Objective:To investigate the efficacy and safety of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN) for patients with renal tumors.Methods:A total of 32 renal tumor patients undergoing RAPN with modified early unclamping technique between January 2019 and August 2020 were retrospectively collected, including 18 males and 14 females. The average age was (48.5±11.2) years old, average BMI was (23.8±3.7) kg/m 2, average tumor size was (4.2±1.4)cm with 18 left tumors and 14 right tumors, average R. E.N.A.L. score was 7.6±0.4, and average preoperative eGFR was (84.0±18.6)ml/(min·1.73 m 2). The control group included 66 renal tumor patients undergoing RAPN with standard unclamping technique during the same period by the same surgeon, including 42 males and 24 females. The average age was (50.2±13.8) years old, average BMI was (24.0±4.5)kg/m 2, average tumor size was (4.1±1.6)cm with 35 left tumors and 31 right tumors, average R. E.N.A.L. score was 7.5±0.5, and average preoperative eGFR was (82.8±20.2) ml/(min·1.73 m 2). There was no significant difference in above variables between two groups. Modified early unclamping technique used barbed wire to continually suture 2-3 needles in a short time to close the large space at the outer after the inner suture, and then loosen the blocking clip to restore renal blood supply. The operative time, warm ischemia time, blood loss, postoperative tube removal time, postoperative hospital stay and 3 months postoperative renal function of two groups were compared. Results:All of the 98 RAPN were performed successfully and no patient was converted to radical nephrectomy or open surgery. There was no significant difference in operation time [(120.9±22.8)vs.(111.6±25.0)min, P=0.079], postoperative tube removal time [(4.0±0.6)day vs.(3.8±0.8) day, P=0.214] and postoperative hospital stay [(5.1±0.7)day vs.(5.2±0.5) day, P=0.419] between the two groups. Compared with the standard unclamping group, the modified early unclamping group had obvious less warm ischemia time [(13.5±3.6)min vs.(21.2±4.4) min, P<0.001]. There was no difference in intraoperative estimated blood loss between two groups (110 ml vs. 100 ml, P=0.480). No blood transfusion, urine leakage, postoperative hemorrhage occurred in either group. The 3 months postoperative renal function decline of modified early unclamping group was slightly less than standard unclamping group [(10.5±7.6)ml/(min·1.73m 2)vs.(13.2±6.4) ml/(min·1.73m 2)], but did not reach statistical significance ( P=0.069). The median follow-up period was 12.4 months(4-24 months) without any recurrence or metastasis. Conclusions:The modified early unclamping technique in RAPN for patients with renal tumors is safe and feasible. Compared with the standard unclamping technique, the modified early unclamping technique could shorten the warm ischemia time without increasing blood loss and complications, and might protect the postoperative renal function, which has high value in clinical practice.

Objective:To compare the efficacy and safety of robot-assisted laparoscopic and laparoscopic partial nephrectomy (RAPN and LPN) for patients with completely endophytic renal tumor.Methods:A total of 73 patients with completely endophytic renal tumor receiving RAPN (n=29) or LPN (n=44) in our center between January 2015 and June 2021 were retrospectively collected. There were 21 males and 8 females in RAPN group. The average age was 48.6±13.7 years old, average tumor size was 2.9±0.9 cm with 13 left tumors and 16 right tumors, average R. E.N.A.L. score was 9.2±1.0, and average preoperative eGFR was 82.6±10.7 ml/(min·1.73 m 2). There were 27 males and 17 females in LPN group. The average age was 50.1±12.3 years old, average tumor size was 2.9±0.9 cm with 24 left tumors and 20 right tumors, average R. E.N.A.L. score was 9.1±1.3, and average preoperative eGFR was 81.7±9.6 ml/(min·1.73 m 2). There was no significant difference in above variables between two groups. The operative time, warm ischemia time, blood loss, postoperative complication, postoperative hospital stay and postoperative 3 months renal function of two groups were compared. Results:All 73 patients successfully underwent RAPN or LPN and no patient converted to radical nephrectomy or open surgery. There was no significant difference in operation time [140(80, 160) min vs. 150 (90, 180) min, P=0.264], intraoperative estimated blood loss[150 (100, 200)vs. 180 (120, 200) ml, P=0.576]and postoperative hospital stay (7.0±2.7 vs. 7.4±2.1 days, P=0.480) between two groups. Compared with LPN group, RAPN group had obvious less warm ischemia time (23.1±3.3 vs. 27.6±4.7 min, P<0.001). No obvious complication occurred in RAPN group and one case with postoperative hemorrhage occurred in LPN group. No positive margin occurred in either group. There was no difference in renal function 3 months after operation between the two groups [73.2±6.3 vs.70.5±7.6ml/(min·1.73 m 2), P=0.117]. The median follow-up period was 22.6 months with no tumor recurrence or metastasis. Conclusions:For experienced surgeons, both RAPN and LPN are safe and feasible for patients with completely endophytic renal tumor. Compared with LPN, RAPN has advantages of perioperative curative effect, which could reduce the operating difficulty and shorten the warm ischemia time.

