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To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy (epR-spRP) and extraperitoneal robotic multiport radical prostatectomy (epR-mpRP) performed with the da Vinci Si Surgical System, comparison was performed between 30 single-port (SP group) and 26 multiport (MP group) cases. Comparisons included operative time, estimated blood loss (EBL), hospital stay, peritoneal violation, pain scores, scar satisfaction, continence, and erectile function. The median operation time and EBL were not different between the two groups. In the SP group, the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients (P < 0.001). The median postoperative hospital stay in the SP group was shorter than that in the MP group (P < 0.001). The rate of peritoneal damage in the SP group was less than that in the MP group (P = 0.017). The pain score and overall need for pain medications in the SP group were lower than those in the MP group (P < 0.001 and P = 0.015, respectively). Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively (P = 0.007). At 3 months, the cancer control, recovery of erectile function, and urinary continence rates were similar between the two groups. It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system. Therefore, epR-spRP can be a treatment option for localized prostate cancer. Although epR-spRP still has a learning curve, it has advantages for postoperative pain and self-assessed cosmesis. In the absence of the single-port robotic surgery platform, we can still provide minimally invasive surgery for patients.
Subject(s)
Aged , Humans , Male , Middle Aged , Blood Loss, Surgical/statistics & numerical data , Outcome Assessment, Health Care/statistics & numerical data , Perioperative Medicine/statistics & numerical data , Prostatectomy/methods , Prostatic Neoplasms/surgery , Quality Assurance, Health Care/statistics & numerical data , Robotic Surgical Procedures/statistics & numerical dataABSTRACT
Da Vinci robotic surgical system has many unique advantages, including 3D high-definition vision system, simulation wrist with high degree of freedom, automatically removing the physiologic hand tremor and allowing sitting position for the operators. It was introduced into Chinese mainland in 2006, and has been widely applied in many fields, especially in urology (accounting for 46% of all clinical fields). In this paper, we analyzed the latest 15 years' application data of robot-assisted laparoscopic technique in urology in China and discussed the application characteristics and existing problems.
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The glymphatic system is a cerebrospinal fluid-interstitial fluid exchange system dependent on the water channel aquaporin-4 polarized on astrocyte endfeet, which is proposed to account for the clearance of abnormal proteins (e.g. β-amyloid) and metabolites (e.g. lactate) from the brain. Accumulating studies have revealed that glymphatic activity during sleep and general anesthesia is dramatically enhanced, while its function is significantly damaged during aging, traumatic brain injury, Alzheimer's disease, stroke, and diabetes. The glymphatic hypothesis is a breakthrough in the field of neuroscience recently, which would considerably enhance our comprehension on the cerebrospinal fluid circulation and its role in the maintenance of brain homeostasis. In this review, we briefly introduced the conceptualization of glymphatic system, summarized the recent progresses, and prospected its future investigation and potential clinical application.
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Objective: To report the first clinical case of robotic-assisted laparoscopic nephrectomy(right) combined with inferior vena caval thrombectomy for level II tumor thrombus in China. Methods: A 73-year-old female patient presented with "gross hematuria and flank discomfort for 4 months" was admitted to our hospital. Preoperative CT scans revealed a 4.9 cm×4.7 cm right renal cancer, grossly extending into the inferior vena cava (IVC, length of the IVC tumor thrombus: 4.6 cm). After three months of neoadjuvant targeted molecular therapies (TKIs), the tumor size reduced to 4.3 cm×4.4 cm on CT and the IVC tumor thrombus length reduced to 3.3 cm. IVC filter was placed cephalad 2 days before surgery under DSA intervention. The patient was placed in recumbent position during the operation; a 12-mm optical port was placed to the right of the rectus abdominis at 2 cm above the umbilicus. Two 8-mm robotic ports and three 12-mm assistant ports were placed percutaneously under direct visualization through a stab incision. The robotic system was then docked, with the colon reflected medially and the duodenum kocherized. The IVC sheath was opened, and the IVC was dissected circumferentially above and below the insertion of the right renal vein to the extent dictated by the length of the thrombus. With the right renal artery dissected and transected, the vessel loops were used to create modified-Rummel tourniquets. The vena cava below and above tumor thrombus, and the left renal vein were cross-clamped. With the vessel loops cinched down completely and secured by hem-o-lok clips, the wall of the IVC was then incised longitudinally for approximately 5 cm. The tumor thrombus was delivered intact along with the invaded IVC wall. The IVC was closed and tourniquet was loosened. After adequate hemostasis was achieved, the specimen was placed into an entrapment sac and incisions were closed by layers. Results: The procedure was smoothly completed. The total operating time was 363 min and the total IVC cross-clamp time was 47 min. The estimated blood loss was 1 200 mL. The amount of intraoperative transfusion was 1 200 mL and 1 000 mL postoperative blood transfusion was required for a low level of hemoglobin. The bowel function recovered at day 3 after operation and drainage was maintained for 3 days. The patient was discharged 16 days after operation. Conclusion: We successfully completed the first clinical case of robotic-assisted laparoscopic nephrectomy combined with inferior vena caval thrombectomy for level II tumor thrombus in China; it is a safe and feasible procedure, but has great technical difficulty, so the patients should be chosen with great care.
