Initial experience of laparoendoscopic single-site radical prostatectomy with a novel purpose-built robotic system

Objective This prospective single-arm clinical trial aimed to evaluated the feasibility and safety of the application of the SHURUI system(Beijing Surgerii Technology Co.,Ltd.,Beijing,China),a novel purpose-built robotic system,in single-port robotic radical prostatectomy.Methods Sixteen patients diagnosed with prostate cancer were prospectively enrolled in and underwent robotic radical prostatectomy from October 2021 to August 2022 by the SHURUI single-port robotic surgical system.The demographic and baseline data,surgical,oncological,and functional outcomes as well as follow-up data were recorded.Results The mean operative time was 226.3(standard deviation[SD]52.0)min,and the mean console time was 183.4(SD 48.3)min,with the mean estimated blood loss of 116.3(SD 90.0)mL.The mean length of postoperative hospital stay was 4.50(SD 0.97)days.Two patients had postoperative complications(Clavien-Dindo Grade II),and both patients improved after conservative treatment.All patients’postoperative prostate-specific antigen levels decreased to below 0.2 ng/mL 1 month after discharge.The mean prostate-specific antigen level further decreased to a mean of 0.0219(SD 0.0641)ng/mL 6 months after surgery.Thirty days postoperatively,12 out of 16 patients reported using no more than one urinary pad per day,and all patients reported satisfactory urinary control without the need for pads 6 months after surgery.Conclusion The SHURUI system is safe and feasible in performing radical prostatectomy via both transperitoneal and extraperitoneal approaches.Tumor control and urinary continence were satisfying for patients enrolled in.The next phase involves conducting a large-scale,multicenter randomized controlled trial to thoroughly assess the effectiveness and safety of the new technology in a broader population.

A Single-Site Positioning Method Based on TOA and DOA Estimation Using Virtual Stations in NLOS Environment

This paper presents a single-site positioning method based on the joint estimation of propagation time-of-arrival(TOA) and direction-of-arrival(DOA), with the assist of virtual stations in the typical non-line-of-sight(NLOS) environment. Consider the influence of multipath noise on the positioning performance, the proposed method firstly presents a modified high-resolution estimation technique called Multipath noise Limiting Matrix Pencil(MLMP) algorithm to achieve the TOA/DOA estimations, in which the matrix pencil and matrix enhancement process are implemented to deal with the measurements from the uniform linear array(ULA) receiver. Meanwhile, the subspace dimension estimation is improved via an adaptive threshold, for enhancing the performance of high-resolution techniques in low signal-noise-ration(SNR) situation. Next the proposed method generates virtual stations utilizing the known floor plan of surrounding reflectors, and adopts a weighted Least Square(WLS) position estimator to calculate the required position, combining the TOA/DOA estimations with the location of virtual stations. Simulations are conducted to evaluate the proposed method under NLOSconditions, and the results show that comparing with the multipath fingerprinting scheme, the proposed method has better performance in various simulation scenarios.

Laparoendoscopic single-site distal pancreatectomy in pigs

AIM: To explore the technique for laparoendoscopic single-site distal pancreatectomy.

Robotic single-site supracervical hysterectomy with manual morcellation:Preliminary experience

AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016.We evaluated the feasibility,safety and outcomes among these patients.RESULTS The mean surgical time was 244 min and the estimated blood loss was 216 mL,with no blood transfusion necessitated.The docking time was shortened gradually from 30 to 10 min.We spent 148 min on console operation.Manual morcel ation time was also short,ranging from 5 to 10 min.The mean hospital stay was 5 d.Lower VAS pain score was also noted.There is no complication during or after surgery.CONCLUSION RSSSH is feasible and safe,incurs less postoperative pain and gives good cosmetic appearance.The technique of inbag,manual morcellation can avoid tumor dissemination.

