With advances in imaging and the growing emphasis on nephron preservation, partial nephrectomy has become central in the management of T1 renal tumors and has gradually been extended to complex renal masses, where surgical challenges are greater.This article reviews the current status, key technical advances, and clinical application strategies of minimally invasive partial nephrectomy for complex renal tumors.It compares the suitability and advantages of laparoscopic and robot-assisted approaches across different levels of tumor complexity, and summarizes the value of three-dimensional reconstruction, precise selective vascular control, and intraoperative navigation in improving surgical safety and controllability. It elaborates on the management pathways and technical strategies for typical scenarios such as renal hilar lesions, completely intrarenal tumors, cystic tumors, and multifocal tumors, and summarizes operative techniques and perioperative risk-control considerations for high-risk cases, including solitary kidneys, T2 or higher stage tumors, tumors with local invasion of the renal pelvis, and those complicated with vascular tumor thrombus.The article also briefly discusses controversies regarding indication boundaries and the balance between functional preservation and oncologic safety, and highlights the trend toward a standardized, reproducible precision surgery paradigm supported by intelligent planning and quality-control systems.

Objective To explore the research hotspots and developmental trends in urological education through a bibliometric analysis. Methods Relevant literature on urological education was retrieved from the Web of Science Core Collection and the China National Knowledge Infrastructure (CNKI) databases, covering all records up to Sep.16, 2025.A comprehensive bibliometric analysis was performed on the retrieved publications. Results A total of 303 Chinese and 290 English articles were collected.The annual number of publications demonstrated an overall upward trend.Harvard University in the United States was the most productive institution in this field. Conclusion Urological clinical education has attracted increasing attention from clinicians and medical trainees.Highly cited studies consistently highlight three actionable priorities for urological education:firstly, improving long-term knowledge retention through structured, spaced, and feedback-rich learning designs; secondly, standardizing simulation-based skills training with validated assessment and staged credentialing; thirdly, strengthening training system resilience while expanding non-technical skills training.These directions provide implementable pathways for optimizing urological teaching practices and the standardized residency training programs.

Objective:To explore the application and research progress of lasers in the treatment of kidney neoplasms through an integrated bibliometric and Meta-analysis study.Methods:On June 7th, 2024, an online search of the Web of Science Core Collection (WoSCC) and China National Knowledge Infrastructure (CNKI) databases for all relevant literature on lasers in kidney neoplasms was conducted. The retrieved results were subjected to a comprehensive bibliometric analysis. The high-quality studies were then screened to further describe the clinical characteristics of patients who underwent laser-assisted laparoscopic partial nephrectomy (LLPN). Subsequently, a Meta-analysis was performed using RevMan 5.4.1 software on further selected high-quality studies to compare the changes in renal function before and after LLPN treatment, and the differences in efficacy between LLPN and traditional laparoscopic partial nephrectomy (LPN).Results:Our study obtained a total of 549 publications on lasers in kidney neoplasms, including 513 in English and 36 in Chinese. Bibliometric analysis revealed an overall upward trend in the annual publications and citations in this field. China was found to be a leading contributor ranking second in total publications ( n=100, 18.2%). The primary application of laser treatment was in nephron-sparing surgery for kidney neoplasms, especially in LPN. We further screened 11 high-quality studies comprising 284 patients who underwent LLPN for kidney neoplasms. Comprehensive descriptive statistical analysis was performed on clinical characteristics of the 284 patients. All patients had T 1a stage tumors with a mean tumor length of 2.6 cm (range: 0.8-4.0 cm), all being local, solitary, and exophytic tumors. Further Meta-analysis indicated that there were no significant differences in renal function indicators including both serum creatinine levels ( MD=4.52, 95% CI-9.73-0.69, P = 0.09) and estimated glomerular filtration rate ( MD=3.05, 95% CI-1.03-7.13, P= 0.14) before and after LLPN. Additionally, compared to traditional LPN, LLPN showed significantly reduced operative time ( MD=-10.58, 95% CI= -13.11-8.06, P<0.001), but no significant differences in estimated blood loss ( MD= -27.09, 95% CI-67.38-13.21, P=0.19) and hospital stay ( MD=-1.59, 95% CI-3.42-0.25, P=0.09). Conclusions:The application of lasers in managing of kidney neoplasms is arousing increasing attention among urologists. LLPN offers several advantages, including precise cutting and effective hemostasis. This technique demonstrates considerable clinical value for patients with exophytic T 1a kidney neoplasms undergoing "zero-ischemia" nephron-sparing surgery.