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Objective To summarize our experience on the first clinical case of transperitoneal 3D laparoendoscopic single- site(LESS) nephrectomy in mainland China, and to assess its safety and feasibility after obtaining the informed consents. Methods On August 5, 2013, we performed a 3D LESS nephrectomy using Karl Storz 3D endoscope and a multi-channel Quad- Port (Olympus™) through a 3 cm skin incision at our institute. The patient was a 69 years old man, with a body mass index (BMI) of 27. 7 kg/m2 and a preoperative serum creatinine level of 81 μmol/L. 99mTc DTPA was used to determine the glomerular filtration rate(GFR). The preoperative unilateral renal functionwas 65 mL/min for the left side and 9. 5 mL/min for the right side. And therefore he was diagnosed as "right kidney severe hydrocephalus" and received right nephrectomy. A 3 cm external retus incision was made at the umbilicus level at 1 cm site. After dissection of the renal pedicle blood vessels the renal blood vessels, the ureterogonadal packet was left en bloc and transected at the level when crossing the common iliac vessels. The kidney was extracted through the original incision after the skin incision was extended to 4 cm. Results The procedure was smoothly completed without any extra skin incision. The operating time was 154 min, with an estimated blood loss of 150 mL. The gastrointestinal function recovered on the first day after operation. Postoperative serum creatinine level on the first day was 76 μmol/L. Donor Visual Analog Pain Scores at postoperative day 1, 2 and 3 were 2/10, 1/10 and 0/10, respectively. The recovery of the patient was uneventful and he was discharged on the 3rd postoperative day. Conclusion Transperitoneal 3D laparoendoscopic single-site nephrectomy is safe, feasible and effective. It has the clinical benefits of less pain, rapid recovery and small incision. The procedure allows for a strong stereo perception, accurate manipulation, and a decreased demand for hand-eye coordination of hand, with a promising clinical future. But more clinical experience needs to be accumulated through more cases.
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Objeciive To investigate the cinnical benefits and role of robot-asiisted laparoscopic partial nephrectomy RAPN) by comparing the clinical data of patients receiving the RAPN or conventional laparoscopic partial nephrectomy (CLPN). Methods A retrospective analyris was performed for 67 patients who underwent either RAPN (n = 24) or CLPN (n = 43) between January 2011 and December 2012 at our institution. Preoperative dinical stages of both groups were T1N0M0. Univariate analytis and logistic regression modll were used to detect factors affecting indication sdection in RAPN. The intraoperative parameters and postoperative outcomes were compared between RAPN and CLPN groups matched for DAP score. Results Univariate and multivariate logistic regresion analytis revealed that DAP score (/3=1. 987, P = 0. 022, 95%CI[1. 34, 39. 79]) was the only predictor of RAPN approach in logistic regresion analytis. Only 38 DAP matched cases in RAPN (n = 19) and CLPN (= 19) were included for analytis, and the demographics were comparable between the matched two groups except for the preoperative estimated glomeruiar filtration rate (eGFR). One open converion was required in the RAPN group due to intra-operation bleeding, and all the cases were smoothly completed in the conventional iaparoscopic group. There were no significant differencesbetween the matched two groups regarding the estimated blood loss, time off oraHntake, highest visual analog pain scale, length of stay, comphcation rate or transfusion rate (all P>0. 05). Patients undergoing RAPN had a rigniticancly shorter warm ischemia time ([27. 0±5. 3] min vs [34. 2 ±7. 3] min, P0. 05). Conclusion RAPN requires a shorter warm ischemia time and provides a more rapid learning curve, good surgical safety and good short-term efficacy. For surgeons with experienced CLPN technique, they can use RAPN to treat Hgh-complexity tumorswhich are beyond the conventional laparoscopic technique.
