Jie Dong

Case Report “5G wireless + wired network”-based multi-console robotic telesurgery: adaptability to complex surgical procedures and diverse network infrastructures—a case report Zixing Ye, Yongxue Ding, Weifeng Xu, Yi Xie, Mingwei Qin, Jing Fan, Liang Cui, Na Li, Xin Qiao, Yu Fang, Zhigang Ji, Yan Yang, Jie Dong

Homeobox B4 (HOXB4) is a homeobox transcription factor implicated in development and oncogenesis; however, its role in bladder cancer (BCa) remains insufficiently defined. Bladder cancer is among the most common malignancies worldwide, and its high rates of recurrence and progression highlight the need to identify new molecular drivers and therapeutic targets. In this study, we show that HOXB4 is overexpressed in BCa and that elevated levels of HOXB4 are associated with unfavorable clinical outcomes. Functionally, HOXB4 knockdown markedly suppressed cellular proliferation, migration, invasion, and experimental lung colonization in vitro and in vivo. Furthermore, transcriptomic analyses and validation assays, including quantitative PCR, immunoblotting, RNA‐sequencing, luciferase reporter, and chromatin immunoprecipitation (ChIP) assays, demonstrated that perturbing HOXB4 modulates Hedgehog signaling. Mechanistically, HOXB4 bound to the Smoothened (SMO) promoter and transcriptionally activated SMO, thereby amplifying Hedgehog pathway activity and promoting malignant phenotypes in BCa cells. Collectively, these findings delineate a HOXB4‐SMO axis that drives BCa progression and suggest this pathway as a candidate target for patient stratification and therapeutic exploration. Future studies should validate these findings in larger multi‐center cohorts and assess the therapeutic potential of SMO inhibition in preclinical BCa models.

Background: While the immunomodulatory function of FAM174B in bladder cancer (BLCA) has yet to be fully elucidated, elucidating its biological mechanisms could potentially enhance immunotherapeutic outcomes for this malignancy.

With the rapid advancement of technology, minimally invasive surgery, particularly laparoscopic surgery, has made significant progress in the field of surgery. Despite the advantages of laparoscopic surgery, a systematic training system for laparoscopic procedures is lacking in Chinese postgraduate medical education. Our study aims to explore the prevalence of laparoscopic training among resident and attending physicians in China and to assess the current state of training programs. A 10-item questionnaire was distributed to 1,750 resident and attending physicians specializing in surgery across China, with 1,324 valid responses (75.7% response rate). The survey focused on demographics, training curriculum content, and feedback on training effectiveness. Data analysis was conducted using Microsoft Excel and IBM SPSS. Among the 1,324 respondents, 30.7% reported receiving laparoscopic training, primarily at the attending physician stage. Only 4% of resident physicians and 14% of attending physicians could independently perform complex laparoscopic surgeries. Most respondents (76.6%) could only assist in surgeries. The majority expressed a desire for more frequent and longer training sessions, with suture training being identified as the most beneficial. This study underscores the critical need for comprehensive laparoscopic training in China. Early, frequent, and structured training programs are essential for developing proficient laparoscopic surgeons. Future initiatives should focus on expanding access to training at all levels of medical education, ensuring continuous skill development and improved surgical care quality.

Purpose: AirSeal is a valve-less trocar insufflation system which is widely used in robotic urologic surgeries. More evidence is needed concerning the application and cost of AirSeal in retroperitoneal robot-assisted laparoscopic partial nephrectomy. Methods: We conducted a randomized controlled trial enrolling 62 patients who underwent retroperitoneal robot-assisted laparoscopic partial nephrectomy from February 2022 to February 2023 in the Peking Union Medical College Hospital. Patients were randomly assigned into AirSeal insufflation (AIS) group and conventional insufflation (CIS) group. The primary outcome was the rate of subcutaneous emphysema (SCE). Results: The SCE rate in the AIS group (12.9%) was significantly lower than that in the CIS group (35.5%) (P = 0.038). Lower maximum end-tidal carbon dioxide (CO₂) (41 vs 45 mmHg, P = 0.011), PaCO₂ at the end of the operation (40 vs 45 mmHg, P < 0.001), maximum tidal volume (512 vs 570 ml, P = 0.003), frequency of lens cleaning (3 vs 5, P < 0.001), pain score at 8 h (3 vs 4, P = 0.025), 12 h (2 vs 3, P = 0.029) postoperatively and at time of discharge (1 vs 2, P = 0.002) were observed in the AIS group, despite a higher hospitalization cost (68,197 vs 64658RMB, P < 0.001). Logistic regression analysis identified insufflation approach was the only influencing factor for the occurrence of SCE events. Conclusion: AirSeal insufflation system exhibited similar efficacy and improved safety for retroperitoneal robot-assisted laparoscopic partial nephrectomy than conventional insufflation system, despite an affordable increase of hospitalization costs.

Background. Robot‐assisted nephroureterectomy (RANU) has been more and more applied since 21st century. However, the high cost limits the widespread use of robot system. A relatively low‐cost new robotic surgical system (KD‐SR‐01™) has recently been developed in China. Objective. To assess the safety and efficacy of the KD‐SR‐01™ Surgical System in RANU. Methods. Patients with upper‐tract urothelial tumor and undergoing RANU with the KD‐SR‐01™ Robotic System were prospectively included. Surgeries were all performed by a single surgeon. Patients’ demographic and clinical characteristics, perioperative data, pathology findings, and follow‐up data were collected. Key Findings. 9 patients were enrolled in this study, and the surgeries went smoothly with no conversion to open. The 1^st docking time, the 2^nd docking time, and the operation time were 222 s, 169 s, and 202 min respectively. No equipment‐related adverse events occurred. All patients were followed up for at least 3 months, and one patient experienced bladder recurrences. Conclusions and Clinical Implications. This study is the first to verify that the KD‐SR‐01™ robot system is effective and safe in RANU and has advantages in terms of its rotation boom during redocking and its price. This trial is registered with ChiCTR2200056672.

Cytoreductive nephrectomy (CN) combined with systemic therapy is commonly used to treat metastatic clear-cell renal cell carcinoma (mccRCC). However, prognostic models for these patients are limited. In the present study, the clinical data of 782 mccRCC patients who received both CN and systemic therapy were obtained from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2016), and patients were divided into training and internal test cohorts. A total of 144 patients who met the same criteria from our center (Peking Union Medical College Hospital) were placed in the external test cohort. The cancer-specific survival rate (CSS) at 1, 3, and 5 years was set as the research outcome. Then, four ML models, i.e., a gradient boosting machine (GBM), support vector machine (SVM), random forest (RF), and logistic regression (LR), were established. Fifteen potential independent features were included in this study. Model performance was evaluated using the area under the receiver operating characteristic curves (AUC), calibration plots, and decision curve analysis (DCA). Seven clinical features, namely pathological grade, T stage, N stage, number of metastatic sites, brain or liver metastases, and metastasectomy were selected for subsequent analysis via the recursive feature elimination (RFE) algorithm. In conclusion, the GBM model performed best at 1-, 3- and 5-year CSS prediction (0.836, 0.819 and 0.808, respectively in the internal test cohort and 0.819, 0.805 and 0.786, respectively in the external cohort). Furthermore, we divided the patients into three strata (high-, intermediate- and low-risk) via X-tile analysis and concluded that clinically individualized treatment can be aided by these practical prognostic models.