Objective:To evaluate the feasibility and safety of laparoendoscopic single-site robot-assisted nephroureterectomy(LESS-RANU)by comparing perioperative,pathological,and oncological results with the conventional multip...Objective:To evaluate the feasibility and safety of laparoendoscopic single-site robot-assisted nephroureterectomy(LESS-RANU)by comparing perioperative,pathological,and oncological results with the conventional multiport laparoendoscopic approach in the retroperitoneal approach for the management of urinary tract urothelial carcinoma.Methods:Between January 2021 and October 2024,our center treated 56 patients with urinary tract urothelial carcinoma using either the LESS-RANU(n�31)or the conventional multi-port laparoscopic nephroureterectomy(LNU)(n�25)via the retroperitoneal approach.Data including demographic,perioperative,pathological,and oncological characteristics were collected.Results:No significant differences were found in patient demographics and tumor characteristics between the two groups.No serious intraoperative complications occurred in both groups.The mean operation time,skin incision length,Visual Analog Scale pain scores,time for repositioning and follow-up duration for the LESS-RANU group and the LNU group were 138.23 min and 180.40 min,6.48 cm and 15.40 cm,3.23 and 4.60,5.71 min and 30.24 min,and 10.84 months and 22.88 months,respectively(p<0.001).There were no significant differences in other perioperative data between the two groups.Multiple linear regression identified an association of body mass index with operation time in the LESS-RANU group(p<0.001).The mean operative time of the subsequent 15 patients was significantly lower than that of the initial 16 patients(130.33 min vs.145.31 min,p=0.044).There were no significant differences in the pathological characteristics between the two groups.Recurrences developed in four patients:one in the LESS-RANU group and three in the LNU group.-Conclusion:LESS-RANU is safe and more effective compared to LNU via the retroperitoneal approach,especially for patients with low body mass index.展开更多
BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisi...BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisional infections,without affecting tumor outcomes.However,lesions in the right lobe of the liver are deep and obstructed by the ribs,making exposure difficult and increasing the degree of surgical difficulty;thus,liver tumors in the deep right lobe pose technical challenges in standard laparoscopic surgery.AIM To investigate the safety and efficacy of laparoscopic retroperitoneal partial hepatectomy for liver tumors.METHODS The clinical data of 72 patients who underwent laparoscopic retroperitoneal partial hepatectomy for liver tumors between January 2018 and December 2024 at the First People’s Hospital of Yunnan Province were analyzed.Of the 72 patients included,34 were male and 38 were female,with ages ranging from 34 years to 72 years(median age,45 years).The tumors were all located in the right lobe of the liver,with 30 cases in segment S6,27 cases in segment S7,and 15 cases in segment S8;the mean tumor diameter was 7.5±3.4 cm.The postoperative tumor indices,liver function,and postoperative complications were analyzed to evaluate the clinical efficacy of laparoscopic partial hepatectomy via the retroperitoneal approach.RESULTS The surgeries were successfully completed in all patients,and conversion to open surgery was required in 10 patients.The mean operative time,blood loss,drain retention time,and length of postoperative hospital stay were 140±30 minutes,150±46 mL,3.8±1.2 days,and 8.3±5.3 days,respectively.Liver function tests returned to normal in all patients within two weeks of surgery.Fifteen patients developed atelectasis and pleural effusion and were managed with incision and drainage and antibiotics.Two patients developed uncomplicated minimal ascites,and the remaining patients had no perioperative complications,such as abdominal hemorrhage,infection,liver failure,bile leakage,and other adverse events.All patients were successfully treated.CONCLUSION Laparoscopic retroperitoneal partial hepatectomy is a safe and effective approach for right hepatic space-occupying lesions,particularly in segments S6,S7,and S8,with fewer postoperative complications,less trauma,and faster recovery times.This procedure provides a new surgical access for resection of deep tumors in the right lobe of the liver and has clear clinical implications.展开更多
Approximately 5%of patients with renal cancer present with synchronous bilateral renal masses(SBRM).1,2 Bilateral renal tumors associated with hereditary syndromes often exhibit more aggressive biological behaviors co...Approximately 5%of patients with renal cancer present with synchronous bilateral renal masses(SBRM).1,2 Bilateral renal tumors associated with hereditary syndromes often exhibit more aggressive biological behaviors compared to sporadic SBRM cases.3,4 Notably,the prognosis for sporadic cases,in terms of cancerspecific and distant metastasis-free survival,is comparable to that of unilateral renal masses.展开更多
Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were t...Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.展开更多