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Objective To assess the safety, feasibility and efficacy of retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy in treatment of R. E. N. A. L. tumors with R. E. N. A. L. score
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Objective To transfect CXCR4 and enhanced green fluorescent protein (EGFP)-CXCR4 plasmids into renal carcinoma cell line A498 cells to preparecell lines stably expressing CXCR4. Methods Two specific plasmids containing CXCR4 or EGFP-CXCR4 were transfected into renal cell carcinoma cell line A498. Then the cells stably expressing CXCR4 were screened by using G418. Confocal microscopy was used to observe the changes of EGFP-CXCR4 fusion protein in A498 cells before and after stimulation with SDF-1. Western blotting analysis was used to determine CXCR4 expression after transfection. Proliferation of A498 cells was detected by MTT and the invasion ability of cells was detected by transwell assay. Results The sequencing result of two plasmids was consistent with CXCR4 DNA sequence, and two cell lines were screened out by G418 screening after the plasmids were transfected into A498 cells. EGFP-CXCR4 fusion protein was found in the cell membrane and cytoplasm of EGFP-CXCR4 transfection group under confocal microscopy. EGFP-CXCR4 migrated into cells after SDF-1 stimulation. Western blotting analysis revealed higher CXCR4 expression in A498 cells stably transfected with CXCR4 plasmids compared with normal A498 cells. The proliferation of cells in pCNDA-CXCR4 and pEGFP-CXCR4 groups were significantly higher than that in normal A498 cell group (P<0. 01). Transwell assay showed that the cell invasion ability of cells with stable CXCR4 expression was significantly increased compared with that in the normal A498 cell group (P<0. 01). Conclusion We have successfully established A498 cell lines stably expressing CXCR4, which have enhanced proliferation levels and higher invasive ability.
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Objective To summarize our experience on the first clinical series of retroperitoneal laparoendoscopic single-site(LESS) renal cryoablation in mainland China and to assess its safety and feasibility after obtaining the informed consents. Methods Two patients with small renal masses underwent retroperitoneal laparoendoscopic single-site renal cryoablation by the same urologic surgical team at March 14, 2012 and March 19, 2012 in our department. The male patient was 79 years old, with the Charlson comorbidity index (CCI, Age-weighted) being 4, maximal tumor diameter being 2. 7 cm, R. E. N. A. L. score being 2 + 2 + 3 + p+3 = 10p,and preoperation eGFR being 61. 5 ml/(min • 1. 73 m2). The female patient was 43 years old with CCI (Age-weighted) being 3, maximal tumor diameter being 2. 6 cm, R. E. N. A. L. score being 1 + 1 + 1 + a+2 = 5a, and preoperation eGFR being 187. 8 ml/(min • 1. 73 m2). At the level of midaxillary line, we made a 2-cm longitudinal skin incision at the mid-point between the iliac crest and the inferior margin of 12th rib. The renal masses were fully isolated and exposed, and then two 2-mm cryoprobes were percutaneously introduced and placed into the tumor under laparoscopic visualization. Two freeze-thaw cryoablation cycles were performed according to the instruction of EndoCare Cryo-Care Surgery System. Results The two procedures were smoothly completed without any extra skin incision. The operative duration, cyroablation time, estimated blood loss, and postoperative hospital stay of the male and female patients were 185/170 min, 30/30 min, 50 /30 ml, 6/5 d, respectively; and the postoperative pain scores measured by the visual analogscale (VAS) were 2/1, 1/1, and 0/0 at day 1, day 2, and day 3, respectively. Pathologic examination revealed clear cell renal cell carcinoma in both patients (Fuhrman gradeH and I). The eGFR at 1-month after operation was 60. 2/144. 3 ml/(min • 1. 73 m2) in both patients. CT scan found no evidence of recurrence at the cyroablative region 1 week and 1 month after operation. Conclusion Our initial experience shows that laparoendoscopic single-site renal cryoablation is a safe, feasible and effective procedure, with small incision, less pain, less damage of renal function, rapid recovery, and satisfactory short-term effect, but the patients should be carefully chosen. And the long-term effect should be confirmed by large sample study.