Transumbilical laparoendoscopic single-site surgery of simple nephrectomy of nonfunctioning kidney: a two-year experience

Background： Laparoendoscopic single-site surgery （LESS） may serve as a potential alternative to conventional laparoscopy and is developing quickly, but still in its infancy. The study is to present our two-year experience in transumbilical LESS simple nephrectomy （LESS-SN） for non-functioning kidney, in an effort to evaluate its feasibility, clinical outcomes and potential advantages. Methods： From December 2008 to December 2010, a total of 11 patients with body mass index （BMI）≤30 underwent transumbilical TriPortTM LESS-SN by a single experienced urologist at our institution. The indications for nephrectomy included nonfunctioning kidney associated with ureteropelvic junction stricture （n=l）, ureteral calculi （n=6）, tuberculosis （n=3）, and ureteral stricture （n=l）. Patient demographics perioperative and follow-up data were prospectively collected and analyzed. Results： Ten procedures were successfully completed with one patient converted to open surgery due to uncontrollable bleeding. The mean operative time was 189.2 （ranging 100-320 min） with an estimated blood loss of 204.5 （ranging 50-1 000 ml）. There were two complications of bleeding （1- intra-, 1- post-）. The mean hospitalization after surgery was 7.9 d （ranging 4-17 d） With a regular follow-up of 1, 6, 12, and 24 months after surgery, all patients remained symptom-free with an intra-umbilical scar. Conclusion： Transumbilical LESS simple nephrectomy for nonfunctioning kidney can be accomplished with favorable surgical outcomes and a superiority of cosmesis. However, cases with chronic inflammation are not suitable for initial up-take and should only be attempted by the very experienced laparoscopist.

Synchronous bilateral laparoendoscopic single-site urological surgeries via the umbilicus:a report of 2 cases

Objective： To describe two cases of bilateral transumbilical laparoendoscopic single-site（LESS） surgeries in a single operative session and assess the safety, feasibility and efficacy. Methods： One patient underwent right ureterolithotomy and left varicocelectomy, and the patient was performed with right simple nephrectomy for nonfunctioning kidney due to ureteral calculus and left ureterolithotomy using a novel multichannel TriPortTM via a single 2-3 cm transumbilical incision Results： The right-side ureterolithotomy and left-side varicocelectomy were finished in 229 minutes, with a total estimated blood loss of 50 hal. The right-side simple nephrectomy and left-side ureterolithotomy in the other patient were finished in 340 minutes, with a total estimated blood loss of 100 ml. There were no major complications. At the latest follow-up, both patients remained symptom-free and there were no evidences of recurrence. Both of them were delighted for the single scarConclusion： Synchronous LESS urologic procedure via a single umbilical incision is technically feasible, safe and efficacious with a promising potential

Transumbilical laparoendoscopic single-site surgery(LESS) partial nephrectomy:a median follow-up of 2 years

Objective:Nephron-sparing surgery(NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis;LESS is developing quickly and its indications have been expanded,but still in its infancy.The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy(LESS-PN),so as to assess its utility, safety and efficacy.Methods:From August 2009 to October 2010,3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution.Patient demographics,perioperative and follow-up data were prospectively collected and analyzed.Results:All the three procedures were successfully completed.A 5-mm ancillary trocar was utilized in all 3 cases.The mean operative duration was 226.3(210-254 min) with an estimated blood loss of 56.7 ml (20-100 ml).Mean warm ischemia time was 35.7 min(19-48 min).One patient was transfused due to postoperative bleeding. The recovery was uneventful and mean length of postoperative stay was 13 days(12-14 days).At the latest follow-up,all patients remained symptom-free and had normal renal function without evidence of recurrence,and they were delighted for a hidden transumbilical scar.Conclusion:Transumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging.Surgical outcomes at a median follow-up of 2 years are promising,while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.

