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Objective: To investigate the efficacy of intraoperative cognitive navigation on laparoscopic radical prostatectomy using 3D prostatic models created by U-shaped convolutional neural network (U-net) and reconstructed through Medical Image Interaction Tool Kit (MITK) platform., Methods: A total of 5 000 pieces of prostate cancer magnetic resonance (MR) imaging discovery sets with manual annotations were used to train a modified U-net, and a set of clinically demand-oriented, stable and efficient full convolutional neural network algorithm was constructed. The MR images were cropped and segmented automatically by using modified U-net, and the segmentation data were automatically reconstructed using MITK platform according to our own protocols. The modeling data were output as STL format, and the prostate models were simultaneously displayed on an android tablet during the operation to help achieving cognitive navigation., Results: Based on original U-net architecture, we established a modified U-net from a 201-case MR imaging training set. The network performance was tested and compared with human segmentations and other segmentation networks by using one certain testing data set. Auto segmentation of multi-structures (such as prostate, prostate tumors, seminal vesicles, rectus, neurovascular bundles and dorsal venous complex) were successfully achieved. Secondary automatic 3D reconstruction had been carried out through MITK platform. During the surgery, 3D models of prostatic area were simultaneously displayed on an android tablet, and the cognitive navigation was successfully achieved. Intra-operation organ visualization demonstrated the structural relationships among the key structures in great detail and the degree of tumor invasion was visualized directly., Conclusion: The modified U-net was able to achieve automatic segmentations of important structures of prostate area. Secondary 3D model reconstruction and demonstration could provide intraoperative visualization of vital structures of prostate area, which could help achieve cognitive fusion navigation for surgeons. The application of these techniques could finally reduce positive surgical margin rates, and may improve the efficacy and oncological outcomes of laparoscopic prostatectomy.

Objective: To evaluate the feasibility, efficacy and safety of laparoscopic partial nephrectomy for complex renal cystic lesions., Methods: A retrospective cohort study was conducted on the clinical data of 27 patients with complex renal cystic lesions treated by laparoscopic partial nephrectomy from May 2008 to April 2011 in Peking University Third Hospital. According to the Bosniak classification, 7 cases were lesions of grade IIF, 11 of grade III, and 9 of grade IV. The mean diameter of cystic lesions was (3.58±0.75) cm, and 4 lesions were larger than 4.0 cm., Results: All procedures were performed through retroperitoneal approach and successful. The mean operative time was (123.1±16.8) min, ranging from 100 min to 160 min, and the mean renal warm ischemia time was (29.7±3.5) min, ranging from 25 min to 40 min. Blood loss in the operations was from 50 mL to 110 mL, the mean being (75.5±21.8) mL. The postoperative hospital stay was 4 to 6 days, and the mean was (5.11±0.85) days. Postoperative pathological results included 10 simple renal cysts (37.0%), 2 cases of adult cystic nephroma (7.4%), 1 mixed epithelial and stromal tumor (3.7%), 13 cases of renal cell carcinoma with cystic change (48.1%), and 1 multilocular cystic renal cell carcinoma (3.7%). The results showed that 14.3% of cystic lesions of grade IIF, 45.5% of grade III and 88.9% of grade IV were malignant. In the follow-up ranging from 12 to 48 months (median 24 months), there was no case of recurrence., Conclusion: The differentiation between benign and malignant renal cystic lesions before surgery remains difficult. According to the Bosniak classification, radiological diagnostic findings are standardized, but still limited in the accuracy to determine the dignity of pathological entity. Laparoscopic partial nephrectomy is feasible to treat complex renal cystic lesions, and is a safe and effective minimally invasive option.

Objective: To evaluate urinary continence outcomes after laparoscopic radical prostatectomy (LRP), and explore the learning curve for continence., Methods: Between May 2006 and May 2011, 200 consecutive patients with clinically localized prostate cancer underwent LRP in Peking University Third Hospital, of whom 160 were performed by a single surgeon and followed up successfully. The average age was (71.9±5.5) years (their age range: 56 to 85 years). All the patients were continent before operation. Of these patients, 11 had undergone previous transurethral resection of the prostate (TURP) and the other 149 were diagnosed by transrectal prostate biopsy. No metastasis was found before surgery. The data about the patients and the operations were recorded. The time from operation till urinary continence was obtained and accessed by interviews. Continence was defined as the use of no pad and no urinary leakage or loss of a few drops occasionally. The patients were divided into 4 equal groups in the 40 consecutive series to determine whether continence was statistically different in group A (1-40) as compared with the other groups., Results: All the operations were performed laparoscopically without any conversion to open surgery. The mean operative duration was (230±57) min (ranging from 110 to 493 min), the median estimated blood loss was 200 mL (ranging from 30 to 1 200 mL), 12 patients (7.5%) received blood transfusions intraoperatively, and the average hospital stay after surgery was (11.8±7.9) d (ranging from 5 to 60 days). The distribution of pathologic stages was as follows: T2a 20%, T2b 16.9%, T2c 40%, T3a 15%, T3b 5.6% and T4 2.5%. The overall positive surgical margin (PSM) rate was 32.5%. The overall continence rates (no pad) were 14.4% after 1 month, 48.8% after 3 months, 77.5% after 6 months and 86.3% after 12 months. At the end of the follow-up, 21 patients (13.1%) were still incontinent . There was a significant difference in continence between the early (Group A) and later groups (P<0.05)., Conclusion: Continence results after LRP were encouraging, which were comparable to the results in previously published open series. Continence could be improved with increasing surgical experience, and it takes 40-50 cases to reach a plateau for surgeons who have some experiences of laparoscopic operations.

