Safety and efficacy of domestic single-port robotic surgery system for extraperitoneal urological surgery / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of the novel single-port surgical robotic surgical system in extraperitoneal urological surgery.Methods:From February to April 2022, patients was prospectively enrolled who required laparoscopic radical prostatectomy, partial nephrectomy and adrenal tumor resection in urology department. Inclusion criteria were: age ≥ 18 years old; BMI 18.5-30 kg/m 2; American Society of Anesthesiologists (ASA) physical status classification system grades 1 to 3; can cooperate with the completion of the visits and related examinations stipulated in the plan, and participate voluntarily clinical trials, and consent or the guardian agrees to sign the informed consent form; tumor indicators meet one of the following surgical treatment indications: kidney tumor T 1 stage, single, maximum tumor diameter ≤ 4 cm; prostate cancer, stage ≤ T 2b, preoperative PSA ≤ 20 ng /ml; Gleason score ≤ 7; adrenal tumor diameter ≤ 7 cm, for non-functioning adrenal adenoma, tumor diameter ≥ 3 cm. Exclusion criteria were: patients with other malignancies or a history of other malignancies and the investigators believe that they are not suitable for inclusion in this researcher; patients who have received the same type of urological surgery in the past and are not suitable for participating in this study as assessed by the investigators; included Those who have undergone other major surgery within the first 3 months and during the trial period, or who cannot recover from the side effects of any such surgery; syphilis, hepatitis B, HIV infection and carriers; long-term use of anticoagulants or blood system diseases; Unable to use effective contraception during the trial period and other conditions that the investigators deem inappropriate to participate in this trial. All operations were performed by a novel single-port robotic surgical operating system, and all surgical procedures were performed through an extraperitoneal approach. Surgical method: the surgical system is mainly composed of a remote console including a high-definition display, a surgical equipment trolley, a surgical execution system that accommodates a serpentine robotic arm, and a bendable serpentine robotic arm. In this study, the extraperitoneal approach was used. For radical prostatectomy, the patient was placed in a supine position, a longitudinal incision of about 3 cm was made below the umbilicus, the anterior rectus sheath was incised, the extraperitoneal space was separated, and an operating sheath was placed. A 12 mm trocar is placed between the right McBurney point and the umbilicus as an auxiliary hole. For partial nephrectomy and adrenal tumor resection, the patient is placed in the lateral position, and an 3cm incision is made 2 cm above the iliac crest on the midaxillary line as the main operating hole. The skin, subcutaneous tissue, and muscle were incised to the retroperitoneal cavity, and a 12mm trocar was placed at the level of the anterior superior iliac spine on the anterior axillary line as an auxiliary hole. The operation was performed after connecting each robotic arm. After the operation, the specimen was placed in the specimen bag, and a drainage tube is placed in the auxiliary hole, the specimen was taken out, and the incision was closed in turn. Preoperative basic information, operation time, blood loss, incision size, postoperative complications, preoperative and postoperative PSA score, eGFR index, postoperative pathological information and other perioperative information were collected. Results:A total of 17 patients were included in this study, including 6 with prostate cancer, 8 with renal tumor, and 3 with adrenal tumor. There were 9 males and 8 females, with an average age of (56.7±14.6) years and a BMI of (23.3±3.4) kg/m 2. The mean operation time of radical prostatectomy was (244.6±35.1) min, the mean operating time of the chief surgeon was (184.0±39.0) min, and the mean blood loss was (36.6±23.8) ml. Postoperative positive margin was found in 2 cases. The average operation time of partial nephrectomy was (189.6±49.4) minutes, the average operating time of the chief surgeon was (115±39.7) minutes, the average blood loss was (12.7±8.3) ml, and the average warm ischemia time was (23.1±10.8) minutes. There was no significant difference in the eGFR index before and after the operation ( P>0.05). The average operation time of adrenalectomy was (177.6±26.9) min, the average operating time of the chief surgeon was (99±20.4) min, and the average blood loss was (11.6±6.2) ml. The overall average operation time of the three surgical methods was (206.9±50.1) min, the overall average operating time of the chief surgeon was (136.5±51.1) min, the overall average blood loss was (21.0±9.2) ml, and the overall average incision size was (3.5±0.5) cm, all added a 12 mm auxiliary channel, and the overall average hospital stay was (8.1±2.7) days. All operations were successfully completed, and there was no conversion to open surgery during the operation, and no operation holes were added. There was no Clavien-Dindo≥grade 3 complication after operation. Conclusions:The novel single-port robot could safely and effectively perform radical prostatectomy, partial nephrectomy and adrenalectomy which are common in urology through extraperitoneal approach.