OBJECTIVE To optimize the steaming and processing technology of wine-steamed Taxillus chinensis， and to characterize its quality. METHODS Using the content of avicularin， quercitrin， quercetin and appearance traits as evaluation indicators， the analytic hierarchy process （AHP）-entropy weight method was used to determine the weights of each indicator， and the comprehensive scores of those indicators were used as response values. Box-Behnken response surface method was used to investigate the effects of solid-liquid ratio （g/mL）， soaking time， and steaming time on the processing technology of wine-steamed T. chinensis， optimize the best processing technology， and verify it. Fifteen batches of T. chinensis decoction pieces from different origins were used to prepare wine-steamed T. chinensis using the best processing technology， and their qualities were characterized. RESULTS The optimal processing technology for wine-steamed T. chinensis was to take 100 g of T. chinensis decoction pieces， add 20 mL of yellow wine， seal and moisten for 2 h， steam at normal pressure for 1 h， take out and dry at 50 ℃. The surface of wine-steamed T. chinensis prepared by the optimal processing technology was reddish brown or brownish， and its powder was dark brown， with a hard or brittle texture that was easy to break， and had a slight aroma of alcohol， and an astringent taste. Results of microscopic and thin-layer identification for the stem cross-section of wine-steamed T. chinensis were the same as those of raw T. chinensis. The contents of moisture， total ash and acid-insoluble ash were 3.92%-8.75%， 2.27%-5.08%， and 0.19%-0.82%， respectively； the contents of water-soluble extract were 11.28%-18.56%， and the contents of alcohol-soluble extract were 3.36%-8.58%； the contents of avicularin， quercitrin， and quercetin were 0.22-1.64， 0.26-2.45， and 0.01-0.38 mg/g， respectively. CONCLUSIONS This study successfully optimized the processing technology of wine-steamed T. chinensis and preliminarily characterized its quality， which can provide reference for the standardized processing and establishment of quality standards for wine-steamed T. chinensis decoction mail：wyl@sxtcm.edu.cn pieces.

OBJECTIVE To optimize the steaming and processing technology of wine-steamed Taxillus chinensis， and to characterize its quality. METHODS Using the content of avicularin， quercitrin， quercetin and appearance traits as evaluation indicators， the analytic hierarchy process （AHP）-entropy weight method was used to determine the weights of each indicator， and the comprehensive scores of those indicators were used as response values. Box-Behnken response surface method was used to investigate the effects of solid-liquid ratio （g/mL）， soaking time， and steaming time on the processing technology of wine-steamed T. chinensis， optimize the best processing technology， and verify it. Fifteen batches of T. chinensis decoction pieces from different origins were used to prepare wine-steamed T. chinensis using the best processing technology， and their qualities were characterized. RESULTS The optimal processing technology for wine-steamed T. chinensis was to take 100 g of T. chinensis decoction pieces， add 20 mL of yellow wine， seal and moisten for 2 h， steam at normal pressure for 1 h， take out and dry at 50 ℃. The surface of wine-steamed T. chinensis prepared by the optimal processing technology was reddish brown or brownish， and its powder was dark brown， with a hard or brittle texture that was easy to break， and had a slight aroma of alcohol， and an astringent taste. Results of microscopic and thin-layer identification for the stem cross-section of wine-steamed T. chinensis were the same as those of raw T. chinensis. The contents of moisture， total ash and acid-insoluble ash were 3.92%-8.75%， 2.27%-5.08%， and 0.19%-0.82%， respectively； the contents of water-soluble extract were 11.28%-18.56%， and the contents of alcohol-soluble extract were 3.36%-8.58%； the contents of avicularin， quercitrin， and quercetin were 0.22-1.64， 0.26-2.45， and 0.01-0.38 mg/g， respectively. CONCLUSIONS This study successfully optimized the processing technology of wine-steamed T. chinensis and preliminarily characterized its quality， which can provide reference for the standardized processing and establishment of quality standards for wine-steamed T. chinensis decoction mail：wyl@sxtcm.edu.cn pieces.