Wang Linhui

Laparoendoscopic Single-site Surgery in Urology: Worldwide Multi-institutional Analysis of 1076 Cases

BACKGROUND Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years. OBJECTIVE To report a large multi-institutional worldwide series of LESS in urology. DESIGN, SETTING, AND PARTICIPANTS Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis. INTERVENTION Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques. MEASUREMENTS Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications. RESULTS AND LIMITATIONS Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160±93 min and estimated blood loss was 148±234 ml. Skin incision length at closure was 3.5±1.5 cm. Mean hospital stay was 3.6±2.7 d with a visual analog pain score at discharge of 1.5±1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases. CONCLUSIONS This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.

Adrenal ganglioneuromas: A 10-year experience in a Chinese population

BACKGROUND Adrenal ganglioneuroma (GN) is extremely rare. The present study is to describe the largest series of this adrenal tumor treated in a single medical center to our knowledge. METHODS Clinical details, radiologic, laboratory, and pathologic findings as well as follow-up data were analyzed retrospectively in 17 patients with incidentally discovered adrenal GN who received operative resection at a tertiary referral hospital in eastern China between June 1999 and June 2009. RESULTS The mean age of the 17 GN patients was 39.2 years (range, 7-72; male:female ratio, 1:2.4), of whom 13 patients had unilateral GN on the right side, and the remaining 4 on the left side. None of the 17 tumors was hormonally active. Only 6 of the 17 GN cases were diagnosed as benign nerve cell tumors by computed tomography or magnetic resonance imaging before operation. Treatment consisted of open unilateral adrenalectomy in 9 patients and laparoscopy in 8 patients. The mean pathologic size of the adrenal GNs was 6.3 +/- 3.1 cm (range, 1.0-13.0). Ultrastructural examination provided additional support for confirming the diagnosis. CONCLUSION Although there have been some clues for radiologic diagnosis of adrenal GN, pre-operative mis- and maldiagnosis are not infrequent. We recommend that complete operative resection should be considered once malignancy cannot be excluded by pre-operative evaluation. Laparoscopic adrenalectomy is a reasonable option at least for tumors < or =7 cm.

Adrenal incidentalomas: Experience from a retrospective study in a Chinese population

BACKGROUND With no generally accepted criteria for preoperative differential diagnosis between benign and malignant adrenal lesions, management of adrenal incidentalomas, especially those between 4 and 6 cm, remains controversial. PATIENTS AND METHODS Clinical details, radiological diagnosis, laboratory examination, intervention measures, and follow-up data were noted in 152 patients with adrenal incidentaloma hospitalized at a tertiary referral hospital in eastern China between July 1999 and February 2008. Pathologic diagnoses were analyzed in surgical cases. RESULTS Of 143 surgical patients, the mean pathologic size of the tumors was 5.6 ± 3.2 cm (range 0.5 to 22.0 cm). The final benign pathologic diagnosis mainly included adrenocortical adenoma (31.3%), pheochromocytoma (18.8%), myelolipoma (16.7%), and ganglioneuromas (9.0%). The incidence of malignancy was 6.9%. Based on the size criterion of 6 cm, there was a significant difference between malignant and benign tumor groups (P=0.007), but based on the size criterion of 4 or 5 cm, there was no significant difference between the two groups. CONCLUSIONS In our experience, the incidence of malignancy in adrenal incidentalomas was generally low, but relatively high in adrenal incidentalomas >6 cm. Nerve cell tumors constitute a significant number of cases of adrenal incidentaloma. Overtreatment of nonfunctional incidentalomas <4 cm remains frequent in China, and close follow-up for this group is recommended. Factors such as radiologic characteristics and patient concern should be taken into account for nonfunctional incidentalomas between 4 and 6 cm (not including 6 cm), for which laparoscopic adrenalectomy is a reasonable option.

Monitoring gene expression profile changes in bladder transitional cell carcinoma using cDNA microarray.