Duplicated inferior vena cava in a patient undergoing right transumbilical laparoendoscopic single-site (LESS) radical nephrectomy

LaparoEndoscopic Single-site(LESS) renal surgery emerging as a potential alternative to conventional laparoscopy,is technically challenging and the major vascular anomaly may increase the risk of intraoperative haemorrhage.Herein,we present a case of right transumbilical LESS radical nephrectomy which was successfully performed in the presence of double inferior vena cava and duplicated the standard laparoscopic techniques.Most importantly,to bring such an aberrant vascular anatomy to the attention of laparoscopic,especially LESS surgeons with high resolution pictorial illustrations.

A Comparison between Laparoendoscopic Single-Site and Conventional Laparoscopic Renal Stone Removal Surgery: A Study of Application in Two Cases

Aim: To present our initial experience of applying laparoendoscopic single-site surgery (LESS) nephrolithotomy in the treatment of renal calculi. Methods: In August 2010 and April 2012, the LESS nephrolithotomy technique was applied to treat two patients with a renal calculus. One patient had a calculus measuring 5 × 3 cm, and the second patient's measured 3 × 3 cm. Both patients underwent general anesthesia. The operations were performed through a retroperitoneal approach with a single-port instrument inserted through the retroperitoneal incision. The standard laparoscopic retroperitoneal technique was performed, and the calculi were removed by incising the area of the thin renal cortex and the renal pelvis, respectively. The operating time, estimated blood loss, intraoperative complications, other complications, drainage time, and post-operative hospital stay were recorded. Results: Both procedures were completed successfully. No additional trocars were added. No conversion to standard laparoscopic or open surgery was needed. The operating times were 130 min and 120 min, and the estimated blood losses were 40 mL and 30 mL. There were no intraoperative complications. The wound drainage times were 3 d and 2 d, respectively and the post-operative hospital stays were 8 d and 7 d, respectively. There was no secondary bleeding or wound infection. Follow-up times were 2 years and 3 months, respectively. No incidence of hydronephrosis was recorded. Conclusions: LESS nephrolithotomy is safe and feasible for treating kidney calculi. It can be applied in patients with large renal calculi and regionally thin renal parenchyma.

Single-site laparoscopic partial nephrectomy: Where are we going?

AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.

Laparoendoscopic Single-Site Combined Hysterectomy and Nephrectomy in Deep Infiltrating Endometriosis

Within the advance ports and instruments, laparoendoscopic single-site (LESS) surgery has been increasingly used among gynaecologic surgeons. In addition, advanced port systems have enabled to perform concomitant surgical procedures via transumbilical incision. However, combined surgical operations are rarely reported in the literature, particularly in gynaecology. This case report presents a 42-year-old woman who undergo concomitant LESS hysterectomy and nephrectomy due to deep infiltrating endometriosis (DIE) and end stage renal disease. The operation is performed in approximately 3 hours without any complications, and the patient is discharged on postoperative third day. This case demonstrates that complex concomitant operations even in a patient with DIE can be performed using a LESS surgical approach.

Directly Knitted Ruthenium Pincer Complexes with Enhanced Activity as Recyclable Single-Site Catalysts for Hydrogenation of CO_(2)to Methanol

Considering the importance of the valorization of CO_(2),a number of phosphine-containing ruthenium pincer complexes have been successfully heterogenized using a“direct knitting”strategy without any premodification.The resulting porous organometallic polymers(POMPs)with high specific-surface areas,hierarchical pores,and uniformly dispersed Ru single-sites exhibited outstanding catalytic activity toward the N-formylation of diverse amines with CO_(2).Besides excellent turnover number(TON,5×10^(5))and turnover frequency(TOF,5592 h-1),the obtained formamides were readily hydrogenated to methanol with the same catalyst.Consequently,an amine-assisted direct hydrogenation system of CO_(2)to methanol was established by POMPs with higher activity and TON(1.46×10^(4))than their molecular precursors,shedding light on the direct valorization of CO_(2)and carbon neutral recycling.