Objective To investigate the efficacy and safety of using the fourth arm in retroperitoneal robot-assisted partial nephrectomy(PN)for cT1b stage renal tumors.Methods Clinical data of 49 patients with cT1b stage renal tumors who underwent retroperitoneal robot-assisted PN performed by the same surgeon in our hospital during Jan.2022 and Dec.2023 were retrospectively analyzed.The patients were divided into two groups based on whether the fourth arm was used or not:application group(n=21)and non-application group(n=28).The basic information,operation time,warm ischemia time,intraoperative blood loss,postoperative complications and other data were compared between the two groups.Results All operations were successful,with no conversion to open surgery or radical nephrectomy.The application group had significantly shorter operation time[(128.76±31.58)min vs.(151.11±33.21)min,P=0.021],shorter warm ischemia time[(24.67±4.80)min vs.(27.61±3.54)min,P=0.017],and less intraoperative blood loss[(109.05±39.99)mL vs.(139.29±54.43)mL,P=0.037]compared with the non-application group.The increase of postoperative creatinine was(18.64±16.05)μmol/L in the application group and(20.30±13.49)μmol/L in the non-application group respectively.Complications occurred in 3 cases in the application group and 5 cases in the non-application group,with no significant difference(P＞0.05).Conclusion When we perform the retroperitoneal robot-assisted partial nephrectomy for cT1b stage renal tumors,using the fourth arm can shorten the operation time and warm ischemia time,and reduce the intraoperative blood loss,which should be applied more in clinic.

Objective:To compare the efficacy of robot assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) in the treatment of pediatric renal tumors.Methods:A retrospective analysis was conducted on the clinical data of 29 children with renal tumors admitted to Xinhua Hospital from March 2019 to March 2024. Among them, there were 10 cases in the RAPN group, including 6 males and 4 females; The median age is 7.5 (4, 12) years old, with a tumor diameter of (4.3±1.6) cm, a median R. E. N. A.L. score of 9 (8, 11), and relative tumor size (tumor volume/contralateral kidney volume) of (34.0%±19.3%). There were 19 cases in the LPN group, 8 males and 11 females; the median age is 5.0(4, 11) years old, with a tumor diameter of (4.4±1.6) cm, a median R. E. N. A.L. score of 9 (8, 11), and relative tumor size(37.7%±18.1%). There was no statistically significant difference in preoperative characteristics between the two groups ( P>0.05). Both groups underwent partial nephrectomy, with renal artery occlusion and then warm ischemia. Clinical data from both groups during and postoperatively were compared, and a simple linear regression analysis was utilized to assess the correlation between the relative size of the tumor and the duration of intraoperative warm ischemia. Results:All 29 cases underwent a successful surgery. Compared with the LPN group, the total surgery time in the RAPN group was (115.0±28.4) minutes versus (127.9±28.2) min( P=0.25); the warm ischemia time was (20.9±3.0) min versus (27.0±4.5) min, respectively( P<0.01); the intraoperative bleeding was (50.0±24.5) ml and (80.0±21.2) ml( P<0.01); the difference in hemoglobin level before and after surgery was (10.3±3.5) g/L versus (12.9±2.7) g/L( P<0.05), respectively; the median postoperative drainage time was 3.5 (3, 4) days versus 4.0(3, 6) days( P=0.17); the median postoperative hospital stay was 4.5 (4, 8) days versus 6.0(5, 10) days( P<0.05). There were 3 cases of renal cell carcinoma associated with the MiT family translocation, 2 cases of mixed epithelial and stromal tumors, and 2 cases of cystic nephroma by postoperative pathological examination in the RAPN group. There were 10 cases of nephroblastoma, 3 cases of teratoma, 2 cases of renal cell carcinoma associated with the MiT family translocation, 2 cases of metanephric adenoma, 1 case of unclassified renal cell carcinoma, and 1 case of cystic nephroma in the LPN group. Apart from one child in the LPN group who developed a postoperative fever over 39℃, no other severe complications occurred during or after the surgery in the remaining patients. Compared with preoperative parameters, eGFR decreased (8.9±18.9) ml/(min·1.73m 2) and (21.4±34.8) ml/(min·1.73m 2) in the RAPN group and LPN group, respectively, 1 month postoperatively( P=0.36); three months after surgery, eGFR was followed up, and the RAPN group and LPN group showed a decrease of (5.9±23.4) ml/(min·1.73m 2) and (13.9±20.1) ml/(min·1.73m 2) compared with preoperative levels, respectively( P=0.42). Linear regression analysis indicated that in the LPN group, intraoperative warm ischemia time exhibited a progressively increasing trend with the augmentation of the tumor's relative size, and warm ischemia time = 0.1688×tumor relative size+ 20.64, ( R2=0.46, P<0.01). Based on this, it is estimated that when the tumor's relative size exceeds 55.5%, the intraoperative warm ischemia time often surpassed 30 minutes. However, in the RAPN group, this trend is not statistically significant (P>0.05). Conclusions:Both LPN and RAPN are safe and feasible for the treatment of pediatric renal tumors. Compared with LPN, RAPN surgery has advantages of shortening warm ischemia time and reducing intraoperative bleeding, which helps patients recover early. RAPN is a better choice for children with a relative renal tumors size over 55.5%.

