Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Laparoscopic Nephrectomy: A Case Series.

BACKGROUND Wünderlich syndrome (WS) is a rare diagnosis of nontraumatic spontaneous renal hemorrhage into the subcapsular, perirenal, or pararenal spaces. Prompt and effective intervention is necessary for an accurate pathological diagnosis and preservation of life. In the current literature, open surgery is the primary option when conservative treatment fails, but there can be serious trauma and corresponding consequences. Herein, we present 3 cases of Wünderlich syndrome managed by robot-assisted laparoscopic nephrectomy via a retroperitoneal approach. CASE REPORT Patient 1 was a 44-year-old woman with right flank pain for 6 h. Patient 2 was a 53-year-old woman with a history of diabetes who had pain in her right flank pain and nausea for 1 day. Patient 3 was a 45-year-old man with left flank pain for 1 day. All cases of WS were confirmed by CT. All 3 patients were treated with retroperitoneal robot-assisted nephrectomy after conservative treatment failed. Pathological examination confirmed that patient 1 had angiomyolipoma, and patients 2 and 3 had renal clear cell carcinoma. At the 9-month follow-up, renal function was good and no evidence of recurrence or metastasis has been detected. CONCLUSIONS These cases have highlighted the importance of the clinical history and imaging findings in the diagnosis of Wünderlich syndrome, and show that rapid management can be achieved using robot-assisted laparoscopic nephrectomy. However, it is crucial to have a skilled surgical team and adequate preoperative preparation.

Modified hood technique for single-port robot-assisted radical prostatectomy contributes to early recovery of continence.

Background and purpose: Urinary incontinence is one of the common side effects of robot-assisted radical prostatectomy (RARP). Here, we described the modified Hood technique for single-port RARP (sp-RARP) and assessed the interest of this new technique for early continence recovery. Methods: We retrospectively reviewed 24 patients who underwent sp-RARP modified hood technique from June 2021 to December 2021. The pre-and intraoperative variables, postoperative functional and oncological outcomes of patients were collected and analyzed. The continence rates were estimated at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal. Continence was defined as wearing no pad over a 24 h period. Results: Mean time of operation and estimated blood loss were 183 min and 170 ml, respectively. The postoperative continence rates at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal were 41.7%, 54.2%, 75.0%, 91.7% and 95.8%, respectively. There were two patients who detected positive surgical margins and no patients observed complications requiring further treatment. Conclusion: The modified hood technique is a safe and feasible method that provides better outcomes in terms of early return of continence, without increasing estimated blood loss and compromising oncologic outcomes.

Construction and Validation of a Novel Cuproptosis-Related Seven-lncRNA Signature to Predict the Outcomes, Immunotherapeutic Responses, and Targeted Therapy in Patients with Clear Cell Renal Cell Carcinoma.

Background: Cuproptosis was recently recognized as a novel form of cell death, linked closely to the occurrence and progression of cancer. We aimed to identify prognostic cuproptosis-related long noncoding RNAs (lncRNAs) and build a risk signature to predict the prognosis and treatment responses of clear cell renal cell carcinoma (ccRCC) in this work. Methods: LASSO-Cox regression was conducted to construct the signature based on prognostic cuproptosis-related lncRNAs (CR-lncRNAs). The signature's reliability and sensitivity were assessed by the Kaplan-Meier survival analysis and receiver operating characteristic analysis. External validation was performed via data from the International Cancer Genome Consortium database. On the basis of CR-lncRNAs, an lncRNA-microRNA-mRNA regulatory network was created, and functional enrichment analysis was used to investigate the underlying biological roles of these genes. In addition, the relationship between the risk signature and immunotherapy and targeted therapy responses was examined. Finally, the expression levels of seven candidate lncRNAs between tumor and normal cells were compared in vitro using quantitative real-time PCR. Results: A seven-CR-lncRNA risk signature was constructed, which showed a stronger potential for survival prediction than standard clinicopathological features in patients with kidney cancer. Functional enrichment analysis showed that the CR-lncRNA risk signature was enriched in ion transport-related molecular functions as well as various immune-related biological processes. Furthermore, we discovered that individuals in the high-risk group were more likely than those in the low-risk group to respond to immunotherapy and targeted therapies with medications like sunitinib and pazopanib. Finally, quantitative real-time PCR revealed that the expression levels of seven candidate lncRNAs differed significantly between RCC and healthy kidney cells. Conclusion: In summary, we generated a CR-lncRNA risk signature that may be utilized to predict outcomes in patients with ccRCC and responsiveness to immunotherapy and targeted treatment, potentially serving as a reference for clinical personalized medicine.

How many cases are required to achieving early proficiency in purely off-clamp robot-assisted partial nephrectomy?

Background and purpose: Off-clamp robot-assisted partial nephrectomy (Offc-RAPN) is a technically challenging procedure that can effectively avoid renal ischemia owing to the absence of hilar vessel preparation and clamping. However, data on the learning curve (LC) for this technique are limited. The purpose of this study was to assess the LC of Offc-RAPN and compare the perioperative outcomes between different learning phases. Methods: This retrospective study included 50 consecutive patients who underwent purely Offc-RAPN between January 2022 and April 2023. Multidimensional cumulative sum (CUSUM) analysis method was used to assess LC. Spearman's correlation and LOWESS analysis were performed to analyze the continuous variables of perioperative outcomes. Baseline characteristics and perioperative outcomes were compared using χ2-test, t-test and U-test. Results: CUSUM analysis identified two LC phases: phase I (the first 24 cases) and phase II (the subsequent 26 cases). Phase II showed significant reductions in mean operative time (133.5 vs. 115.31 min; p = 0.04), mean console time (103.21 vs. 81.27 min; p = 0.01), and mean postoperative length of stay (5.33 vs. 4.30 days; p = 0.04) compared to phase I. However, no significant differences were observed in other perioperative outcomes or baseline characteristics between the two LC phases. Conclusions: Offc-RAPN performed by a surgeon with experience in laparoscopic and robotic surgeries achieved early proficiency in 24 cases. Moreover, Offc-RAPN alone is safe and feasible even in the initial phase of the LC for an experienced surgeon.

Case report and literature review: Robot-assisted laparoscopic left renal mucinous cystadenocarcinoma radical nephrectomy.

Background: Mucinous cystadenocarcinoma (MC) of the kidney is a rare renal epithelial tumor originating from the renal pelvic urothelium. There are only a few published reports on MC. Due to its rare and unknown tissue origin, its diagnosis is difficult which almost can be diagnosed through the pathological method. Case presentation: In this case report, we report a female patient whose chief complaint was low back pain lasting for one month. The three-dimensional computed tomography scan of the urinary system detected approximately 7 cm of a left renal cystic mass. The renal cystic mass was diagnosed as MC after robot-assisted laparoscopic radical nephrectomy. The MC originated from the kidney after completing colorectal adenocarcinoma and ovarian adenocarcinoma. Conclusions: We reported a case of MC of the kidney which was a rare renal tumor. We not only aimed to present an unusual case of MC and review the previous literature on its pathology and differential diagnosis, but also used new method to treat this type of tumor.