PURPOSE Differential gene expression profiles between normal bladder mucosas and bladder transitional cell carcinomas TCC were detected. MATERIALS AND METHODS cDNA microarrays were prepared by spotting PCR products of 12,800 human genes onto specially treated glass slides. The cDNA probes were prepared by labeling normal bladder mucosa mRNA and TCC tissue mRNA with Cy3-dUTP and Cy5-dUTP respectively through reverse transcription. The arrays were then hybridized against the cDNA probe mixture and the fluorescent signals were scanned. The ratios of Cy5/Cy3 were computed. Northern analysis was used to confirm the results of microarray hybridization. RESULTS Eighty-three genes (0.65%), whose ratios of Cy5/Cy3 were greater than 4.0 or less than 0.25, were screened out after 10 groups of hybridization. In the cancerous tissues 28 of them showed higher expression and 55 lower. Twenty-three genes are unregistered in GenBank. These differentially expressed genes are always involved in the physiological processes such as signal transduction, apoptosis and cell cycle, etc. CONCLUSIONS This technique provides a powerful method for quantitative analysis of the expression levels of thousands of genes in parallel, and is used to identify genes involved in TCC carcinogenesis. The data obtained by this means are comparable to those obtained by other methods. Using cDNA microarrays to define alterations in gene expression associated with a specific cancer may be an efficient way to uncover the clues to specific molecular derangements that account for its pathogenesis and thus identify potential targets for therapeutic intervention.

Preoperative diagnosis of renal oncocytoma: case report and literature review

Abstract To differentiate renal oncocytoma from renal carcinoma, the clinical data of four patients with incidentally found renal oncocytomas were studied in this report. And additional Immunohistochemistry examinations were done to confirm diagnosis. Renal oncocytomas were found incidentally in four patients during medical examination. No characteristic changes were found in laboratory tests. Radiology examination provided the location and possibility of renal oncocytoma. History, laboratory test and radiology exanimation indicated the diagnosis of renal oncocytoma, but the final identify of renal oncocytoma need pathology examination.

LESS Adrenal Surgery

One-port, single-incision laparoscopy is part of the natural development of minimally invasive surgery. Laparoendoscopic single-site (LESS) surgery has been conceived as a natural evolution to a further reduction of surgical trauma and has been steadily gaining momentum during the past 6 years. The population has a favorable perception of scarless surgery, even in the case of increased procedural risks of complications, in spite of cure and surgical safety being the main concerns. Compared with conventional laparoscopic surgery, LESS adrenal surgery is more difficult. The clear disadvantages of LESS adrenal surgery include instrument congestion around a single port and the inability to achieve adequate triangulation. In this chapter, the LESS adrenalectomy and LESS partial adrenalectomy would be discussed. And particularly in LESS adrenalectomy, the transperitoneal approach and retroperitoneal approach would be represented step by step. The advantages and disadvantages of each transperitoneal approach and retroperitoneal approach during LESS adrenal surgery would be discussed.

RNA干扰 p 38基因对肾癌786-O细胞生物学特性的影响及对舒尼替尼的增敏作用

目的探讨RNA干扰p38基因对人肾癌细胞株786-O增殖、侵袭、细胞周期和细胞对舒尼替尼敏感性的影响。 方法构建针对p38的siRNA531和siRNA659两条siRNA，分别将其转染至肾癌786-O细胞株，即为siRNA531组和siRNA659组，同时设置转染无义siRNA的阴性对照组和仅加转染试剂的空白对照组。应用RT-PCR技术检测786-O细胞p38 mRNA的表达，蛋白质印迹法检测p38蛋白的表达。CCK-8法检测细胞的增殖情况和对舒尼替尼的敏感性，流式细胞术检测细胞的周期改变情况，Transwell实验检测细胞的侵袭能力。 结果RT-PCR及蛋白质印迹法检测发现siRNA转染后786-O细胞p38 mRNA及蛋白的表达均降低。与空白对照组和阴性对照组相比，siRNA531组和siRNA659组786-O细胞在转染后3~5 d时的增殖率均降低（P < 0.05，P < 0.01），细胞对舒尼替尼的敏感性增加，两组对舒尼替尼的IC50值均低于阴性对照组[（3.2±0.3）、（1.4±0.1）μmol/mL vs（5.4±0.2）μmol/mL，P < 0.05]。siRNA531组、siRNA659组G1期细胞数量明显多于对照组，且两组786-O细胞出现G0/G1阻滞。转染24 h后，两组的穿膜细胞数分别为56.43±6.02、34.00±8.12，与阴性对照组（76.27±5.08）相比，两组细胞的侵袭能力均下降（P < 0. 01）。 结论通过转染p38特异性siRNA可以成功沉默肾癌细胞株786-O的p38基因的表达，抑制肾癌细胞株786-O的增殖、侵袭能力，增加其对舒尼替尼的敏感性，为后续研究肾癌治疗及靶向耐药奠定基础。