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Objectives: Renal cancer is a common malignancy of the urinary system, and the partial nephrectomy is a common surgical modality for early renal cancer. 3D printing technology can create a visual three-dimensional model by using 3D digital models of the patient's imaging data. With this model, surgeons can perform preoperative assessment to clarify the location, depth, and blood supply of the tumor, which helps to develop preoperative plans and achieve better surgical outcomes. In this study, the R.E.N.A.L scoring system was used to stratify patients with renal tumors and to explore the clinical application value of 3D printing technology in laparoscopic partial nephrectomy., Methods: A total of 114 renal cancer patients who received laparoscopic partial nephrectomy in Xiangya Hospital from June 2019 to December 2020 were enrolled. The patients were assigned into an experimental group ( n =52) and a control group ( n =62) according to whether 3D printing technology was performed, and the differences in perioperative parameters between the 2 groups were compared. Thirty-nine patients were assigned into a low-complexity group (4-6 points), 32 into a moderate-complexity group (7-9 points), and 43 into a high-complexity group (10-12 points) according to R.E.N.A.L score, and the differences in perioperative parameters between the experimental group and the control group in each score group were compared., Results: The experimental group had shorter operative time, renal ischemia time, and postoperative hospital stay (all P <0.05), less intraoperative blood loss ( P =0.047), and smaller postoperative blood creatinine change ( P =0.032) compared with the control group. In the low-complexity group, there were no statistically significant differences between the experimental group and the control group in operation time, renal ischemia time, intraoperative blood loss, postoperative blood creatinine changes, and postoperative hospital stay (all P >0.05). In the moderate- and high- complexity groups, the experimental group had shorter operative time, renal ischemia time, and postoperative hospital stay ( P <0.05 or P <0.001), less intraoperative blood loss ( P =0.022 and P <0.001, respectively), and smaller postoperative blood creatinine changes ( P <0.05 and P <0.001, respectively) compared with the control group., Conclusions: Compared with renal tumor patients with R.E.N.A.L score<7, renal cancer patients with R.E.N.A.L score≥7 may benefit more from 3D printing assessment before undergoing partial nephrectomy.

Background: To perform a systematic review and meta-analysis evaluating the perioperative, functional, and oncological outcomes and cost of robot-assisted radical prostatectomy (RARP), or laparoscopic radical prostatectomy (LRP) comparing with open radical prostatectomy (ORP) in men with clinically localized prostate cancer through all prospective comparative studies., Methods: A comprehensive literature search was performed in August 2018 using the Pubmed, Medline, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) and prospective studies including patients with clinically localized prostate cancer were eligible for study inclusion. Cumulative analysis was conducted using Review Manager v. 5.3 software., Results: Two RCTs and 9 prospective studies were included in this systematic review. There were no significant differences between RARP/LRP and ORP in overall complication rate, major complication rate, overall positive surgical margin (PSM) rate, ≤pT2 tumor PSM rate, ≥pT3 tumor PSM rate. Moreover, RARP/LRP and ORP showed similarity in biochemical recurrence (BCR) rate at 3, 12, 24 months postoperatively. Urinary continence and erectile function at 12 months postoperatively between RARP and ORP are also comparable. RARP/LRP were associated with significantly lower estimated blood loss [mean difference (MD) -749.67, 95% CI -1038.52 to -460.82, P = .001], lower transfusion rate (OR 0.17, 95% CI 0.10 to 0.30, P < .001) and less hospitalization duration (MD -1.18, 95% CI -2.18 to -0.19, P = .02). And RARP/LRP required more operative time (MD 50.02, 95% CI 6.50 to 93.55, P = .02) and cost., Conclusion: RARP/LRP is associated with lower blood loss, transfusion rate and less hospitalization duration. The available data were insufficient to prove the superiority of any surgical approach in terms of postoperative complications, functional and oncologic outcomes.