Objective: To present the preliminary experience of the operative procedure and clinical outcomes of retroperitoneal laparoscopic nephroureterectomy (RPLNU) with a midline lower abdominal transperitoneal incision for native upper urinary tract transitional cell carcinoma (UUT-TCC) ipsilateral to a transplanted kidney., Methods: In the study, 15 renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU via a midline lower abdominal transperitoneal incision between November 2005 and January 2009. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-8 cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment and extracted completely. The intact specimen was removed manually via the same incision. The cystostomy was generally sutured., Results: The mean operation time was 253 minutes. The mean estimated blood loss was 245 mL. Three patients needed blood transfusion. No open conversion was required during the retroperitoneoscopic nephrectomy. Two of the patients suffered from minor complications. The pathological findings confirmed UUT-TCC in all the patients with 9 of the pelvises and 9 of the ureters. Five of the patients were involved with bladder TCC. With the mean follow-up of 35 months, none of them had retroperitoneal recurrence or distant metastasis, 2 of the 5 patients with bladder TCC had recurrence in bladder and 4 had contralateral native UUT-TCC after the first unilateral nephroureterectomy., Conclusion: RPLNU with a midline lower abdominal transperitoneal incision may be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with satisfactory oncologic outcomes.

Objective: To evaluate the efficacy and safety of transumbilical single-port laparoscopic radical nephrectomy., Methods: The clinical data of laparoscopic radical nephrectomy performed from June 2010 to October 2010 in Peking University Third Hospital were analyzed retrospectively. In the study, 10 patients underwent transumbilical single-port laparoscopic radical nephrectomy (LESS) and 15 received retroperitoneal laparoscopic radical nephrectomy. The data on general presentation, tumor size, tumor location, operative time, blood loss, complications, Visual Analog Pain Scale (VAPS), postoperative hospital stay, pathological results were collected to compare between the two groups. Our homemade single-site equipment was used in the LESS approach and the kidney was dissociated after being cut off the renal vessel and extracted through the umbilical incision. The retroperitoneal approach followed the standard surgical procedures, and the specimens were removed from the extended incision., Results: All the procedures were completed without conversion to open radical nephrectomy. Compared with traditional laparoscopic surgery, the operative time (P=0.001) and VAPS (P=0.002) showed significant difference in LESS group,and no difference was noted in other factors (P>0.05). There was no secondary bleeding, wound infection, intestinal obstruction, incision hernia and other severe postoperative complications. The follow-up of 6 to 10 months showed no local recurrence., Conclusion: Transumbilical single-port laparoscopic radical nephrectomy is feasible, effective and safe. It gives a more mini-invasive and cosmetic option for young or female patients.

Objective: To present the clinical results of 51 patients of clinically localized prostate cancer treated by laparoscopic radical prostatectomy, especially recovery of urinary continence. To analysis how to improve recovery of urinary continence., Methods: From February 2004 to March 2008, we performed LRP on 51 patients. All patients were diagnosed by pathological result preoperatively. T1a-1b 4 cases (8%), T1c 15 cases (29%), T2a 7 cases (14%), T2b 5 cases (10%), T2c 20 cases (39%)., Results: Forty-nine cases were treated by LRP successfully. There were two cases converted to open surgery. Urine leaking happened in 3 cases, but recovered without intervention. Urinary catheter duration was 14 - 45 days (mean 16 days). Six months and 12 months after LRP, incontinence happened 7/39 cases (17.9%) and 5/20 cases (25%) respectively. Complete incontinence happened in one case. The ratio of incontinence happened in the first 20 cases and the following 31 cases were 6/20 (30%) and 7/31 (22%) respectively. There were two cases had rectal injury. Both cases underwent colostomy. Duration of follow up were from 3 - 53 months (mean 17 months). Two cases recurred. One of them was treated with hormone therapy, the other one died of operation for lung metastasis. Other patients' serum total PSA were less than 0.2 microg/L., Conclusions: Extraperitoneal laparoscopic radical prostatectomy is efficient and safe approach for localized prostate cancer. The correct handling of pubic prostatic ligaments, external urethral sphincter and neurovascular bundle are important for recovery of urinary continence. And so does the experience of LRP.