Robot-Assisted Laparoscopic Radical Prostatectomy Using the KangDuo Surgical Robot System vs the da Vinci Si Robotic System.

Objective: To compare the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RARP) performed using the KangDuo surgical robot system to the da Vinci Si robotic system in clinically localized prostate cancer (KD-RARP vs DV-RARP). Methods: A total of 16 patients underwent extraperitoneal KD-RARP performed by a single experienced surgeon using the KangDuo surgical robot system between May 2021 and August 2021. The data were prospectively collected. The most recent 16 cases of extraperitoneal DV-RARP performed in 2021 by the same surgeon were selected from a prospectively maintained database for comparison to prevent operator variability. Preoperative, perioperative, and postoperative data were collected and compared between the two groups. Results: No significant difference was noted between the two groups in terms of basic clinical characteristics. All operations were performed successfully without open or traditional laparoscopic conversion. KD-RARP had a significantly longer operation time compared with DV-RARP (127 [107-159] vs 70.5 [54-90] minutes, p < 0.001). No significant differences between the two groups were observed in neurovascular bundle sparing, estimated blood loss, postoperative hospital stay duration, complications, positive surgical margins, biochemical recurrence, and continence recovery 3 months after catheter removal. Conclusions: RARP using the KangDuo surgical robot system achieved similar short-term oncological and functional outcomes with a disadvantage in operation time compared with the da Vinci Si robotic system. A multicenter randomized clinical trial with a larger sample size is needed for more experience.

Robot-assisted Partial Nephrectomy with the Newly Developed KangDuo Surgical Robot Versus the da Vinci Si Surgical System: A Double-center Prospective Randomized Controlled Noninferiority Trial.

BACKGROUND: The KangDuo surgical robot (KD-SR) was recently developed in China. OBJECTIVE: To compare the safety and efficacy of the KD-SR versus the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS: A double-center prospective randomized controlled noninferiority trial of patients aged 18-75 yr with a suspicion of T1a N0M0 renal cancer (RENAL nephrometry score ≤9) was conducted. INTERVENTION: RAPN with the KD-SR versus the DV-SS-Si. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was the success rate of operation. The operation was successful if (1) there was no open or laparoscopic conversion, (2) the warm ischemia time was <30 min for RENAL nephrometry scores of 4-6 or 40 min for RENAL nephrometry scores of 7-9, and (3) the pathological margin was negative. The secondary endpoint was the estimated glomerular filtration rate (eGFR). A threshold of 10% was set to demonstrate noninferiority. RESULTS AND LIMITATIONS: From September 2020 to March 2021, 100 participants were enrolled, of whom 99 (49 in the KD-SR group and 50 in the DV-SS-Si group) were finally included in the full analysis set and 98 (49 in the KD-SR group and -49 in the DV-SS-Si group) in the per-protocol set. Baseline demographic and clinical characteristics were similar between the two groups. All surgeries were completed successfully. The eGFR at postoperative weeks 4-12 and adverse events were similar between the two groups. The docking time and suture time per stitch were longer in the KD-SR group. The main limitation was that a negative margin was considered as the primary outcome rather than survival. CONCLUSIONS: The KD-SR achieved noninferior outcomes as compared with the DV-SS-Si regarding safety and efficacy for T1a tumors. PATIENT SUMMARY: The first trial comparing the KangDuo surgical robot (KD-SR) versus the da Vinci Si Surgical System for robot-assisted partial nephrectomy showed that the KD-SR is a viable option for minimally invasive treatment of T1a renal tumors.

Pyeloplasty with the Kangduo Surgical Robot vs the da Vinci Si Robotic System: Preliminary Results.

Objective: To share our experience in robot-assisted pyeloplasty (RAP) with the Kangduo (KD) surgical robot vs the da Vinci Si (DV) robotic system (KD-RAP vs DV-RAP, respectively). Methods: From August 2019 to February 2021, 16 patients with ureteropelvic junction obstruction (UPJO) underwent KD-RAP and other 16 patients with UPJO accepted DV-RAP. All procedures were performed by the same surgeon. The perioperative results and follow-up data were prospectively collected and compared. Results: There was no conversion to open or laparoscopic surgery. The mean operation time was significantly longer in the KD-RAP group than the DV-RAP group (141 ± 28 minutes vs 118 ± 31 minutes, respectively, p = 0.04). The time per stitch was significantly longer in the KD-RAP group than the DV-RAP group (1.7 ± 0.5 minutes vs 1.4 ± 0.3 minutes, respectively, p = 0.05). No significant difference was noted in the estimated blood loss and the postoperative length of hospitalization. At a median follow-up of 19 (range 17-21) and 19.5 (range 14-33) months for the KD-RAP and DV-RAP groups, respectively, no difference was noted in the success rates between the KD-RAP and DV-RAP groups (93.75% and 100%, respectively; p = 0.31). Complications were comparable between the two groups (p = 0.54). One (6.3%) patient developed urinary infection, which responded well to oral antibiotics in KD-RAP group and 2 (12.5%) patients suffered from irritation symptoms of bladder, which improved after removal of Double-J stent in the DV-RAP group. Conclusions: The RAP with the use of the KD system was feasible, safe, and effective. The DV-RAP group showed advantage in the operation time and the time per stitch.

