Zhen-jie Wu

Transperitoneal laparoendoscopic single-site nephrectomy combined with flexible 3-D laparoscope for partial nephrectomy in pigs：a preliminary experience

Objective To use transperitoneal laparoendoscopic single-site(LESS)partial nephrectomy combined with flexible 3-D laparoscope for partial nephrectomy in pigs,and to introduce our experience on LESS training in a pig model for partial nephrectomy.Methods A male pig was given general anesthesia and was put in a supine position.A 3.5cm incision was made through the right abdominal rectus. A multi- channel QuadPort(OlympusTM) was established. Artificial pneumoperitoneum was created by 14mmHg(1mmHg=0.133kPa);the lower pole and the kidney pedicle of the right kidney were isolated.The lower pole of the right kidney was resected after the renal artery was blocked.Figure-8 sutures were used to close the wound,with no notable bleeding noticed after opening the blood.The specimen was enclosed in an endoscopic pouch and pulled out from the incision.Results The procedure was smoothly completed without any extra incision.The operating time was 47 min;the period of renal artery occlusion was 21 min(5 min for resection,16 min for stitching);and the intraoperative blood loss was 20mL.There was no complication during the operation.Conclusion Our initial experience shows that 3D-LESS partial nephrectomy procedure is technically difficult,but it is safe,feasible and effective.Flexible 3D laparoscopy can provide clear 3D visualization,improving the operating accuracy and reducing the fighting of instruments.Thepig model used in this study can help surgeons to obtain experience on 3D-LESS partial nephrectomy.

Renal carcinoma related factor is up-regulated in high Fuhrman grade renal cell carcinoma tissues and affects prognosis of patients

Objective To identify differentially expressed long non-coding RNAs( lncRNAs) in different Fuhrman grade renal cell carcinoma( RCC) tissues,and to investigate the association of one of these lncRNAs-renal carcinoma related factor( RCRF) with the clinicopathologic features of RCC patients,helping the prognosis of RCC patients. Methods A total of 6 RCC tumor tissues were used for lncRNA chip screening,with 3 being FuhrmanⅠgrade and the rest being Fuhrman Ⅲ-Ⅳ grade. Then another 40 RCC tumor tissues( 22 FuhrmanⅠ-Ⅱgrade and 18 Fuhrman Ⅲ-Ⅳ grade) and the matched adjacent noncancerous tissues were subjected to qPCR examination for RCRF expression,and the relationship of RCRF expression with the clinical stage,tumor grade,lymph node metastasis and distant metastasis was analyzed. Results A total of 320 differentially expressed lncRNAs were screened out from RCC tumor tissues. Compared with the adjacent normal tissues,RCC tissues,especially the high grade ones,had significantly up-regulated RCRF expression( P 0. 01). It was also found that RCRF expression was associated with the pathological grade,lymph node metastasis and distant metastasis of RCC( P 0. 05). Conclusion RCRF is up-regulated in high Fuhrman grade tissues and may affect the prognosis of RCC patients.

da Vinci robot-assisted laparoscopic partial nephrectomy for renal tumors with PADUA score≥10

Objective To evaluate the safety,feasibility and efficacy of da Vinci robot-assisted laparoscopic partial nephrectomy in treating renal tumors with PADUA score≥10,so as to discuss its clinical potential.Methods Between May 2012 and September 2013,da Vinci robot-assisted laparoscopic partial nephrectomy was performed for 37 renal tumors withPADUA score≥10 by a single urologist in our institution.The information of the patients were:age 52.3±10.1(32-72)years old;body mass index 24.9±3.88(17.1-34.3)kg/m2;Charlson Co-morbidity Index(Age-weighted)0.5±0.84(0-3);and tumor laterality(L/R)20/17.The tumors were unilateral and solitary lesions,with a mean diameter of 4.2±1.19(2.1-7.2)cm,a PADUA score of 10.8±0.87(10-13),and a preoperative estimated glomerular filtration rate(eGFR)of 101.2±25.58(46.6-198.7)mL/(min·1.73m2).The renal arteries veins,and renal surroundings were isolated and the tumors were excised with or without blocking renal pedicle;all these procedures together with renorrhaphy were done by da Vinci robot-assisted laparoscopic techniques.Results All the 37 cases were smoothly done without surgical conversion,intraoperative complications or transfusion.The mean operative time was 241±50.0(120-330)min,estimated blood loss was 185±169.9(50-1 000)mL,and renal ischemia time was 26.7±9.90(0-50)min.The mean postoperative hospital stay was 11.4±3.44(8-19)days,with an overall complication rate of 13.5%(5/37).Pathological examination revealed no positive surgical margin,and there were 28 cases of renal clear cell carcinoma,3 papillary cell carcinoma,and 5different types of benign lesions.All the patients were alive during a mean follow-up of 5.9±4.64(1-12)months,with no local recurrence or distant metastasis.Nevertheless,eGFR was decreased by a mean of 8%,showing significant difference compared with that before operation(Z=-2.883,P=0.004).Conclusion For high PADUA score renal tumors,da Vinci robot-assisted laparoscopic partial nephrectomy has the advantages of minimal invasiveness,better safety,fine manipulation,and renal function preservation,although the cancer control outcome awaits further follow-up.