Comparison of surgical effect and postoperative patient experience between laparoendoscopic single-site and conventional laparoscopic varicocelectomy, a systematic.review and meta-analysis

The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy （LESSV） and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design （RCT and non-RCT）. The odds ratio （OR） or standardized mean difference （SMD） and their 95% confidence intervals （95% CIs） were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work （overall： SMD = -1.454, 95% Ch -2.502m0.405, P= 0.007; non-RCT： SMD = -2.906, 95% Ch -3.796-2.017, P= 0.000; and RCT： SMD = -0.841, 95% Ch -1.393-0.289, P = 0.003） and less pain experience at 3 h or 6 h （SMD = -0.447, 95% Ch -0.754-0.139, P = 0.004）, day 1 （SMD = -0.477, 95% Ch -0.905-0.05, P = 0.029）, and day 2 （SMD = -0.612, 95% Ch -1.099-0.125, P= 0.014） postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect （improvement of semen quality and scrotal pain relief）, and complications （hydrocele and recurrence） yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.

Advanced Ni-Nx-C single-site catalysts for CO2 electroreduction to CO based on hierarchical carbon nanocages and S-doping

Metal-nitrogen-carbon materials are promising catalysts for CO2 electroreduction to CO. Herein, by taking the unique hierarchical carbon nanocages as the support, an advanced nickel-nitrogen-carbon single-site catalyst is conveniently prepared by pyrolyzing the mixture of NiCl2 and phenanthroline, which exhibits a Faradaic efficiency plateau of > 87% in a wide potential window of −0.6 – −1.0 V. Further S-doping by adding KSCN into the precursor much enhances the CO specific current density by 68%, up to 37.5 A·g−1 at −0.8 V, along with an improved CO Faradaic efficiency plateau of > 90%. Such an enhancement can be ascribed to the facilitated CO pathway and suppressed hydrogen evolution from thermodynamic viewpoint as well as the increased electroactive surface area and improved charge transfer fromkinetic viewpoint due to the S-doping. This study demonstrates a simple and effective approach to advanced electrocatalysts by synergetic modification of the porous carbon-based support and electronic structure of the active sites.

Recent progress and prospect of carbon-free single-site catalysts for the hydrogen and oxygen evolution reactions

The key challenge for scalable production of hydrogen from water lies in the rational design and preparation of high-performance and earth-abundant electrocatalysts to replace precious metal Pt and IrO_(2) for hydrogen evolution reaction(HER)and oxygen evolution reaction(OER).Although atomic M-N-C materials have been extensively studied in heterogeneous catalysis field,the insufficient antioxidant capacity of carbonous substrates hinders their practical application in OER.Developing highly active and stable OER electrocatalysts is the key for electrochemical water splitting.This review presents feasible design strategies for fabricating carbon-free single-site catalysts and their applications in HER/OER and overall water splitting.The constitutive relationships between structure,composition,and catalytic performance for HER and OER are detailly discussed,providing ponderable insights into rationally constructing high-performance HER and OER electrocatalysts.The perspectives on the challenges and future research orientations in single-site catalysts for electrochemical water splitting are suggested.

Boosting faradaic efficiency of CO_(2)electroreduction to CO for Fe-NC single-site catalysts by stabilizing Fe^(3+)sites via F-doping

The atomically dispersed Fe^(3+)sites of Fe-N-C single-site catalysts(SSCs)are demonstrated as the active sites for CO_(2)electroreduction(CO_(2)RR)to CO but suffer from the reduction to Fe^(2+)at~−0.5 V,accompanied by the drop of CO faradaic efficiency(FECO)and deterioration of partial current(JCO).Herein,we report the construction of F-doped Fe-N-C SSCs and the electron-withdrawing character of fluorine could stabilize Fe3+sites,which promotes the FECO from the volcano-like highest value(88.2%@−0.40 V)to the high plateau(>88.5%@−0.40-−0.60 V),with a much-increased JCO(from 3.24 to 11.23 mA·cm^(−2)).The enhancement is ascribed to the thermodynamically facilitated CO_(2)RR and suppressed competing hydrogen evolution reaction,as well as the kinetically increased electroactive surface area and improved charge transfer,due to the stabilized Fe^(3+)sites and enriched defects by fluorine doping.This finding provides an efficient strategy to enhance the CO_(2)RR performance of Fe-N-C SSCs by stabilizing Fe^(3+).