Robot-Assisted Radical Prostatectomy Using the KangDuo Surgical Robot-01 System: A Prospective, Single-Center, Single-Arm Clinical Study.

PURPOSE: Our goal was to evaluate the feasibility, safety and effectiveness of the KangDuo Surgical Robot-01 (KD-SR-01) system for robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS: This prospective, single-center, single-arm clinical study was conducted from May 2021 to August 2021. Sixteen RARP procedures with the KD-SR-01 system were performed by 1 surgeon. The perioperative and followup data were prospectively recorded. Early oncologic outcomes were assessed according to surgical margin status and continence was defined as no more than 1 pad daily or urine leakage of ≤20 gm by the 24-hour pad weight test. Ergonomics were assessed with the NASA-TLX (National Aeronautics and Space Administration Task Load Index). RESULTS: All cases were completed successfully without conversion to traditional RARP, laparoscopic surgery or open surgery. The median docking time, console time and urethrovesical anastomosis time were 5.9 (range, 2.5-11.5), 87 (range, 70-120) and 14.4 minutes (range, 12.0-25.7), respectively. The median estimated blood loss was 50 ml (range, 10-200). None of patients required intraoperative transfusion. The median postoperative hospital stay was 5 days (range, 4-10). Overall, a positive surgical margin occurred in 4 (25%) patients. No biochemical recurrence occurred within 1 month after surgery. The continence rate was 87.5% (14/16) at 1 month after catheter removal. No severe intraoperative or postoperative complications (Clavien-Dindo grade ≥3) occurred. The surgeon reported a high comfort level with a NASA-TLX global score of 22.7±3.2. CONCLUSIONS: The KD-SR-01 system is feasible, safe and effective for management of localized prostate cancer.

Partial nephrectomy through retroperitoneal approach with a new surgical robot system, KD-SR-01.

BACKGROUND: To present our experiences with partial nephrectomy (PN) through retroperitoneal approach (RP) with the Kangduo robotic system. METHODS: From December 2020 to February 2021, the perioperative data of 11 patients underwent PN through RP with the Kangduo robotic system were collected prospectively. RESULTS: For the R.E.N.A.L. nephrometry score, 72.7% of patients had a low score (4-6) and 27.3% of patients had a medium score (7-9). Seven tumours were posterior (P), four tumours were on the midline (X). All procedures were completed successfully. The median warm ischemia time was 18.5 (IQR, 13.7-21.0) min. None of the patients had positive surgical margins at definitive histology (all pT1a). No high-grade perioperative complications or device-related adverse events occurred. At a mean follow-up of 8 ± 0.8 months, no complications occurred in all patients. CONCLUSIONS: RPPN using the novel Kangduo robotic system is a safe and effective option for managing posterior and lateral renal tumours with R.E.N.A.L. nephrometry scores ≤9.

The effect of optimized carbon source on the synthesis and composition of exopolysaccharides produced by Lactobacillus paracasei.

This study aimed to predict the optimal carbon source for higher production of exopolysaccharides (EPS) by Lactobacillus paracasei TD 062, and to evaluate the effect of this carbon source on the production and monosaccharide composition of EPS. We evaluated the EPS production capacity of 20 strains of L. paracasei under the same conditions. We further investigated L. paracasei TD 062, which showed the highest EPS-producing activity (0.609 g/L), by examining the associated biosynthesis pathways for EPS. Genomics revealed that fructose, mannose, trehalose, glucose, galactose, and lactose were carbon sources that L. paracasei TD 062 could use to produce EPS. We identified an EPS synthesis gene cluster that could participate in transport, export, and sugar chain synthesis, and generate 6 sugar nucleotides. Experimental results showed that the sugar content of the EPS produced using fermentation with the optimized carbon source (fructose, mannose, trehalose, glucose, galactose, and lactose) increased by 115%. Furthermore, use of the optimized carbon source changed the monosaccharide content of the associated EPS. The results of enzyme activity measurements showed significant increases in the activity of 2 key enzymes involved in the glycoside synthesis pathway. Our study revealed that optimizing the carbon source provided for fermentation not only increased the production of EPS, but also affected the composition of the monosaccharides by increasing enzyme activity in the underlying synthesis pathways, suggesting an important role for carbon source in the production of EPS by L. paracasei TD 062.

Physicochemical and transcriptomic responses of Lactobacillus brevis JLD715 to sodium selenite.