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Objective: To compare the efficacy of laparoscopic radical nephrectomy(LRN) and open radical nephrectomy (ORN) for clinical stage T2 renal cell carcinoma. Methods: A total of 138 patients underwent radical nephrectomy for renal cell carcinoma, including 63 by LRN and 75 by ORN. Renal cell carcinoma was pathologically confirmed in all the patients. The patients were followed up for 5-36 months, with a median of 24 months. The surgical blood loss, operation time, and time of starting food postoperatively, and hospital stay were compared between the two groups. Results: The operation tíme was 90- 385 min (a mean of [213 ± 61. 6] min) for LRN and 55-320 min (a mean of [173 ± 52. 3] min)for ORN (P = 0. 000). The blood losswas 30-1 600 ml (a mean of [220±291. 8] ml) for LRN and 50-1 400 ml (a mean of [319 ±244. 1] ml) for ORN (P = 032). The fasting period of surgery was 1-4 d (a mean of [2. 4±0. 82] d) for LRN and 2-5 d (amean of [3. 1±1. 02] d) for ORN(P = 0. 000). The hospital stay was 4-15 d (a mean of [7. 3±2. 50] d) for LRN and 6-15 d (amean of [9. 3±2. 25] d) for ORN (P = 0. 000). Conclusion: The efficacy of LRN is similar to that of ORN. LRN has the advantages of minimal invasiveness and rapid postoperative recovery. The complication of LRN is similar to ORN, and it might be an alternative treatment for clinical T2 stage renal cell carcinomas.
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<p><b>OBJECTIVE</b>To investigate the effects of prostate cancer cell line PC-3 conditioned medium (PC- 3-CM) on the proliferation and osteogenic differentiation of human bone marrow human basalis mesenchymal stem cells (hBMSCs).</p><p><b>METHODS</b>hBMSCs were isolated and culture-expanded by density gradient centrifugation from normal volunteers. PC-3 cells were cultured till the time of logarithmic growth and then transferred to a fresh medium, which, after 24 hours of incubation, was collected as PC-3-CM. Passage 3 hBMSCs were cultured in the fresh medium alone (the control group) or that with 50% PC-3-CM (the experimental group), and the effect of PC-3-CM on the proliferation activity of the hBMSCs was detected by WST-8 assay. Based on the types of medium used, the hBMSCs were divided into Groups I (control), II (50% PC-3-CM), III (osteoblast inducer) and IV (osteoblast inducer containing 50% PC-3 CM). The effects of PC-3-CM on the osteoblastic differentiation of the hBMSCs were determined by ALP staining, ALP activity detection, Von Kossa staining, and calcium quantitation.</p><p><b>RESULTS</b>At 1, 3, 5 and 7 days of incubation, the absorbance values of the cells in the experimental group were 0.4370 +/- 0.0285, 0.7980 +/- 0.0213, 1.9090 +/- 0.0612 and 2.3023 +/- 0.0610, and those in the control group were 0.4060 +/- 0.0223, 0.6643 +/- 0.0075, 1.3727 +/- 0.0176 and 1.7947 +/- 0.0115, respectively, with significant differences between the two groups (P < 0.01) except on day 1 (P > 0.05). The positive rate and intensity of ALP staining were gradually increased in the four groups, with the ALP activities of 0.29 +/- 0.03, 1.30 +/- 0.03, 2.13 +/- 0.08, and 3.80 +/- 0.03, respectively (P < 0.01), and so was the intensity of Von Kossa staining, with the calcium depositions of 0.04 +/- 0.01, 0.44 +/- 0.05, 0.98 +/- 0.03, and 1.27 +/- 0.04, respectively (P < 0.01).</p><p><b>CONCLUSION</b>PC-3- CM can promote the proliferation and osteogenic differentiation of human bone marrow mesenchymal stem cells.</p>
Subject(s)
Humans , Male , Bone Marrow Cells , Cell Biology , Cell Differentiation , Cell Line, Tumor , Cell Proliferation , Cells, Cultured , Culture Media, Conditioned , Pharmacology , Mesenchymal Stem Cells , Cell Biology , Osteoblasts , Cell Biology , Osteogenesis , Prostatic NeoplasmsABSTRACT