Objective:To compare the efficacy of robot assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) in the treatment of pediatric renal tumors.Methods:A retrospective analysis was conducted on the clinical data of 29 children with renal tumors admitted to Xinhua Hospital from March 2019 to March 2024. Among them, there were 10 cases in the RAPN group, including 6 males and 4 females; The median age is 7.5 (4, 12) years old, with a tumor diameter of (4.3±1.6) cm, a median R. E. N. A.L. score of 9 (8, 11), and relative tumor size (tumor volume/contralateral kidney volume) of (34.0%±19.3%). There were 19 cases in the LPN group, 8 males and 11 females; the median age is 5.0(4, 11) years old, with a tumor diameter of (4.4±1.6) cm, a median R. E. N. A.L. score of 9 (8, 11), and relative tumor size(37.7%±18.1%). There was no statistically significant difference in preoperative characteristics between the two groups ( P>0.05). Both groups underwent partial nephrectomy, with renal artery occlusion and then warm ischemia. Clinical data from both groups during and postoperatively were compared, and a simple linear regression analysis was utilized to assess the correlation between the relative size of the tumor and the duration of intraoperative warm ischemia. Results:All 29 cases underwent a successful surgery. Compared with the LPN group, the total surgery time in the RAPN group was (115.0±28.4) minutes versus (127.9±28.2) min( P=0.25); the warm ischemia time was (20.9±3.0) min versus (27.0±4.5) min, respectively( P<0.01); the intraoperative bleeding was (50.0±24.5) ml and (80.0±21.2) ml( P<0.01); the difference in hemoglobin level before and after surgery was (10.3±3.5) g/L versus (12.9±2.7) g/L( P<0.05), respectively; the median postoperative drainage time was 3.5 (3, 4) days versus 4.0(3, 6) days( P=0.17); the median postoperative hospital stay was 4.5 (4, 8) days versus 6.0(5, 10) days( P<0.05). There were 3 cases of renal cell carcinoma associated with the MiT family translocation, 2 cases of mixed epithelial and stromal tumors, and 2 cases of cystic nephroma by postoperative pathological examination in the RAPN group. There were 10 cases of nephroblastoma, 3 cases of teratoma, 2 cases of renal cell carcinoma associated with the MiT family translocation, 2 cases of metanephric adenoma, 1 case of unclassified renal cell carcinoma, and 1 case of cystic nephroma in the LPN group. Apart from one child in the LPN group who developed a postoperative fever over 39℃, no other severe complications occurred during or after the surgery in the remaining patients. Compared with preoperative parameters, eGFR decreased (8.9±18.9) ml/(min·1.73m 2) and (21.4±34.8) ml/(min·1.73m 2) in the RAPN group and LPN group, respectively, 1 month postoperatively( P=0.36); three months after surgery, eGFR was followed up, and the RAPN group and LPN group showed a decrease of (5.9±23.4) ml/(min·1.73m 2) and (13.9±20.1) ml/(min·1.73m 2) compared with preoperative levels, respectively( P=0.42). Linear regression analysis indicated that in the LPN group, intraoperative warm ischemia time exhibited a progressively increasing trend with the augmentation of the tumor's relative size, and warm ischemia time = 0.1688×tumor relative size+ 20.64, ( R2=0.46, P<0.01). Based on this, it is estimated that when the tumor's relative size exceeds 55.5%, the intraoperative warm ischemia time often surpassed 30 minutes. However, in the RAPN group, this trend is not statistically significant (P>0.05). Conclusions:Both LPN and RAPN are safe and feasible for the treatment of pediatric renal tumors. Compared with LPN, RAPN surgery has advantages of shortening warm ischemia time and reducing intraoperative bleeding, which helps patients recover early. RAPN is a better choice for children with a relative renal tumors size over 55.5%.

