| With the development of the laparoscopic technology,laparoscopy has been widely used in the urology surgery including destroying and reconstructing operation,varying from unroofing of renal cyst to complex tumor radical resection.However,traditional laparoscopy,due to its shortage of stereo sense,could only provide us the two-dimension vision.It is quite different from what we can see in the open surgery which brings difficulties to operation.Three-dimension laparoscopy is a newly imaging system which was input in China in recent years.Since it can provide three-dimension stereo vision,it has been applied to more and more complex and difficult laparoscopic surgery,especially in terms of precise operation such as suture.The principle of three-dimension imaging is simple.Two tunnels are used to absorb pictures respectively and then cast to the special screen.The stereo images would present via the non-polarization glasses which can integrate the overlapped pictures.It might bring some discomfort such as dizzy,nausea,fatigue to new-coming surgeons.However,the symptoms would be cleared away after training for a period.The First Affiliated Hospital of Anhui Medical University,Urology Department was one of the most initial institute to import three-dimension laparoscopy technology and put it into practice.Thus,affluent experience has been accumulated.We designed a series of studies to evaluate three-dimension laparoscopy technology's application in complicated urology surgery and its influence on visual fatigue.Study One: as we know,radical prostectomy is one of the most effective method to cure localized prostate cancer.Due to its advantages such as minimal invasion,less blood loss,etc.laparoscopic radical prostectomy has almost taken place of the traditional open surgery.But the process is complicated including tumor resection and urethra reconstruction.Therefore,we designed Study One to assess the application of three-dimension laparoscopic radical prostectomy.A retrospective review was made.66 patients(from Mar.2012 to Feb.2014)who had underwent laparoscopic radical prostectomy in the First Affiliated Hospital of Anhui Medical University were brought into the study.We analyzed their clinical data.43 cases received three-dimension laparoscopy surgery while other 23 cases underwent two-dimension laparoscopy surgery.The results showed that the former surgery approach was prior to the latter one with statistic significance in terms of operation time,blood loss,the incidence of post-operation incontinentia urinae and the erection function,except for post-operation hospitalization days.Therefore,we considered that three-dimension laparoscopic surgery is worthy of using in prostectmy since it can provide real naked stereo vision,distinguish anatomic layers,enhance operation's precision and decrease blood loss and incidence of complications.Study Two: suture is always the difficult part of two-dimension laparoscopic operation and it is also the indispensable process of the reconstruct surgery in upper urinary tract.Theoretically speaking,three-dimension laparoscopy possesses clear-stereo-vision which can make suture more smoothly.Herein,we compared three-dimension with two-dimension laparoscopic operation in upper urinary tract reconstruction surgery.25 patients(from Jan.2012 to Sep.2014)who were diagnosed with ureteropelvic junction obstruction(UPJO)were analyzed.Among them,13 patients underwent operation with three-dimension laparoscopy while the other 12 patients were with two-dimension laparoscopy.All the patients were taken Anderson-Hynes approach which is accepted as standard.Operation time,blood loss,drainage-tube retaining time and hospitalization time were considered as the comparison items.The results showed that the operation time of three-dimension laparoscopy was shorter than that of two-dimension laparoscopy(P<0.05).There were no statistical difference between the two groups in terms of blood loss,drainage-tube retaining time and hospitalization time.Therefore,laparoscopic surgery which contains suture process with three-dimension laparoscopy can provide more distinct vision and shorten operation time.Study Three: non-polarization glass is necessary for the three-dimension laparoscopy.However,some fresh surgeons may suffer eyes dry,dizzy,nausea and the like discomfort symptoms.After a period of training,these troubles can be overcome.In order to discover three-dimension laparoscopic technology's influence on vision,we invited 19 non-laparoscopic experience residents to practice.They were separated at random into two groups,Group A,10 surgeons and Group B,9 surgeons.In the first day,Group A practice three-dimension laparoscopy and Group B operate two-dimension laparoscopy and reversed the laparoscopy for the participants at the second day.Questionnaires referred to vision fatigue and vision function exams were done before and after the practice immediately.The questionnaires contained items of blurred vision,difficulty in refocusing from one distance to another,irritated or burning eyes,dry eyes,eyestrain,headache,tired eyes,sensitivity to bright lights and discomfort in eyes.The functional parameters included horizontal phoria,fusion range,accommodative convergence/accommodation ratio and tear film breakup time.The results demonstrated that when comparing three-dimension laparoscopy group with two-dimension group,symptom scores showed statistically significant difference in blurred vision,irritated or burning eyes,dry eyes,eyestrain,headache,discomfort in eyes.The objective visual functional parameters had no significant difference between the two groups.Therefore, we deemed that although subjective feelings were uncomfortable,there was no objective evidence to indicate that the three-dimension laparoscopy resulted in an increment of visual fatigue which could be tolerated by the surgeons.In summary,as a new minimal invasive imagine system,three-dimension technology can provide more realistic depth perception to the viewer and enable more accurate understanding and analysis of an object especially for those complicated surgery containing suture process.Although it may induce unwanted visual disturbance,its influence is limited compared with conventional two-dimension laparoscopy and it could be tolerated by surgeons.Renal cell carcinoma(RCC)is the fifth most common cancer worldwide,and becomes one of the leading causes of genitourinary cancer-related death in both males and females.Genetic alternations,alcohol consumption,occupationally harmful exposure and even obesity are well-established risk factors of RCC.Omentin-1 is a plasma adipokine synthesized in visceral adipose tissue,and its circulating serum concentration alters not only in conditions associated with insulin resistance such as Polycystic Ovary Syndrome(PCOS),but also in colorectal cancer and prostate cancer.To our best knowledge,the relationshibetween omentin-1 and RCC has not been clarified previously.Objective We evaluated serum omentin-1levels in RCC patients in the current matched case-control study.Method Forty-one patients newly diagnosed with RCC and forty-two healthy controls confirmed by the comprehensive medical examination were assessed.The omentin-1 concentrations were determined via utilizing enzyme-linked immunosorbent assays(ELISA)in the paired groups,in which the patients and healthy controls had no statistically significant differences in gender,age,systolic blood pressure(SBP),diastolic blood pressure(DBP),waist-hip ratio(WHR),estimate glomerular filtration rate(e GFR),body-mass index(BMI)and biochemical parameters.Result The omentin-1 levels in healthy people were 9.86 ± 1.44 ng/m L and the circulating omentin-1levels were dramatically decreased to 3.62 ± 0.76 ng/m L in RCC patients(p < 0.001).Besides,we revealed a negative correlation between omentin-1 with WHR(r = 0.261,p = 0.017)and BMI(r = 0.310,p = 0.004),further indicating BMI was the main influential factor on omentin-1 levels(p = 0.0091).Conclusion We deduce that there is the relativity between omentin-1 and RCC.But this relationship is not affected by obesity.BMI is an independent influencing factor of serum omentin-1 level in RCC patients.Follow-up studies would be conducted to establish the concrete mechanisms underlying the altered circulating levels of omentin-1 and elucidate the interaction between ‘‘RCC complex system” and adipose tissues,which may together provide promising and novel pharmacological insights for RCC theragnosis in the near future. |
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