BACKGROUND: Elemental selenium, as a new type of selenium supplement, can be prepared by microorganisms reducing inorganic selenium. In this study, Lactobacillus brevis JLD715 was incubated in broth containing different concentrations of sodium selenite (Na2 SeO3 ). RESULTS: The results showed that the bacterial biomass of L. brevis JLD715 decreased due to the inhibition of Na2 SeO3 . The cell membrane of L. brevis JLD715 treated with Na2 SeO3 was damaged, as evidenced by the reduction of intracellular ATP concentration, depolarization of cell membrane, reduction of intracellular pH and impairment of membrane integrity. In addition, we investigated the metabolism mechanism of Na2 SeO3 by L. brevis JLD715 based on transcriptome sequencing. A total of 461 genes were significantly differentially expressed under Na2 SeO3 treatment, of which 231 genes were up-regulated and 230 genes were down-regulated. These genes were involved in pathways such as pyruvate metabolism, fatty acid biosynthesis, selenocompound metabolism and nucleotide-binding oligomerization domain-like (NOD-like) receptor signaling. Meanwhile, the genes related to sulfhydryl oxidoreductase, electron carrier proteins and transmembrane transport proteins synthesis were significantly up-regulated. CONCLUSION: To sum up, the findings of this research will contribute to providing support for the application of L. brevis JLD715 in selenium-enriched functional foods. © 2021 Society of Chemical Industry.

Comparison of KD-SR-01 robotic partial nephrectomy and 3D-laparoscopic partial nephrectomy from an operative and ergonomic perspective: A prospective randomized controlled study in porcine models.

BACKGROUND: To investigate the feasibility, validity and security of a new robot platform called KD-SR-01 and compare relative merits of KD-SR-01 robotic partial nephrectomy (KD-RPN) and 3D-Laparoscopic Partial Nephrectomy (3D-LPN). METHODS: Twelve porcine models were randomly and equally divided for KD-RPN and 3D-LPN. The perioperative outcomes, physical and mental workload of the surgeon were compared. Physical workload was evaluated with surface electromyography. Mental workload was evaluated with National Aeronautics and Space Administration Task Load Index (NASA-TLX). RESULTS: All surgeries were performed successfully. The average docking time of KD-RPN was 6 min. The estimated blood loss was lower in KD-RPN (p < 0.05). There were no differences in all the other operative variables (p > 0.05). KD-RPN showed advantages in physical workload and was significantly superior in mental workload (p < 0.05). CONCLUSIONS: KD-RPN is technically feasible, valid and safe in porcine models. It's comparable from operative perspective while KD-RPN had advantages over 3D-LPN from ergonomic perspective.

Cytological features of oogenesis and their evolutionary significance in the fern Osmunda japonica.

The development of the egg and canal cells in the fern Osmunda japonica Thunb. was studied during oogenesis by transmission electron microscopy. The mature egg possesses no fertilization pore and no typical egg envelope. In addition, an extra wall formed around the canal cells during oogenesis and apparently blocked protoplasmic connections between the egg and the canal cells. The periodic acid Schiff (PAS) reaction revealed that the extra wall was most likely composed of polysaccharides. Maturation of the egg was accompanied by the formation of a separation cavity above the egg and by some changes in the morphology of the nucleus and cytoplasmic organelles. The chromatin of the nucleus becomes condensed and the upper surface of the nucleus becomes closely associated with the plasmalemma. Amyloplasts in the egg cytoplasm were numerous and conspicuous, with most in close proximity to the nucleus. Finally, the cytoplasm on one side of the egg became vesiculated and the overlying plasmalemma was easily disrupted. These cytological features of the egg and the canal cells during oogenesis in O. japonica are markedly different from those of the leptosporangiate ferns and suggest a significant evolutionary divergence in reproductive cellular features between Osmundaceae and leptosporangiate ferns.

[Stage I testis teratoma in adults: treatment options and recurrence factors].

OBJECTIVE: To study the clinical outcomes of stage I testis teratoma, including pure teratoma, and to provide information on the treatment options for this disease. METHODS: We retrospectively analyzed 27 cases of orchiectomy for stage I testis teratoma, excluding epidermoid cyst, and investigated its recurrence associated with treatment methods and clinicopathological factors. RESULTS: Four of the 27 cases relapsed, all in the orchiectomy group and confined to the retroperitoneal region, 3 with and the other 1 without risk factors, but with no death. No recurrence was found in those treated by orchiectomy followed by chemotherapy with bleomycin, etoposide and platinum (BEP). The total rate of recurrence was 15.8%. No severe side effects were observed in the 9 patients undergoing adjuvant BEP chemotherapy. CONCLUSION: Risk factors may increase the recurrence rate of stage I testis teratoma, while postoperative adjuvant chemotherapy can reduce it, including that of pure teratoma, though surveillance policy remains the most popular option after orchiectomy.