The anterior retroperitoneal approach is a technique to treat disc degenerative disease (DDD), spinal deformities, traumas, tumors and infections. It can be used to perform Anterior Lumbar Interbody Fusions (ALIF) or ...The anterior retroperitoneal approach is a technique to treat disc degenerative disease (DDD), spinal deformities, traumas, tumors and infections. It can be used to perform Anterior Lumbar Interbody Fusions (ALIF) or Total Disc Replacements (TDR). Though being a fast procedure that is becoming more often used by spinal surgeons, the anterior approach requires an adequate knowledge of the anatomy of the abdomen to lessen the risks of intraoperative complications. The authors’ preferred technique is the left retroperitoneal video-assisted approach, using an endoscope to visualize and magnify the deep anatomical structures, discectomy procedure and hardware implant. In a review of our casuistry from 2010 to 2012, 163 patients underwent an anterior lumbar approach, and 139 of these had a single L4-5 or L5-S1 level treatment. A 3.6% rate of global complications (1.44% of major vascular injuries) has been observed, with a mean operation time of 116.4 minutes and a mean blood loss of 156.1 ml. These values show how the anterior retroperitoneal video-assisted approach for the treatment of lumbar diseases is a fast procedure that implies low blood loss, with a low rate of intraoperative complications.展开更多
Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fract...Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively.展开更多
Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy(rRAPN)with a new robotic platform called KangDuo Surgical Robot-01(KD-SR-01)syste...Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy(rRAPN)with a new robotic platform called KangDuo Surgical Robot-01(KD-SR-01)system(Suzhou KangDuo Robot Co.,Ltd.,Suzhou,China)and discuss its surgical technique.Methods A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney.The R.E.N.A.L.nephrometry score of this patient was 4x.This patient underwent rRAPN with KD-SR-01.The perinephric fat between the tumor and Gerota's fascia was preserved,which was used for internal suspension traction during tumor resection.Postoperative follow-up data were collected.Results The surgery was successfully carried out with a duration of 127 min,in which the docking time was 6 min 25 s and console time was 60 min.The warm ischemia time was 19 min 53 s,and the estimated blood loss was 0 mL.The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma,with a negative surgical margin.The World Health Organization/International Society of Urological Pathology(WHO/ISUP)grade of this patient was Grade 2.No recurrence was observed during the 6-month follow-up.Conclusion Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.展开更多
The simultaneous kidney transplantation and ipsilateral native nephrectomy for autosomal dominant polycystic kidney disease does not seem to be associated with increased rates of comorbidity and complications.This out...The simultaneous kidney transplantation and ipsilateral native nephrectomy for autosomal dominant polycystic kidney disease does not seem to be associated with increased rates of comorbidity and complications.This outcome can efficiently be achieved when the indication and surgical approach of native nephrectomy are properly justified.展开更多
基金supported by the Key Medical Scientific Research Project of the Jiangsu Commission of Health(No.ZD2021028 to Zhu Q)the General Project of the Medical Scientific Research of the Jiangsu Commission of Health(No.Z2021074 to Shen L).
文摘Objective:To evaluate the feasibility and safety of laparoendoscopic single-site robot-assisted nephroureterectomy(LESS-RANU)by comparing perioperative,pathological,and oncological results with the conventional multiport laparoendoscopic approach in the retroperitoneal approach for the management of urinary tract urothelial carcinoma.Methods:Between January 2021 and October 2024,our center treated 56 patients with urinary tract urothelial carcinoma using either the LESS-RANU(n�31)or the conventional multi-port laparoscopic nephroureterectomy(LNU)(n�25)via the retroperitoneal approach.Data including demographic,perioperative,pathological,and oncological characteristics were collected.Results:No significant differences were found in patient demographics and tumor characteristics between the two groups.No serious intraoperative complications occurred in both groups.The mean operation time,skin incision length,Visual Analog Scale pain scores,time for repositioning and follow-up duration for the LESS-RANU group and the LNU group were 138.23 min and 180.40 min,6.48 cm and 15.40 cm,3.23 and 4.60,5.71 min and 30.24 min,and 10.84 months and 22.88 months,respectively(p<0.001).There were no significant differences in other perioperative data between the two groups.Multiple linear regression identified an association of body mass index with operation time in the LESS-RANU group(p<0.001).The mean operative time of the subsequent 15 patients was significantly lower than that of the initial 16 patients(130.33 min vs.145.31 min,p=0.044).There were no significant differences in the pathological characteristics between the two groups.Recurrences developed in four patients:one in the LESS-RANU group and three in the LNU group.-Conclusion:LESS-RANU is safe and more effective compared to LNU via the retroperitoneal approach,especially for patients with low body mass index.
基金Supported by Yunnan Provincial Clinical Medicine Center for Digestive System Diseases,No.2024YNLCYXZX0132.