Objective:To explore the effect of tibial nerve vibration on triceps surae spasticity in stroke survivors and its electrophysiological mechanism.Methods:Thirty stroke survivors with upper limb spasticity were randomly divided into a treatment group and a control group, each of 30. Both groups were given routine rehabilitation training while the treatment group was additionally provided with local vibration of the tibial nerve with an amplitude of 0.3mm at 60Hz. Before and after the treatment, the modified Ashworth scale (MAS) and Clonus grading were used to assess muscle tone and spasticity. Electrophysiological functions were evaluated using the tibial nerve motor and sensory conduction test and F wave and H reflex sensing.Results:Before the treatment there were no significant differences between the two groups in their average MAS scores, Clonus grading, maximum H amplitude (Hmax), the ratio of maximum H to maximum M amplitude (H/M) or the intensity of stimulus required to elicit Hmax. After the treatment, however, all of those measurements had improved significantly in both groups with the average improvements in the treatment group significantly greater than those in the control group.Conclusions:Local vibration of the tibial nerve combined with traditional rehabilitation is more effective than traditional rehabilitation alone in relieving triceps surae spasticity and reducing muscle tone after a stroke. The vibration seems to inhibit excitation of the reflex pathway.

Objective:To explore the safety and efficacy of laparoscopic non-blocking partial nephrectomy assisted by high power lateral green laser in the treatment of T 1a renal tumor. Methods:The clinical data of 10 patients with T1a stage renal tumor from February 2021 to April 2021 in department of urology, Gongli hospital affiliated to Naval Military Medical University were retrospectively analyzed. There were 7 males and 3 females, aged 47.0-74.0 years, with average of(58.8±9.7)years old. The diameter of the tumor ranged from 2.0 cm to 3.8 cm, with an average of (3.1±0.6)cm. There were 6 cases on the left side and 4 cases on the right side, locate on lumbar side in 9 cases and ventral sied in 1 case. The R. E.N.A.L score was 4.0-6.0, with an average of (5.0±0.8). The preoperative creatinine was 66.9-90.1μmol/L, with an average of (75.1±9.0)μmol/L, preoperative GFR of 44. 6- 67. 3 ml /min, with an average of(56.7±7.7)ml/min, preoperative hemoglobin level of 119.0-156.0g/L, with an average of (135.8±11.4)g/L. All patients underwent laparoscopic non-blocking partial nephrectomy assisted by 180w lateral green laser, free the surrounding area of the tumor fully and completely expose the renal tumor. The laser fiber was placed through the green laser hand piece, and the fiber was connected with normal saline to wash the strip. The initial green laser vaporization power was set at 80W, and the hemostasis power at 35W.About 3mm away from the edge of the tumor, and one optical fiber away from the renal parenchyma, the renal parenchyma was cut with 80W power. In order to reduce the interference by smoke, high-pressure flushing was used through the optical fiber while vaporizing, and an attractor was used to push and peel the tumor. In case of bleeding during operation, hemostatic power can be used to close the bleeding point and gradually advance until the tumor was completely removed. The wounds of renal inner medulla and renal outer cortex were continuously sutured in 1-3 layers with barbed suture. It involved 9 cases via retroperitoneal approach and 1 case via abdominal approach. The operation time, postoperative hemoglobin decrease, extraction time of negative pressure drainage, postoperative hospital stay, postoperative pathology and postoperative complications were recorded, and the serum creatinine level and GFR level of the affected side were followed up 1 month after operation.Results:All the operations were successfully completed, and there was no conversion to open surgery or radical nephrectomy. One case changed to scissors fast resection and sutured hemostasis due to severe intraoperative bleeding. The operation time was 90.0-120.0 min, with the average of (104.5±9.0)min. The postoperative hemoglobin level was 96.0-132.0g/L, with an average of (115.2±11.8)g/L, and the difference was statistically significant ( P<0.05). The postoperative hemoglobin decreased from 12.0g/L to 25.0g/L, with an average of (20.6±4.6)g/L. The time of vacuum drainage was 5.0-7.0 days, with an average of (5.7±0.7)d. Postoperative hospital stay was 6.0-8.0 days, with an average of (6.7±0.7)d. No bleeding, urinary leakage and other complications occurred in all patients. There were 7 cases of clear cell carcinoma, 2 cases of papillary renal cell carcinoma and 1 case of angiomyolipoma. All margins were negative. One month after operation, creatinine ranged from 66.0 to 90.4μmol/L, with an average of (76.8±8.3)μmol/L, which was not significantly different compared with that before operation ( P>0.05). One month after operation, GFR was 45.1-60.8 ml/min, and with an average of (55.5±4.7)ml/min, and there was no significant difference compared with preoperative data( P>0.05). Conclusions:For T 1aN 0M 0 stage and exophytic renal tumors, laparoscopic non-blocking partial nephrectomy assisted by lateral green laser is safe and effective.