Transurethral assistant transumbilical laparoendoscopic single-site radical prostatectomy

The laparoendoscopic single-site （LESS） technique is the latest technical innovation in laparoscopic surgery to undergo exponential development in urology. This study undertaken to illustrate our initial experience LESS radical prostatectomy （RP） and analyze early outcomes. Nineteen patients diagnosed with prostate cancer underwent LESS-RP in our institute. The patients were divided into two groups： conventional LESS and transurethral assistant LESS. Preoperative, perioperative, postoperative, pathologic, and functional outcomes data were assessed. With the help of a transurethral assistant, the mean operation and anastomosis time were decreased markedly. No focal positive margins were encountered. No prostate-specific antigen recurrence was detected 1 month postoperatively. Complete continence recovery （no pad） was observed in 32% of the patients at 1 month after the operation. No intraoperative and postoperative complications were reported, LESS-RP is a feasible and effective surgical procedure for treatment of prostate cancer. Moreover, transurethral assistant LESS could reduce the difficulty of LESS-RP and shorten the operation time.

Recent Advances in Non-Precious Metal-Nitrogen-Carbon Single-Site Catalysts for CO_(2)Electroreduction Reaction to CO

The carbon dioxide electroreduction reaction(CO_(2)RR)to fuels and/or chemicals is an efficient prospective strategy to realize global carbon management using intermittent electric energy harvested from renewable sources.Highly efficient inexpensive electrocatalysts are required to achieve high energy and Faradaic efficiencies as well as fast conversion.Metal-nitrogen-carbon(M-N-C)single-site catalysts(SSCs)are highly competitive over precious metal catalysts in the CO_(2)RR to CO due to their high performance,easy regulation and low cost.In the past six years,intensive studies of M-N-C SSCs for CO_(2)RR to CO have been performed,and great progress has been achieved.This review focuses on the important topic of CO_(2)RR to CO with M-N-C SSCs.We first introduce the reaction mechanism of the CO_(2)RR to CO and the regulation of the electronic structure from a theoretical viewpoint.Then,the construction of M-N-C SSCs and the regulation of the electronic structure are demonstrated experimentally.The up-to-date electrocatalytic performance of M-N-C SSCs with different metal centers(Ni,Fe,Co and others)is summarized and compared systematically to highlight structure-performance correlations that were considered from both theoretical and experimental perspectives.Finally,the opportunities,challenges and future outlooks are summarized to deepen and widen research and applications in this promising field.

Laparoendoscopic single-site radical prostatectomy： technique and initial outcomes

Background Laparoendoscopic single-site surgery radical prostatectomy （LESS-RP） is a challenging urological procedure and needs to be further evaluated. This study was undertaken to illustrate the safety and initial results of pure LESS-RP with conventional available instruments.

Cleavable Cys labeling directed Lys site-selective stapling and single-site modification

Site-selective modification of peptide/protein is a vital approach to disclose post-translational modifications(PTMs) and plays a crucial role in chemical biology, as well as drug development. Compared with synthetic and chemical biology methods, chemical modification of native peptide/protein provides a more versatile approach to achieve late-stage diversification for functional studies. Lysine featured high nucleophilicity, frequency, and solvent accessibility, making its site-selective modification important but elusive. Herein, we reported a visible-light-driven and Cys-directed Lys site-selective stapling approach for peptide/protein. By cleavable Cys anchoring, site-selective Lys single-site modification was achieved, and this method could be applied to multi-functionalization.