Objective:To compare the long term and short term outcomes between robotic and open surgery for hilar cholangiocarcinoma radical resection.Methods:This is a single-center and retrospective case-control study. Patients underwent hilar cholangiocarcinoma radical resection between January 2016 and December 2016 at Department of Hepatobiliary Surgery of the General Hospital of the Chinese People′s Liberation Army were included. Safety, effectiveness and long-term prognosis of tumors were evaluated. Patients were divided into robotic hilar cholangiocarcinoma radical surgery group (robotic group, n=16) and open hepatic hilar cholangiocarcinoma radical surgery group (open group, n=31) . All cases were confirmed by pathology histological. Age, gender, histology, resection margin status, extent of surgical resection, disease-free survival (DFS) , and overall survival (OS) were retrospectively collected and analyzed.In the follow-up cohort, the primary outcome was patient death and the secondary outcome was tumor recurrence. Continuous variables were expressed as means and medians and were compared using the Student t test if normally distributed or Wilcoxon-Mann-Whitney test for nonparametric variables. Discrete variables were expressed as frequency and percentages and χ 2 or Fisher exact test, when appropriate, were used for comparisons. Kaplan-Meier curves were used to calculate the probability of survival and comparisons were performed using log-rank test. Results:In this study, compared with the open group, the robotic group had a longer operation time ( (338±71) minutes vs. (256±56) minutes, t=4.251, P=0.001) , but the intraoperative blood loss was less (100 ml vs. 200 ml, Z=121.50, P=0.040) , the gastric tube removal time was earlier (3 days vs. 4 days, Z=136.0, P=0.011) , and the postoperative hospital stay was shorter (9 days vs. 12 days, Z=144.50, P=0.040) , and the difference was statistically significant.There was no significant difference in the blood transfusion rate, R0 resection rate, and tumor size between the two groups.The recurrence rates in the robotic group and open surgery were 53.3% and 67.0%, respectively (χ 2=1.04, P=0.307) .The median survival time of the robotic group and the open group was 22.0 months and 25.0 months. There was no significant difference in the overall survival rate between the two groups ( P>0.05) . Conclusion:Compared with laparotomy, robotic HCC radical resection could have an equivalence or non-inferiority approach with acceptable long-term outcome.

Objective:To compare the long term and short term outcomes between robotic and open surgery for hilar cholangiocarcinoma radical resection.Methods:This is a single-center and retrospective case-control study. Patients underwent hilar cholangiocarcinoma radical resection between January 2016 and December 2016 at Department of Hepatobiliary Surgery of the General Hospital of the Chinese People′s Liberation Army were included. Safety, effectiveness and long-term prognosis of tumors were evaluated. Patients were divided into robotic hilar cholangiocarcinoma radical surgery group (robotic group, n=16) and open hepatic hilar cholangiocarcinoma radical surgery group (open group, n=31) . All cases were confirmed by pathology histological. Age, gender, histology, resection margin status, extent of surgical resection, disease-free survival (DFS) , and overall survival (OS) were retrospectively collected and analyzed.In the follow-up cohort, the primary outcome was patient death and the secondary outcome was tumor recurrence. Continuous variables were expressed as means and medians and were compared using the Student t test if normally distributed or Wilcoxon-Mann-Whitney test for nonparametric variables. Discrete variables were expressed as frequency and percentages and χ 2 or Fisher exact test, when appropriate, were used for comparisons. Kaplan-Meier curves were used to calculate the probability of survival and comparisons were performed using log-rank test. Results:In this study, compared with the open group, the robotic group had a longer operation time ( (338±71) minutes vs. (256±56) minutes, t=4.251, P=0.001) , but the intraoperative blood loss was less (100 ml vs. 200 ml, Z=121.50, P=0.040) , the gastric tube removal time was earlier (3 days vs. 4 days, Z=136.0, P=0.011) , and the postoperative hospital stay was shorter (9 days vs. 12 days, Z=144.50, P=0.040) , and the difference was statistically significant.There was no significant difference in the blood transfusion rate, R0 resection rate, and tumor size between the two groups.The recurrence rates in the robotic group and open surgery were 53.3% and 67.0%, respectively (χ 2=1.04, P=0.307) .The median survival time of the robotic group and the open group was 22.0 months and 25.0 months. There was no significant difference in the overall survival rate between the two groups ( P>0.05) . Conclusion:Compared with laparotomy, robotic HCC radical resection could have an equivalence or non-inferiority approach with acceptable long-term outcome.