Objective:To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19).Methods:Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV.Results:Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs.Conclusions:The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.

Objective To investigate the clinical feasibility and effectiveness of 3-D printing (3DP) combined with 3-D laparoscopic nephron-sparing surgery (LNSS) for partial endogenous renal cell carcinoma.Methods A retrospective analysis was made of the clinical data of 79 patients with partial endogenous renal cell carcinoma who were admitted to our department from July 2015 to October 2018.There were 46 males and 33 females.Their average age was (50.9 ± 7.9) years old,ranged from 33 to 68 years old.Tumor stages were T1aN0M0 in 53 cases and T1bN0M0 in 26 cases.The preoperative serum creatinine ranged from 40 to 107 μmol/L,with an average of (72.4 ± 14.2) μmol/L.The preoperative GFR ranged from 19 to 54 ml/min,with an average of (40.2 ± 6.2) ml/min.Thirty-four patients underwent 2-D laparoscopic nephron-sparing surgery (2DLNSS) based on preoperative enhanced CT scans.Forty-five patients underwent 3-D printing (3DP) based on three-dimensional reconstruction of renal CT scans.Seventeen patients underwent 2-D laparoscopic nephron-sparing surgery guided by 3-D printing model(3DP-2DLNSS),and 28 patients underwent 3-D laparoscopic nephron-sparing surgery guided by 3-D printing (3DP-3DLNSS).Serum creatinine levels ranged from 42 to 122 μmol/L with an average of (86.3 ± 14.8) μmol/L,and creatinine levels ranged from 8 to 66 μmol/L with an average of (19.1 ± 14.1) μmol/L.Six months after operation,the GFR of the kidney was 9-36 ml/min with an average of (21.4 ± 6.4)ml/min,and the fluctuation range was 6-40 ml/min with an average of (19.2 ± 8.8) ml/min.There was no statistical difference in the incidence of complications and pathological types after operation.Results There was no statistical difference in general data of preoperative patients.In intraoperative and post-operative statistics,the time of exploring renal artery was shorter than that of 2DLNSS (33.7 ± 7.5) min in 3DP-2DLNSS (28.3 ± 8.2,P =0.015) min and 3DP-3DLNSS (27.8 ± 6.5,P =0.002) min.In tumor detection time,3 DP-2DLNSS was shorter than 2DLNSS group (41.2 ± 6.6 vs.46.5 ± 6.9 min,P =0.012),and 3 DP-3DLNSS was shorter than 3DP-2DLNSS (35.4 ± 7.3 vs.41.2 ± 6.6 min,P =0.009).In warm ischemia time,3DP-2DLNSS min was shorter than 2DLNSS (23.5 ±9.7 vs.33.9 ±7.5 min P ＜0.001),and 3DP-3DLNSS was shorter than 3DP-2DLNSS (18.3 ± 4.6 vs.23.5 ± 9.7,P =0.023).In surgical time,3DP-2DLNSS (115.7 ± 23.0) min and 3DP-3DLNSS (103.3 ± 22.8) min were shorter than 2DLNSS (132.4 ± 28.9) min (P =0.031,P ＜ 0.001).In intraoperative bleeding volume,3 DP-3 DLNSS was less than 2DLNSS (117.9 ± 17.9 vs.130.6 ± 16.8,P =0.009) ml.Fasting for 1 to 4 days after operation,with an average of (1.7 ± 0.8) days.The indwelling catheterization ranged from 1 to 8 days after operation,with an average of (3.9 ± 1.3) days.Negative pressure drainage was removed 2-9 days after operation,with an average of (4.9 ± 1.4) days.And the hospitalization 5-11 days after operation,with an average of (7.3 ± 1.5) days.Conclusions Preoperative 3D printing combined with intraoperative 3D laparoscopic nephron sparing surgery for partial endogenous renal tumors is safe and effective,which is superior to the previous CT scan alone and intraoperative 2D laparoscopic treatment.