BACKGROUNDVarious rat kidney transplantation models have been introduced over the decades and the study on the models seems to lack novelty and necessity. However, vascular anastomosis, especially renal vein, is still very difficult for trainees. The aim of this study was to provide the modified renal venous anastomosis of rat kidney transplantation to substitute the current method for trainees.

METHODSMale Wistar rats were used as donors and recipients, respectively. Left orthotopic transplantation was performed with a modified technique of renal vein anastomosis, combining the end-to-end sutures with epidural catheter. Meanwhile, the survival rate, warm ischemia time, renal venous anastomosis time, and complications were recorded to evaluate the merits of the modified technique compared with the current recommended technique of rat renal vein. Two trainees took part in the learning of the models in two methods for performing 30 operations, respectively.

RESULTSThe difference in warm ischemia time (from (57.25 ± 7.30) minutes in the first 10 operations to (30.05 ± 1.85) minutes in the third 10 operations) and renal vein anastomosis time (from (32.80 ± 3.80) minutes in the first 10 operations to (19.30 ± 0.98) minutes in the third 10 operations) was significantly short (P < 0.01) and the survival rate was statistically high (from (25 ± 7)% in the first 10 operations to 70% in the third 10 operations) in equal number of operations (P < 0.01) by comparing with the current recommended method ((47.60 ± 7.19) minutes to (22.8 ± 1.85) minutes, (22.40 ± 3.10) minutes to (9.95 ± 1.50) minutes, 45%± 7% to 80%± 0, respectively). The intraoperative complications and postoperative complications of renal venous anastomosis were also significantly decreased (P < 0.01).

CONCLUSIONSThe technique with epidural catheter can shorten the learning curve of the trainee learning rat kidney transplantation. It may replace the currently recommended technique of rat renal vein for trainees.

Anastomosis, Surgical ; methods ; Animals ; Kidney Transplantation ; methods ; Male ; Rats ; Rats, Wistar ; Renal Veins

【Objective】 To explore the clinical value of laparoscopic radical cystectomy based on fascia anatomy for bladder cancer treatment. 【Methods】 The clinical data of 51 patients with bladder cancer who underwent 3D laparoscopic radical cystectomy during Jan.2015 and Jun.2022 were retrospectively analyzed.The surgery was performed based on membrane anatomy technology along four longitudinal and two transverse planes to complete the radical cystectomy.The pelvic plexus was preserved for patients with normal preoperative sexual function. 【Results】 All surgeries were completed without conversion to open operation.The mean operation time was (502.52±108.99) min, mean intraoperative blood loss was (275.96±155.18) mL, mean postoperative drainage time was (4.14±2.41) d, and the mean postoperative hospital stay was (16.37±4.85) d.The mean number of lymph nodes removed was (17.98±11.48).The mean postoperative follow-up was (30.27 ±19.39) months.At the last follow-up, no Clavien ≥grade 3 complications were observed.The estimated overall survival (OS), tumor-specific survival (TSS), and recurrence-free survival (RFS) were 82.4%, 92.2%, and 88.2%, respectively.The lymph node positive patients had shorter OS and RFS (60.0%, 60.0%) than the lymph node negative patients (84.8%, 91.3%).Among the 19 male patients who underwent radical cystectomy with pre-exposure and preservation of pelvic plexus, daytime and nocturnal continence rate were 83.3% and 72.2%, respectively, and 17 patients recovered potency within 6 months postoperatively. 【Conclusion】 Laparoscopic radical cystectomy based on fascia anatomy is safe and effective in laparoscopic radical cystectomy, with standardized surgical procedure, satisfactory oncological outcomes, little hemorrhage, few complications and fast recovery.