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.

Clinical analysis of cystic renal cell carcinoma : a report of 67 cases / 中华泌尿外科杂志

Objective To investigate the diagnosis and treatment of cystic renal cell carcinoma.Methods The clinical data of 67 cases of cystic renal cell carcinoma treated from January 2005 to April 2013 were analyzed retrospectively.Preoperative imaging procedures indicated masses of renal cysts in 67 cases,including malignant tumors in 59 cases.Intraoperative pathological examination was performed in 59 cases and the pathological results showed malignant tumors in 56 cases,renal cyst in 2 cases and multilocular cyst of kidney in 1 case.The surgical procedures included radical nephrectomy (n=19),partial nephrectomy (n =12),retroperitoneal laparoscopic radical nephrectomy (n =9),retroperitoneal laparoscopic partial nephrectomy (n =20),retroperitoneal laparoscopic cyst unroofed then transferred to radical nephrectomy (n =6),and retroperitoneal laparoscopic partial nephrectomy transferred to radical nephrectomy (n =1).Results The 67 cases were diagnosed as renal carcinoma,including clear renal cell carcinoma with cystic changes in 31 cases and multilocular renal cell carcinoma in 36 cases.Sixty-two cases were followed up for 10-110 months (median 56 months),and there was no recurrence or metastasis,among which 7 cases diagnosed as benign pre-operation or intra-operation but malignant by pathological examination after surgery were followed up for 61-103 months (median 82 months).Conclusions Imaging plays an important role in the early diagnosis of cystic renal cell carcinoma.Intraoperative pathological examination should be performed in suspected cases.Nephron-sparing surgery is preferred with good outcome.

The effects of pelvic floor muscle training on symptom and quality of life in female patients with overactive bladder / 中华泌尿外科杂志

Objective To elavluate the efficacy of pelvic floor muscle training (PFMT) on symptoms and quality of life in the treatment of female overactive bladder (OAB).Methods Ninety-one female patients with OAB completed the prospective study and were divided into 2 groups.The study group had PFMT combined with comprehensive health education and tolterodine (n =46),and the control group had comprehensive health education combined with tolterodine (n =45).OAB symptom score (OABSS),King's health questionnaire (KHQ) and modified Oxford scale (MOS) were evaluated at baseline,2 weeks,1 month and 3 months.The patients were followed up for 6 months.Results The MOS and OABSS score in study group before the treatment were 2.87±0.65 and 7.61 ±2.28,respectively,and in control group they were 2.80±0.55 and 7.44±2.41,respectively.There was no significant difference between the 2 grotps (P＞ 0.05).There was no significant difference in KHQ domains before the treatment between the 2 groups (P＞ 0.05).The MOS scores were 3.15±0.63 and 3.57±0.58 after treatment of 1 and 3 months in study group,which were significantly improved compared with the values of 2.89±0.57 and 3.09±0.67 in control group (P＜0.05).The OABSS score was 1.13± 1.93 in study group after treatment of 6 months,which was significantly improved compared with the values of 2.47±2.18 in control group (P＜0.05).The Incontinence impact,Role Limitations,Physical Limitations,Social Limitations and Symptom Severity in study group improved significantly compared with the values in control group after treatment of 3 months (P＜0.05).Domains of KHQ scores were totally significantly improved after treatment of 6 months in study group than in control group(P＜0.05).Conclusion Long term PFMT may play an important role in the treatment of OAB,and can also improve the quality of life of the patients.

Clinical analysis of 15 cases of Paget's disease of the scrotum / 中华男科学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features and treatment of Paget's disease of the scrotum.</p><p><b>METHODS</b>Fifteen cases of Paget's disease of the scrotum, pathologically diagnosed and successfully treated by surgery from 1987 to 2003, were studied retrospectively.</p><p><b>RESULTS</b>Typical pathological features were observed in all the patients. Thirteen cases were followed up for 0. 5 approximately 13 years, of whom 1 case relapsed within 3 years, 2 died of metastasis after 2 years, and 3 died of cardiovascular diseases, with no recurrence in the others.</p><p><b>CONCLUSION</b>Early biopsy and extensive excision of the scrotal lesion is the first choice of treatment for Paget's disease, with good operative effect and satisfactory prognosis. A 2nd operation could be considered for patients of local relapse.</p>