (at the umbilicus), and three 8-mm side ports, were inserted. After insertion of all of the trocars, the surgical cart was docked vertically. The robotic right arm held monopolar curved scissors, and the left arm held tenaculum forceps. A solution of vasopressin diluted to a 0.25 U/mL concentration was injected directly into the myoma. The monopolar curved scissors performed the incision, while the tenaculum forceps applied counter-traction. LM with four ports was performed by a technique similar to the robotic one. The V-loc™ (Covidien, Dublin, Ireland) for barbed continuous suture or Vicryl (Ethicon, Somerville, NJ, USA) for conventional interrupted suture was employed to suture the uterine wall. Myomas were retrieved by electric-power morcellation.

Surgeries were performed using the 4-arm Da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA). The RS-RARP technique was originally described by Galfano et al. [22 (link)]. This posterior surgical approach requires a careful dissection of detrusor fibers from the base of the prostate to prevent ureteral damage, ultimately ensuring the preservation of the bladder neck [23 (link)]. Unilateral or bilateral neurovascular excision was undertaken in patients with erectile dysfunction, high risk or locally advanced disease. The anastomosis between the urethra and the bladder was performed with a running, barbed 3/0 polyglyconate suture (V-LOC^®; Covidien, Mansfield, MA). The integrity of the urethrovesical anastomosis was confirmed intraoperatively with intravesical instillation of 150 ml of sterile saline through a 16F Foley catheter.

All procedures were carried out by four experienced bariatric surgeons or under their direct supervision. The procedures were performed as previous described [14 (link)]. If patients underwent a revisional procedure from an adjustable gastric band, it started with removal of the band followed by direct revision, after which the Port-a-cath was removed prior to skin closure.
For all procedures pneumoperitoneum was obtained. Five trocars (three 12 mm and two 5 mm) were used. In case of LRYGB, the pouch was formed with one horizontal and 3–4 vertical firings of a 45 mm endoscopic stapler (Johnson and Johnson, Sommerville, NY, USA) in the lesser curvature of the stomach. Subsequently the gastrojejunostomy was created in an antecolic, antegastric fashion, posterior by means of a stapler and anteriorly hand sewn using a barbed suture V-loc™ (Covidien, Dublin, Ireland). This was followed by the jejunojejunostomy at 120–150 cm and transection of the connecting loop.
The LSG was created using multiple firings of the Echelon 60 endoscopic stapler. The remnant stomach was removed through the most lateral 12 mm port after the trocar was removed and the incision enlarged (2–3 cm) and sent for pathologic examination.
Pouch revision was performed after inspection in the same fashion as creation of the pouch at primary LRYGB. Often the anastomosis was revised.

A single expert surgeon who had performed over 300 pure laparoscopic partial nephrectomies operated on or supervised in all cases of this study. The approach was determined based on the location of the tumour. Ureteral catheters were not inserted in all cases. After clamping the artery at the hilum and confirming by Doppler ultrasound that blood flow to the kidney ceased, tumour resection commenced. Our procedure is defined as hybrid enucleation according to the Surface–Intermediate–Base margin score (1–1–0).¹⁶ When the sinus was opened, inner running suturing was performed using a 3‐0 barbed suture (V‐Loc™; Covidien, Ireland). Haemostasis was achieved by monopolar soft coagulation (VIO300D or VIO3, ERBE, Germany) and fibrin‐based haemostat (TachoSil®; CSL Behring, Japan). Parenchymal renorrhaphy was not performed.¹⁷ All cases underwent CT within 7 days after surgery to monitor for postoperative complications.