Objective: To investigate the mortality, operation time, cystectomy time, and complications of anterior approach laparoscopic radical cystectomy (ALRC) in Asian males in comparison with posterior approach laparoscopic radical cystectomy (PLRC)., Materials and Methods: One hundred forty-seven male patients with bladder cancer (cT2-3NxM0) in our hospital from May 2011 to January 2018 having undergone laparoscopic radical cystectomy were studied, including 68 patients in PLRC group and 79 patients in ALRC group. Baseline patient characteristics, operative and postoperative characteristics, and postoperative complications were retrospectively collected and analyzed between the two groups., Results: Patients in these two groups exhibited similar baseline characteristics (p > 0.05). Compared with PLRC group, ALRC group required similar operation time (317.3 ± 40.9 vs 321.9 ± 37.5) and cystectomy time (64.8 ± 8.7 vs 65.6 ± 14.0). The ALRC group required less cystectomy time (67.8 ± 10.1 vs 77.4 ± 14.9) when patients' BMI > 24 or patients had large total tumor and blood clot volume (> 160 cm 3 ). Also, estimated blood loss (EBL) of ALRC group was significantly less than that of PLRC group (477.8 ± 97.4 vs 550.4 ± 99.9). There existed no significant differences between the PLRC and ALRC groups in postoperative characteristics and complications., Conclusion: This study revealed that ALRC required less cystectomy time for patients with higher BMI and larger tumor, suggesting less blood loss and similar perioperative complications. ALRC is recommend for male patients, of which BMI > 24 or total tumor and blood clot volume > 160 cm 3 .

Objectives: T1 ventral renal hilar tumors (VRHTs) represent a very special type of tumor, for which laparoscopic partial nephrectomy (LPN) by the retroperitoneal approach is challenging. In this study, we report our surgical technique and Trifecta results., Methods: Renal rotation technique has been established for retroperitoneal laparoscopic partial nephrectomy (RLPN) for VRHTs in our institution. Trifecta was used as a composite outcome measure for assessing quality of PLPN using this technique. A retrospective analysis of RLPN cases in 12 patients with VRHTs was performed., Results: Mean tumor size was 3.4 cm and median R.E.N.A.L. score was 8 (range 7-9). Mean warm ischemia time was 23.1 minutes, suture time 28.1 minutes, estimated blood loss 139.2 mL, operation time 122.8 minutes, and median hospital stay was 4 days. Three patients (25.0%) had Clavien-Dindo grade I-II complications. Seven patients (58.3%) achieved Trifecta. Postoperative pathological examination showed renal cell carcinoma in all cases with negative surgical margin. A median follow-up of 7 months revealed no local recurrence or distant metastases., Conclusions: Our Trifecta outcomes demonstrate that RLPN with renal rotation technique is feasible, safe, and effective for moderately complex VRHTs. The short-term functional and oncologic outcomes are promising; however, long-term follow-up is needed.

Objective: To report a novel technique of laparoscopic retroperitoneal enucleation-separation surgery for specifically located renal angiomyolipoma (RAML) treated in our institute., Patients and Methods: We prospectively analyzed 40 patients who were randomized and received laparoscopic simple enucleation (Group 1) or enucleation-separation (Group 2) from January 2011 to February 2013. Patient characteristics, perioperative outcomes, renal function, and oncologic outcomes were compared between the groups., Results: Average age, body mass index, sex distribution, tumor location and size, and operative time showed no significant difference between the two groups (p > 0.05). Average warm ischemia time in Group 1 was longer than that in Group 2 (25.3 minutes vs 17.6 minutes, p = 0.001). No complications except for one postoperative hemorrhage that occurred in Group 1 were observed. An improved early affected renal function recovery was observed in the Group 2 (percentage of glomerular filtration rate reduction for Group 1 vs Group 2, 24.3% vs 18.3%; p = 0.001). No local recurrences were found during the follow-up period., Conclusion: Laparoscopic simple enucleation and enucleation-separation technique are safe, efficient, and minimally invasive therapies for selected patients with RAMLs. In addition, the enucleation-separation appears to significantly minimize the warm ischemia injury and results in superior short-term renal function preservation, which could be a nephron-sparing alternative for the treatments of RAMLs.