To compare different methods for blockage of renal artery in transperitoneal laparoscopic radical nephrectomy, and evaluate the safety and feasibility of direct access to the renal artery. Methods From May 2008 to December 2010, 64 patients with T1N0M0-T2N0M0 stage renal carcinoma underwent transperitoneal laparoscopic radical nephrectomy using a standard procedure to isolate and block renal artery (group A, 33 patients) or a direct access to the renal artery via ligament of Treitz (left side) or aorta-inferior vena cava (right side; group B, 31 patients). The age, gender, body mass index (BMI), history of previous abdominal surgery, tumor side, tumor maximum diameter, and preoperative TNM stages were all matchable between the two groups. Results One patient in group A was conversed to open surgery due to extensive perirenal adhesion and the others successfully received transperitoneal laparoscopic radical nephrectomy. The operation time, estimated blood loss, intraoperative and postoperative complications, postoperative TNM stage, postoperative fasting time, postoperative indwelling time of drainage tube, postoperative hospital stay and pathological types were similar between the two groups. Patients with T2 stage tumors in Group B had less intraoperation blood loss than those in Group A (P<0.05). Conclusion Direct access to the renal artery is feasible and safe of transperitoneal laparoscopic radical nephrectomy. The method not only fulfils the tumor-free principles and reduces intraoperative blood loss, but also broadens the indications of laparoscopic operations for renal cell carcinoma.
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To summarize the clinical data of renal cell carcinoma (RCC) in our hospital in the past 15 years, and to investigate the mini-invasive rate, resection rate and safety of surgical treatment for RCC. Methods We retrospectively analyzed the clinical data of 2,052 consecutive cases with renal tumors during Jan. 1995 to Nov. 2009. The patients were divided into 3 groups according to the time they were treated. The 1st group: from Jan. 1995 to Dec. 1999; the 2nd group: from Jan. 2000 to Dec. 2004; and the 3rd group: from Jan. 2005 to Nov. 2009. The operation method, resection rate and safety were compared between different groups. Results Among 2,052 patients, 1,516 had T1 stage RCC; 536 cases had T2-4 stage RCC, including 277 with locally advanced RCC (lymphatic metastasis, venous tumor thrombus, resectable local invasion, solitary hepatic or lung metastasis); 217 cases received radical nephrectomy, 41 received palliative surgery, and the surgical procedures were not finished in 19 cases (including 3died during operation due to cancer embolus defluxion). All the 546 patients in the 1st group received open surgery, including 42 receiving nephron-sparing surgery; for 89 cases with locally advanced RCC, radical nephrectomy was done in 64 cases, palliative surgery in 16 cases, and surgery procedures were not finished in 9 cases (including 2 died during operation due to cancer embolus delluxion). Of the 673 cases in the 2nd group, 556 cases received open surgeries, including 95 receiving nephron-sparing surgery and 117 received laparoscopic surgery (via lumbar dank approach); for the 88 cases with locally advanced RCC, radical nephrectomy was done in 68 cases, palliative surgery in 13 cases, and surgery procedures were not finished in 7 cases (including 1 died during operation due to cancer embolus defluxion). Of the 833 cases in the 3rd group, 248 received open surgery, including 142 cases receiving nephron-sparing surgery and 585 received laparoscopic surgeries; 100 cases had locally advanced RCC, and 85 of them received radical nephrectomy, 12 received palliative surgery, and surgical procedures were not finished in 3 cases, with no death cases during the perioperative period. Conclusion Minimally invasive surgery has become the dominant approach for treatment for renal cell carcinoma owning to fast development of laparoscopy. Improvement in surgical technique has promoted the safety and resectable rate of locally advanced RCC, and nephron-spaeing surgery has been more widely used and has gradually been done in a minimally invasive manner. Single-port laparoscopic surgery is gaining increaeing attention in treatment of RCC.