文摘BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisional infections,without affecting tumor outcomes.However,lesions in the right lobe of the liver are deep and obstructed by the ribs,making exposure difficult and increasing the degree of surgical difficulty;thus,liver tumors in the deep right lobe pose technical challenges in standard laparoscopic surgery.AIM To investigate the safety and efficacy of laparoscopic retroperitoneal partial hepatectomy for liver tumors.METHODS The clinical data of 72 patients who underwent laparoscopic retroperitoneal partial hepatectomy for liver tumors between January 2018 and December 2024 at the First People’s Hospital of Yunnan Province were analyzed.Of the 72 patients included,34 were male and 38 were female,with ages ranging from 34 years to 72 years(median age,45 years).The tumors were all located in the right lobe of the liver,with 30 cases in segment S6,27 cases in segment S7,and 15 cases in segment S8;the mean tumor diameter was 7.5±3.4 cm.The postoperative tumor indices,liver function,and postoperative complications were analyzed to evaluate the clinical efficacy of laparoscopic partial hepatectomy via the retroperitoneal approach.RESULTS The surgeries were successfully completed in all patients,and conversion to open surgery was required in 10 patients.The mean operative time,blood loss,drain retention time,and length of postoperative hospital stay were 140±30 minutes,150±46 mL,3.8±1.2 days,and 8.3±5.3 days,respectively.Liver function tests returned to normal in all patients within two weeks of surgery.Fifteen patients developed atelectasis and pleural effusion and were managed with incision and drainage and antibiotics.Two patients developed uncomplicated minimal ascites,and the remaining patients had no perioperative complications,such as abdominal hemorrhage,infection,liver failure,bile leakage,and other adverse events.All patients were successfully treated.CONCLUSION Laparoscopic retroperitoneal partial hepatectomy is a safe and effective approach for right hepatic space-occupying lesions,particularly in segments S6,S7,and S8,with fewer postoperative complications,less trauma,and faster recovery times.This procedure provides a new surgical access for resection of deep tumors in the right lobe of the liver and has clear clinical implications.
文摘Approximately 5%of patients with renal cancer present with synchronous bilateral renal masses(SBRM).1,2 Bilateral renal tumors associated with hereditary syndromes often exhibit more aggressive biological behaviors compared to sporadic SBRM cases.3,4 Notably,the prognosis for sporadic cases,in terms of cancerspecific and distant metastasis-free survival,is comparable to that of unilateral renal masses.
文摘Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.
文摘The anterior retroperitoneal approach is a technique to treat disc degenerative disease (DDD), spinal deformities, traumas, tumors and infections. It can be used to perform Anterior Lumbar Interbody Fusions (ALIF) or Total Disc Replacements (TDR). Though being a fast procedure that is becoming more often used by spinal surgeons, the anterior approach requires an adequate knowledge of the anatomy of the abdomen to lessen the risks of intraoperative complications. The authors’ preferred technique is the left retroperitoneal video-assisted approach, using an endoscope to visualize and magnify the deep anatomical structures, discectomy procedure and hardware implant. In a review of our casuistry from 2010 to 2012, 163 patients underwent an anterior lumbar approach, and 139 of these had a single L4-5 or L5-S1 level treatment. A 3.6% rate of global complications (1.44% of major vascular injuries) has been observed, with a mean operation time of 116.4 minutes and a mean blood loss of 156.1 ml. These values show how the anterior retroperitoneal video-assisted approach for the treatment of lumbar diseases is a fast procedure that implies low blood loss, with a low rate of intraoperative complications.
文摘Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively.
文摘Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy(rRAPN)with a new robotic platform called KangDuo Surgical Robot-01(KD-SR-01)system(Suzhou KangDuo Robot Co.,Ltd.,Suzhou,China)and discuss its surgical technique.Methods A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney.The R.E.N.A.L.nephrometry score of this patient was 4x.This patient underwent rRAPN with KD-SR-01.The perinephric fat between the tumor and Gerota's fascia was preserved,which was used for internal suspension traction during tumor resection.Postoperative follow-up data were collected.Results The surgery was successfully carried out with a duration of 127 min,in which the docking time was 6 min 25 s and console time was 60 min.The warm ischemia time was 19 min 53 s,and the estimated blood loss was 0 mL.The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma,with a negative surgical margin.The World Health Organization/International Society of Urological Pathology(WHO/ISUP)grade of this patient was Grade 2.No recurrence was observed during the 6-month follow-up.Conclusion Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.
文摘The simultaneous kidney transplantation and ipsilateral native nephrectomy for autosomal dominant polycystic kidney disease does not seem to be associated with increased rates of comorbidity and complications.This outcome can efficiently be achieved when the indication and surgical approach of native nephrectomy are properly justified.