Objective: This study presents our initial experience with extraperitoneal and transperitoneal laparoscopic partial cystectomy (LPC) in the treatment of benign non-urothelial bladder tumors., Methods: Eleven patients with benign non-urothelial bladder tumors underwent extraperitoneal or transperitoneal LPC. The five cases with tumors located on the anterior/anterolateral bladder wall received the extraperitoneal approach. The six cases with tumors located around the bladder dome or over the posterior bladder wall received the transperitoneal approach. Key perioperative parameters were recorded., Results: All patients underwent laparoscopic resection smoothly without requiring a conversion to a traditional open procedure, and no patient displayed perioperative complications. Pathology showed benign non-urothelial bladder tumors with normal margins in all eleven patients, including five leiomyoma cases, three pheochromocytoma cases, two paraganglioma cases and one inflammatory fibrous histiocytoma case. Follow-up cystoscopy and imaging studies in all eleven patients (mean follow-up period 32 months) revealed neither residual nor local recurrence., Conclusions: LPC is safe and feasible in select patients with benign non-urothelial bladder tumors and yields satisfactory oncological and functional results. Extraperitoneal LPC should be preferred for lesions located on the anterior/anterolateral bladder wall, while transperitoneal LPC should be preferred for lesions around the bladder dome or over the posterior bladder wall., (© 2014 S. Karger AG, Basel.)

Purpose: To evaluate the role of two different approaches to perform laparoscopic RPLND: transperitoneal laparoscopic retroperitoneal lymph node dissection (TL-RPLND) and extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RPLND)., Materials and Methods: Between February 2003 and April 2013, 39 patients with nonseminomatous germ cell testicular tumors were treated by RPLND in our center. Twenty-one patients had TL-RPLND, and 18 patients had EL-RPLND. We performed a comprehensive retrospective study comparing TL-RPLND and EL-RPLND. Certain parameters, including operative time, estimated blood loss, perioperative complications, resected lymph nodes, postoperative intestinal function recovery time, ejaculation, and postoperative tumor markers, were abstracted and compared., Results: In the EL-RPLND and TL-RPLND groups, the operation times were 178 ± 31 and 207 ± 25 min; the amounts of estimated blood loss were 87 ± 26 and 111 ± 21 ml; the postoperative intestinal function recovery times were 1.2 ± 0.7 and 2.4 ± 0.6 days; the postoperative hospital stays were 5.8 ± 1.1 and 5.5 ± 1.4 days; and the numbers of resected lymph nodes were 16.2 ± 1.5 and 15.8 ± 1.6, respectively. No conversion from laparoscopic to open surgery occurred. No patient in either group received an intraoperative blood transfusion. Overall, two patients developed postoperative fever, and one developed abdominal distension. After a median follow-up of 45 months, no regional relapse or metastases occurred, but 4 patients at clinical stage II were treated successfully by three cycles of platinum-based postoperative chemotherapy. Currently, all patients show no evidence of disease., Conclusion: Our results demonstrate that EL-RPLND was superior to the transperitoneal approach in terms of the operation time, estimated blood loss, and postoperative intestinal function recovery time, whereas no differences were observed in the number of lymph nodes resected. EL-RPLND was demonstrated to be safe and feasible, with satisfactory clinical outcomes when performed by experienced laparoscopic surgeons. Larger cohorts of patients with longer term follow-up are needed for further studies to determine the role of different approaches to L-RPLND.

Objective: To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephronsparing surgery for renal cell carcinoma of the early stage., Methods: Between June 2003 and June 2008, 53 patients (31 males and 22 females) with renal mass were selected to undergo wedge resection of the tumor through retroperitoneal laparoscopy. Spiral computerized tomography (CT) and color Doppler ultrasound were used to provide information for nephron-sparing surgery (NSS). Patients with small (≤ 3 cm), peripheral, shallow and exophytic tumors, at a distance which exceeded approximately 10 mm between the tumor and renal collecting system, were enrolled into our studies. Surgical resection was performed along a resection line about 0.5 cm from the tumors., Results: All procedures were technically successful. Mean operating time was 96 min (ranging from 75 to 110 min). Mean warm ischemia time was 15 min (ranging from 10 to 21 min). Mean estimated blood loss was 70 mL (ranging from 40 to 120 mL). Mean hospital stay after the surgery was 4.2 days (ranging from 3 to 6 days). No intraoperative or postoperative complications occurred. Of 53 patients, 52 had negative surgical margins and a 63-year male patient had a positive surgical margin. Neither local recurrence nor trocar-site metastasis was observed in the 53 patients during follow ups averaging 39 months (ranging from 11 to 83 months)., Conclusion: Under the modified techniques of the surgery and conservative criteria for patient selection, laparoscopic partial nephrectomy can be safely and effectively performed and satisfactory outcomes are achievable.