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Objective To compare different methods for blockage of renal artery in transperitoneal laparoscopic radical nephrectomy, and evaluate the safety and feasibility of direct access to the renal artery. Methods From May 2008 to December 2010, 64 patients withT1N0M0-T2N0M0 stage renal carcinoma underwent transperitoneal laparoscopic radical nephrectomy using a standard procedure to isolate and block renal artery (group A, 33 patients) or a direct access to the renal artery via ligament of Treitz (left side) or aorta-inferior vena cava (right side; group B, 31 patients). The age, gender, body mass index (BMI), history of previous abdominal surgery, tumor side, tumor maximum diameter, and preoperative TNM stages were all matchable between the two groups. Results One patient in group A was conversed to open surgery due to extensive perirenal adhesion and the others successfully received transperitoneal laparoscopic radical nephrectomy. The operation time, estimated blood loss, intraoperative and postoperative complications, postoperative TNM stage, postoperative fasting time, postoperative indwelling time of drainage tube, postoperative hospital stay and pathological types were similar between the two groups. Patients with T2 stage tumors in Group B had less intraoperation blood loss than those in Group A (P<0. 05). Conclusion Direct access to the renal artery is feasible and safe of transperitoneal laparoscopic radical nephrectomy. The method not only fulfils the tumor-free principles and reduces intraoperative blood loss, but also broadens the indications of laparoscopic operations for renal cell carcinoma.
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Objective To summarize the clinical data of renal cell carcinoma (RCC) in our hospital in the past 15 years, and to investigate the mini-invasive rate, resection rate and safety of surgical treatment for RCC. Methods We retrospectively analyzed the clinical data of 2,052 consecutive cases with renal tumors during Jan. 1995 to Nov. 2009. The patients were divided into 3 groups according to the time theywere treated. The 1st group: from Jan. 1995 to Dec. 1999; the 2ndgroup: from Jan. 2000 to Dec. 2004; and the 3rd group: from Jan. 2005 to Nov. 2009. The operation method, resection rate and safety were compared between different groups. Results Among 2, 052 patients, 1, 516 had T1 stage RCC; 536 cases had T2-4 stage RCC, including 277 with locally advanced RCC (lymphatic metastasis, venous tumor thrombus, resectable local invasion, solitary hepatic or lung metastasis) ; 217 cases received radical nephrectomy, 41 received palliative surgery, and the surgical procedures were not finished in 19 cases (including 3died during operation due to cancer embolus defluxion). All the 546 patients in the 1st group received open surgery, including 42 receiving nephron-sparing surgery; for 89 cases with locally advanced RCC, radical nephrectomy was done in 64 cases, palliative surgery in 16 cases, and surgery procedures were not finished in 9 cases (including 2 died during operation due to cancer embolus defluxion). Of the 673 cases in the 2nd group, 556 cases received open surgeries, including 95 receiving nephron-sparing surgery and 117 received laparoscopic surgery (via lumbar flank approach); for the 88 caseswith locally advanced RCC, radical nephrectomy was done in 68 cases, palliative surgery in 13 cases, and surgery procedureswere not finished in 7 cases (including 1 died during operation due to cancer embolus defluxion). Of the 833 cases in the 3rd group, 248 received open surgery, including 142 cases receiving nephron-sparing surgery and 585 received laparoscopic surgeries; 100 cases had locally advanced RCC, and 85 of them received radical nephrectomy, 12 received palliative surgery, and surgical procedures were not finished in 3 cases, with no death cases during the perioperative period. Conclusion Minimally invasive surgery has become the dominant approach for treatment for renal cell carcinoma owning to fast development of laparoscopy. Improvement in surgical technique has promoted the safety and resectable rate of locally advanced RCC, and nephron-sparing surgery has been more widely used and has gradually been done in a minimally invasive manner. Single-port laparoscopic surgery is gaining increasing attention in treatment of RCC.