Objective:To explore the therapeutic effect of low-intensity extracorporeal shock wave (Li-ESW) in model rats with chronic prostatitis and its optimal parameters.Methods:From April to August 2019, 90 healthy male SD rats aged 8 weeks were randomly divided into control group (group C, n=15), model group (group M, n=15) and shock wave treatment group (group T, n=60), which were treated with Li-ESW after being modeled successfully. The rats in group T were supine and treated with focused Li-ESW, and the probe was placed above the anatomical position of the prostate. Treatment scheme was 3 Hz of frequency, 500 pulses, and once a week for 4 weeks. Group T was divided into group T1(0.09 mJ/mm 2), T2(0.20 mJ/mm 2), T3(0.30 mJ/mm 2) and T4(0.40 mJ/mm 2) according to energy flux density, with 15 rats in each group. Before the establishment of the model, the rats in each group were tested with von Frey fiber of 2 g, 4 g and 6 g at the scrotum respectively, and the positive reaction was recorded. There was no significant difference between the three groups ( P>0.05). After one week, the rat model with CP was established by injecting 3% carrageenan into the bilateral lobes of the prostate under anesthesia. And one week after the modeling was completed, the rats in each group underwent von Frey test again to measure pain and evaluate the modeling effects. Group T was then treated once a week for a 4-week period. During the treatment, von Frey test was performed before each treatment to evaluate the treatment effect of the previous week. After the von Frey test for one, two and four weeks of treatment, 5 rats were sacrificed in each group, and the bilateral lobes of the prostate were dissected under aseptic conditions for paraffin inclusion and HE staining. Result:The positive reaction in group M and each group T was significantly more than those in group C ( P<0.001) one week after the modeling was completed, and there was no significant difference between group M and group T. The number of positive reactions in group T2 was lower than that in group M at each time point after treatment ( P<0.05), and it is also less in group T1, T3 and T4 were than that in group M after 3 weeks, 3 and 4 weeks and 2 weeks respectively( P<0.05). In group T2, the number of positive reactions began to decrease after 1 week of treatment, and reached the lowest after 4 weeks, with significant difference in pain measurement results at different time points ( P<0.05). The results of pathological examination showed that there were more inflammatory cells in prostatic stroma and disordered arrangement of epithelial cells in group M than that in group C. The pathological scores of group M, T1, T2, T3 and T4 were 8, 7, 4, 6, 9 after 1 week treatment, 8, 5, 3, 4, 7 points after 2 weeks treatment, and 7, 3, 2, 4, 7 points after 4 weeks treatment, respectively. Conclusions:Low-intensity extracorporeal shock wave treatment had a significant effect on the improvement of symptoms in model rats with chronic prostatitis. Under the scheme of frequency 3 Hz, 500 pulses, once a week for 4 weeks, the optimal parameters is 0.20 mJ/mm 2.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the common diseases in uroloandrology, which recurs easily after treatment. In recent years, the safety and efficacy of extracorporeal shock wave therapy (ESWT) for CP/CPPS has been widely demonstrated. Studies have shown satisfactory short-term (≤12 weeks) outcomes of ESWT, but lack long-term (>12 weeks) follow-up data. In addition, inconsistent indications and unexplained therapeutic mechanisms have limited the further clinical promotion of ESWT. This article summarizes the latest progress and potential mechanism of ESWT in the treatment of CP/CPPS in order to provide new insights for the standardized application of ESWT.

Objective To explore the potential value of applying three-dimensional visualization technology in the robot-assisted laparoscopic nephron sparing partial nephrectomy.Methods From January to December 2018,98 patients with renal carcinoma undergoing robot-assisted laparoscopic nephron sparing surgery were retrospectively analyzed.Forty-one patients in the experimental group accomplished kidney CT examination and three-dimensional reconstruction before surgery,and fifty-seven patients in the control group only completed kidney CT examination.There were 20 males and 21 females in the experimental group with the age of (51.39 ± 14.80) years and body mass index (BMI) of (23.54 ± 3.08) kg/m2.The median tumor diameter was 3.40 cm (range 1.90-8.30 cm) and the mean R.E.N.A.L.score was (5.83 ± 1.51) in the experimental group including 11 cases of transperitoneal,17 cases of retroperitoneal and 13 cases of combined transperitoneal and retroperitoneal access.There were 35 males and 22 females in the control group with the age of (52.84 ± 12.28) years and BMI of (24.01 ±3.30)kg/m2.The median tumor diameter was 3.35 cm (range 1.40-7.0 cm) and the mean R.E.N.A.L.score was (6.17 ± 1.77) in the control group including 15 cases of transperitoneal,31 cases of retroperitoneal and 11 cases of combined transperitoneal and retroperitoneal access.There was no statistical difference between two groups in term of age,gender,BMI score,R.E.N.A.L.score,tumor size,tumor location and operative approach.Results Ninety-eight cases of operation were successfully completed without causing vascular and ureteral injury.The warm ischemia time in the experimental group was significantly shorter than that of the control group [median 15.0 (7.0-26.0) min vs.20.0 (10.0-28.0) min,P--0.02],while no statistical difference was observed in term of operation time [median 130.0 (65.0-340.0) min vs.139.0 (67.0-250.0) min,P =0.22].There was no significant difference between the two groups in the decrease of hemoglobin within 24 hours after operation [median 20.0 (4.0-39.0) g/L vs.15.5 (2.0-40.0) g/L,P =0.56] and the average length of hospital stay after operation [median 6.0(4.0-14.0) d vs.6.0(5.0-14.0) d,P =0.86].The trend of creatinine declining was not statistically significant between the two groups at both 24 hours [median:2.0 (-10.0-28.0) μmol/L vs.7.5 (-17.0-51.0) μ mol/L,P =0.24] and 6 months after operation [median:2.0 (-12.0-57.0) μ mol/L vs.4.5 (-3.0-24.0) μmol/L,P =0.39].Conclusions Preoperative three-dimensional reconstruction is helpful to shorten the warm ischemia time,but it did not show short-term and long-term protection for renal function.