Application of R.E.N.A.L.scoring system in robotic laparoscopic partial nephrectomy

Objective To evaluate the clinical value of R.E.N.A.L.scoring system in analyzing the tumor anatomical feature and indication characteristics of patients undergoing robotic laparoscopic partial nephrectomy(RPN).Methods The clinical data of 70consecutive RPN cases done between March 2012and September 2013by the same surgeon at our institutionwere analyzed in this study.The 70patients(47males and 23females)had a mean age of(52.8±10.3)years,a mean body mass index(BMI)of(24.8±3.25)kg/m2,a mean ASA score of 2.0±0.4,and a mean age-weighted Charlson comorbidity index of(0.7±1.03).There were 38cases on the left(with 1case of solitary kidney)and 32cases on the right(also with 1case of solitary kidney).All the tumors were solitary ones,with the maximal diameter being(3.7±1.31)cm and a mean R.E.N.A.L.score of(8.1±1.31).The patients were divided into three groups according to the R.E.N.A.L.scores,and the clinical variables were compared between groups.Results One patient was transferred to open surgery due to intraoperative hemorrhage and the rest were successfully completed.The operative time was(230±48.3)min,estimated blood loss was(154±135.9)mL,renal ischemia time was(23.0±9.30)min,and the mean postoperative hospital stay was(11.4±4.44)days.The overall transfusion rate was 8.57%(6/70)and the complication rate was 17.1%(12/70).Pathological examination revealed no positive surgical margin;there were 58cases with renal carcinoma,4with angiomyolipoma and 8with other benign renal lesions.All patients were alive and had no local recurrence or distant metastasis at the latest follow-up.Nevertheless,the estimated glomerular filtration rate(eGFR)was significantly different before and after operation(P=0.003).Significant differences were also found among the low,moderate and high tumor complexity groups(according to R.E.N.A.L.scores)regarding the cases finished in the first ten cases(50.0% vs 10.9% vs 11.1%,P=0.033),operative time([213±35.5]vs[225±48.9]vs[269±31.7]min,P=0.008),estimated blood loss([86±31.3]vs[158±148.5]vs[172.0±66.7]mL,P=0.032),and renal ischemia time([18.9±7.54]vs[22.2±8.88]vs[30.4±9.76]min,P=0.019).Conclusion R.E.N.A.L.nephrometry score is closely correlated with the surgical outcomes of RPN.Preoperative application of R.E.N.A.L.scoring system to identify tumor complexity can help to guide the clinical use of da Vinci surgical system for partial nephrectomy.

Clinical application of laparoscopy-assisted small incision surgery in treatment of urological diseases: Clinical application of laparoscopy-assisted small incision surgery in treatment of urological diseases

Objective To apply laparoscopy-assisted small incision surgery in complicated urological operation,and to summarize our experience.Methods We retrospectively analyzed the clinical data of 9 patients with renal tumors(3 with solitary kidney tumors,2 with unilateral multiple tumors,1 with bilateral tumors,and 3 with contralateral renal insufficiency),3 patients with renal pelvic ureteropelvic junction obstruction(UPJO) and multiple stones,and 1 patient with distal ureteral tumor.All patients underwent laparoscopy-assisted small incision surgery in our department from Aug.2007 to Jun.2011.The key steps of the surgery were discussed and the clinical experience was summarized.Results (1) For 9 patients with renal tumors,the incision was 4-6 cm in length,the cold ischemia time was(15±4) min,and the operation time ranged from 90 to 180 min.Drainage tubes were removed within 48 h after operation.No patient had bleeding,urinary fistula or other serious complications.(2) For the 3 patients with UPJO,the incision was 4-5 cm in length and the operation time was 110 to 190 min.Drainage tubes were removed within 3-5 d after operation.No patient had bleeding,urinary fistula or other serious complications.No patient had fever or back pain after removal of double-J stents.Intravenous pyelography showed no hydronephrosis and the renal structure was normal.(3) For the patient with ureteral tumor,the drainage tube was removed 3 d after operation and there was no complication.No patients in the present study used analgesic pump or analgesic medications after surgery.Conclusion Laparoscopy-assisted small incision surgery can reduce the length of incision,minimize injury,and protect renal function.Besides,the method is safe and capable of handling complicated situations,especially suitable for patients who are difficult to receive total laparoscopic surgery.