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Objective To summarize out experience in the first case of transperitoneal laparoendoscopic single-site live donor nephrectomy (LESS-DN) in mainland China and to assess its safety and feasibility. Methods The female donor was aged 59-year-old, with a body mass indexCBMI) of 21. 6 kg/m2 and a preoperative serum creatinine level of 45 μmol/L. Tc 99m-DTPA was used to determine the glomerular filtration rate (GFR). The preoperative unilateral renal function was 50 ml/min for the left side and 56 ml/min for the right side. Recipient was a 41-year-old male, with a BMI of 19. 5 kg/m2 and a preoperative serum creatinine level of 1,446 μmol/L, and who was to receive transplantation due to chronic renal dysfunction (renal failure stage). On Nov. 9th, 2011, the LESS-DN was performed via a multi-channel TriPort™ (Advanced Surgical Concepts, Wicklow, Ireland) through a 5 cm skin incision at our institute. The dissection of the kidney was facilitated with the standard laparoscopic instruments at all the steps. The renal artery and the renal vein were skeletonized after the adrenal vein and the lumber vein, if any, were clipped. The ureterogonadal packet was left en bloc and transected at the level when crossing the common iliac vessels. The kidney was entrapped, and the mouth of the bag loosely cinched around the intact renal artery and vein. The renal artery and the vein were separated. The pre-entrapped kidney was extracted through the original incision after generous cranial and caudal extension of the rectus fascia incision. Results The procedure was smoothly completed without any extra skin incision. The operating time was 210 min, with an estimated blood loss of 50 ml, and a warm ischemia time of 3. 8 min. The lengths of harvested renal artery, vein and ureter were 3. 6 cm, 4. 5 cm and 13 cm, respectively. The length of skin incision at closure was 5 cm. Allograft functioned immediately on transplantation. Donor Visual Analog Pain Scores at postoperative day 1, 2 and 3 were 2. 5/10, 1/10, and 0/10, respectively. The recovery of the donor was uneventful and she was discharged on the 4th postoperative day. Postoperative serum creatinine levels of the recipient at 12 h, 24 h, 2 d, 3 d, 4 d, 5 d, 6 d, 7 d, discharge day, and 1 month postoperatively were 475, 282, 148, 145, 117, 100, 103, 98, 80, and 84 μmol/L, respectively. He was discharged on the 10 day after transplantation. Conclusion Our initial experience shows that the laparoendoscopic single-site live donor nephrectomy is a safe, feasible and effective procedure. It has the clinical benefits of less pain, rapid recovery and good cosmesis, with an encouraging future. But more clinical experience needs to be accumulated.
