Utility of the third arm in robot-assisted laparoscopic partial nephrectomy for complex renal tumor / 中华泌尿外科杂志

Objective To assess the safety and feasibility of utility of the third arm in robotic partial nephrectomy(RPN) through retroperitoneal approach for complex renal tumor.Methods 36 roboticassisted partial nepbrectomy were performed by one surgeon between November 2015 and January 2017,including hilar tumors in 12 cases,central tumors in 11 cases,endophytic tumors in 7 cases and multiple tumors in 6 cases.A 12 mm camera port is placed 2 fingerbreadth above iliac crest.The lateral and medial robotic trocars are placed in the posterior axillary line and anterior axillary plane respectively parallel to the cameraport trocar.Under direct visualization,the peritoneum is swept medially towards the paramedianplane.The fourth arm trocar is placed in the most medial and inferior aspect of the field approximately 7 cm to 8 cm across and parallel to the medial robotic trocar.Descriptive statistics on patient characteristics,operative parameters,and oncologic outcomes are analyzed.Result The 4-arms retroperitoneal approach was used in all patients without any conversion.Mean console time was 127 ± 21 (98-357) min.Mean ischemia time was 25.5 ± 8.3 (12-38) min,Mean estimated blood lost was 198 ± 201.5 (50-510) ml.No patients required blood transfusion,except one case underwent selective intra-arterial embolization with DSA (digital subtraction angiography) and blood transfusion post-operatively.Pathology revealed renal cell carcinoma in 12 patients,angiomyolipoma in 16 patients,chromophobe renal cell carcinoma in 6 cases,oncocytoma in 2 cases and all had negative surgical margins.Under 3 months follow-up,Mean decrease in eGFR was 4.3 ml/(min · 1.73m2).No patients found recurrence or metastasis.Conclusions The third robotic arm provides the console surgeon maximal independence from the surgical assistant when performing kidney retraction,ligation or clamping of renal hilar vessels in complex renal morbidities.It would be beneficial for patient with merits of retroperitoneal approach and overcomes limited space during RPN.

The posterior approach of robot-assisted laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective To explore the feasibility and safety of the posterior approach of robotassisted laparoscopic radical prostatectomy and to the approach.Methods From November 2001 to April 2017,32 patients underwent posterior approach of robot-assisted laparoscopic radical prostatectomy.Patients aged 53 to 81 years,with mean of 66.9 years old.Their prostate volumes were 12.0-73.7 ml with an average of 32.9 ml.All patients were diagnosed by prostate biopsy before surgery.The operation time,blood loss and length of hospital stay were recorded.Results All the operations were completed by robotic assisted laparoscopy with no transition to open surgery.The surgery time was 129-210 minutes with an average of 163.6 minutes.The estimated blood loss was 20-200 ml with an average of 59.3 ml.The hospital stay was 8-21 days with an average of 12.8 days.The postoperative hospital stay was 3-13 days with an average of 6.9 days.The time of postoperative catheter removal was 4-14 days with an average of 7.5 days.Postoperative follow-up was 1-6 months.Twenty-four (75％) patients had early recovery of continence,and all (100％) patients regained continence 3-month postoperatively.Conclusion The posterior approach of robotic assisted laparoscopic radical prostatectomy was a safe and effective surgical technique,which was beneficial in early continence recovery.

Comparison of transperitoneal and retroperitoneal approach in robotic-assisted laparoscopic partial nephrectomy / 中华泌尿外科杂志

Objective To compare the peri-operative outcomes of patients who underwent transperitoneal or retroperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN).Methods From September 2014 to June 2015, 103 patients with kidney neoplasms who underwent RALPN were retrospectively analyzed, including 64 males and 39 females.Their mean age was 52 years(24-80 years) .Forty-four cases (29 male, 15 female) were in transperitoneal group and 59 (35 male, 24 female) in retroperitoneal group according to tumor location.The tumor size was ( 3.8 ±2.3 ) cm in transperitoneal group and ( 3.3 ± 1.4) cm in retroperitoneal group.Results Warm ischemia time (WIT) was (23.5 ±5.3) min in transperitoneal group and (19.1 ±6.9) min in retroperitoneal group (P>0.05).WIT of dorsal mass was (26.3 ±6.0) min and (19.4 ±6.5) min (P>0.05), operation duration was (127.1 ±31.3) min and (91.2 ±24.1) min (P0.05), and bowel recovery time was 2.2 days (2-4 days) and 1.3 days (1-2 days) (P <0.05), respectively.The operation duration, WIT of dorsal mass and bowel recovery time were obviously less in retroperitoneal group than those in transperitoneal group. Conclusions Both transperitoneal and retroperitoneal approach of RALPN were effective and safe for kidney neoplasms patient treatment.Compared with transperitoneal approach, retroperitoneal method could greatly shorten operation time, WIT of dorsal mass and bowel recovery time.

Cloning and identification of frc gene from Oxalobacter frmigenes / 华中科技大学学报（医学）（英德文版）

The cloning and identification of frc gene from Oxalobacter formigenes in the intestines of Chinese people were conducted. The genomic DNA of Oxalobacter formigenes was extracted. frc gene fragment was amplified by polymerase chain reaction (PCR) and linked with pEGFP-C1. The recombinant plasmid was designated pEGFP-frc and was identified by restriction-enzyme digestion and sequencing. Human embryo kidney 293 cells were transfected with pEGFP-frc, then RT-PCR and Western blotting were performed to detect the expression of frc gene. The length of frc gene was found to be 1287 bp, and the homology of nucleotides and amino-acid residue with the sequence in GenBank was 95.88% and 99.07%. Bright green fluorescent light could be observed in 293 cells transfected with the pEGFP-frc. frc mRNA and fusion protein FCoAT-EGFP were detected in the cells. It is concluded that frc gene cloned from the Oxalobacter formigenes in the intestines of Chinese people can be expressed in eucaryotic 293 cells and keep its enzyme activity.

Cloning and Identification of frc Gene from Oxalobacter Frmigenes / 华中科技大学学报（医学）（英德文版）

The cloning and identification of frc gene from Oxalobacter formigenes in the intestines of Chinese people were conducted. The genomic DNA of Oxalobacter formigenes was extracted. frc gene fragment was amplified by polymerase chain reaction (PCR) and linked with pEGFP-C1. The recombinant plasmid was designated pEGFP-frc and was identified by restriction-enzyme digestion and sequencing. Human embryo kidney 293 cells were transfected with pEGFP-frc, then RT-PCR and Western blotting were performed to detect the expression offrc gene. The length of frc gene was found to be 1287 bp, and the homology of nucleotides and amino-acid residue with the sequence in GenBank was 95.88% and 99.07%. Bright green fluorescent light could be observed in 293 cells transfected with the pEGFP-frc. frc mRNA and fusion protein FCoAT-EGFP were detected in the cells. It is concluded that frc gene cloned from the Oxalobacterformigenes in the intestines of Chinese people can be expressed in eucaryotic 293 cells and keep its enzyme activity.