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<p><b>OBJECTIVE</b>To investigate the regulatory effect of the nonsteroidal anti-inflammatory drug NS398 on the expression of the RECK gene in the animal model of prostate cancer.</p><p><b>METHODS</b>Nude mouse models of prostate cancer were divided into an experimental and a control group, the former fed with NS398 at 0.1 mg/g per day for 10, 20 and 30 days, while latter left without medication. All the mice were killed at 30 days, the mRNA expressions of RECK and MMP-9 in the tumor tissues measured by RT-PCR, and the protein level of RECK evaluated by Western blot.</p><p><b>RESULTS</b>Both the mRNA and protein expressions of RECK were increased, while the level of MMP-9 decreased, in an obviously time-dependent manner in the experimental group as compared with the control.</p><p><b>CONCLUSION</b>NS398 obviously inhibits the pathogenesis and metastasis of prostate cancer, which may be attributed to its induction of the expression of the RECK gene and suppression of the expression of MMP-9.</p>
Subject(s)
Animals , Humans , Male , Mice , Anti-Inflammatory Agents, Non-Steroidal , Pharmacology , GPI-Linked Proteins , Metabolism , Gene Expression Regulation , Matrix Metalloproteinase 9 , Metabolism , Mice, Nude , Nitrobenzenes , Pharmacology , Sulfonamides , Pharmacology , Tumor Cells, CulturedABSTRACT
Objective: To use videomimicography to display the skills of retroperitoneal laparoscopic radical nephrectomy in a self control manner, so as to help the beginners to learn the skills quickly. Methods: The videos of 147 cases of retroperitoneal laparoscopic radical nephrectomy for renal-cell carcinomas (T1 N0 M0), which were performed by a surgeon in our department from Jan. 1, 2002 to Dec. 31, 2006, were retrospectively analyzed. The first 30 cases were compared with the last 30 cases in terms of operative manipulation, outcomes, problems in operation, and complications after operation. The difficulties in learning retroperitoneal laparoscopic radical nephrectomy from videos were discussed. Results: There were no differences between the two patient groups in age, gender, the location or size of the tumors. The bleeding volumes, operation time, frequencies of transferring to open surgery, and addition of Trocar in the first 30 patients were significantly more than those in the last 30 patients (all P<0.01). Results of videomimicography demonstrated that the beginners had a poor anatomic knowledge, the exposure and tissue isolation were not enough, and they had a poor basic skill in manipulating laparoscope. Conclusion: Videomimicography can better display the difficulties in retroperitoneal laparoscopic radical nephrectomy in a self control manner, which can help the beginner to understand the operating skills; the method is worth popularizing.
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<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of single-port transumbilical laparoscopic nephrectomy.</p><p><b>METHODS</b>From December 2008 to August 2009, we have performed three cases of single-port transumbilical laparoscopic nephrectomy of nonfunctioning renal by Tri-Port system. Among three patients there were two cases of UPJO and one case of upper ureteral obstruction. Involved kidneys were not visualized in IVU and the GFR were not more than 0.90 ml/s. Tri-Port system was inserted transperitoneal through a 2 cm umbilical incision. The flexible grasper, scissors were used in addition to standard laparoscopic equipment. Renal pedicle was divided by Endoscopic Linear Stapling device. Specimens were extracted through the incision.</p><p><b>RESULTS</b>The first and second case were successful, and the operation time were 85 min and 165 min. The bleeding volume were 50 ml and 100 ml. The discharge time after operation was 3 days and 5 days, respectively. The third case was converted to open surgery because of the edema and adhesion of renal pedicle. At 3 weeks of follow-up, the incisions were hidden in the umbilicus with good cosmetic benefit.</p><p><b>CONCLUSIONS</b>This new method is technically feasible, which combined with these advantages of less trauma and more cosmetic benefit. However, more special instruments and long learning curving may be needed for those surgeons, who are going to carry out it.</p>
Subject(s)
Adult , Humans , Male , Middle Aged , Laparoscopy , Methods , Nephrectomy , Methods , Treatment Outcome , Umbilicus , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To evaluate the feasibility of kidney biopsy by transgastric and transvesical combined approach in the porcine model.</p><p><b>METHODS</b>Five female pigs (20 to 30 kg) were included in this study. All procedures were performed with pigs under general anesthesia. The transvesical access was established by the ureteroscope. Then monitored by ureteroscopy, the transgastric access was established by a needle knife with cautery. The puncture dilation was performed with balloon through the gastroscope. The vesical hole was enlarged with the dilator of ureteroscope sheath. The kidney biopsy was finished by the scissor from the transvesical access and the grasping forcep from the work channel of gastroscope.</p><p><b>RESULTS</b>Among five cases the procedure were successful in three cases with 380 min, 180 min, 78 min respectively. Establishment of transvesical and transgastric accesses took place without complications. The exposure and biopsy of the kidney were easily achieved during operation. The transgastric and transvesical access were not closed in the end.</p><p><b>CONCLUSIONS</b>This new method is a technically feasible procedure in a porcine model. But the safety and the clinical future of it needs more study.</p>