Percutaneous Nephrolithotomy in a Semi-Lateral Position

PURPOSE: In the treatment of large-sized renal stones, percutaneous nephrolithotomy (PNL) is regarded as a minimally invasive surgery with an easy postoperative recovery. In previous procedures, which were done with the patient in a prone position, appropriate measures could not be taken in cases in which a cardiopulmonary emergency appeared. Given this background, we performed PNL in a manner to which the department of urology was accustomed. Then, we attempted to assess the treatment effect and safety of PNL on the basis of our clinical experiences. MATERIALS AND METHODS: This study was conducted in 14 patients who underwent PNL in a semi-lateral position at our medical institution between April and October of 2008. The complete removal of renal stones, blood transfusion, the period of use of a catheter for nephrostomy, complications, and the need for additional procedures after the surgery were examined. RESULTS: Six patients had stones in the pelvis, three had stones in the lower calyx, and five had multiple stones or pelvocalyceal stones. The mean stone size was 2.66 cm (range, 1.56-6.37 cm). In all patients, the renal stone was completely removed and post-procedure complications were minimal except for blood transfusion in one patient. No additional procedures were required in any of the patients. CONCLUSIONS: PNL was performed in a semi-lateral position, which is a position to which the department of urology is accustomed. By use of this position, surgeons and anesthesiologists can reduce the surgical burden due to posture. Based on our clinical experiences, PNL in a semi-lateral position is an effective, safe modalityope

Tumor Exposure and Cold Ischemia Using a LapSac® in Partial Nephrectomy by Video-Assisted Minilaparotomy Surgery (VAMS)

Purpose: We report a new method of tumor exposure through a minilaparotomy window and cold ischemia using a LapSac? during partial nephrectomy by video-assisted minilaparotomy surgery (VAMS). Materials and Methods : Partial nephrectomy was performed by VAMS in a total of 31 patients during a period ranging from January 2004 to June 2006, and tumor exposure and cold ischemia were achieved by using a LapSac?. We investigated the tumor size and location, mean operative time, mean estimated blood loss, mean cold ischemic time, and pathologic outcomes retrospectively. We evaluated preoperative and postoperative renal function with the estimated creatinine clearance rate by the MDRD equation. Results: The mean tumor size was 2.59±1.30 cm and mean surgical time was 182.5±44.5 minutes. Mean cold ischemic time was 31.84±8.43 minutes. Mean estimated blood loss was 445.65±202.77 ml (range, 100-800 ml), and 3 patients required transfusion. A histopathologic examination confirmed a diagnosis of renal cell carcinoma in 22 patients (71%). The surgical margin was positive in 1 patient. Twenty-one patients had a mean followup of 53±8.19 months. Nineteen patients survived without any disease recurrence, 1 patient survived with lung metastasis within 5 months, and 1 patient died of unrelated cause. There was no significant difference between the preoperative and postoperative estimated creatinine clearance rate by using the MDRD equation. Conclusions: Tumor exposure and cold ischemia were attempted in a partial resection of the kidney by VAMS with a LapSac?. This technique for partial nephrectomy by VAMS might be an effective, safe modalityope

Embryonic-Natural Orifice Transluminal Endoscopic Surgery Nephrectomy.

We describe our initial experience with embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) nephrectomy in a nonfunctioning kidney. E-NOTES was performed with modified single port access by using a surgical glove and wound retractor. We used several laparoscopic instruments, such as articulating laparoscopic instruments, clips, conventional laparoscopic graspers, and dissectors. The operative time was 80 minutes. There were no intraoperative complications.ope

(A) study on the synergic anti-mechanism of the histone-deacetylase inhibitor, trichostatin and gemcitabine in bladder cancer cell lines

학위논문(박사) --서울대학교 대학원 :의학과(비뇨기과학전공),2010.2.Docto

전립선비대증과 전립선암에서 세포고사억제 유전자 survivin의 발현

학위논문(석사)--서울대학교 대학원 :의학과 비뇨기과학전공,2004.Maste

Laparoendoscopic Single Site Surgery in Urology - Unique requirments, Practical tips and tricks

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The feasibility of laparoendoscopic single-site nephrectomy: initial experience using home-made single-port device

OBJECTIVES: To report our early experience with laparoendoscopic single-site (LESS) nephrectomy using home-made single-port device for benign nonfunctioning kidney. METHODS: A total of 14 patients with benign nonfunctioning kidney underwent transperitoneal LESS nephrectomy by 2 experienced laparoscopic surgeons. The indications for nephrectomy were nonfunctioning kidney associated with ectopic kidney (n = 2), ureteropelvic junction obstruction (n = 5), genitourinary tuberculosis (n = 4), ureter stone (n = 2), and ureter stricture (n = 1). RESULTS: All procedures were completed successfully. The mean operative time was 151 (85-230) minutes, estimated blood loss 108 (negligible-500) mL, and postoperative hospital stay 3.1 (2-6) days. There were no major complications. CONCLUSIONS: LESS nephrectomy is a feasible and safe surgical option for benign nonfunctioning kidney.ope

Longitudinal Stone Diameter on Coronal Reconstruction of Computed Tomography as a Predictor of Ureteral Stone Expulsion in Medical Expulsive Therapy

OBJECTIVE: To evaluate stone diameter and ureteral dilation using computerized tomography as a predictor of ureteral stone expulsion after medical expulsive therapy. MATERIALS AND METHODS: We retrospectively reviewed the records of 328 patients with symptomatic ureteral stones <10 mm on axial computerized tomography images, who were treated with alpha blockers for 2 weeks. Computerized tomography scans were also performed 2 weeks after medical expulsive therapy to confirm ureteral stone expulsion. Patients were divided into upper ureteral stones and lower ureteral stones above and below the iliac vessels, respectively. Transverse stone diameter and longitudinal stone diameter were defined as the largest stone diameter determined on the axial and coronal computerized tomography images, respectively. Ureteral diameter was determined on one computerized tomography slice proximal to each ureteral stone on axial computerized tomography images, and the ratio of ureter-to-stone diameter was defined as ureteral diameter divided by transverse stone diameter. RESULTS: Among 328 patients, the stone expulsion rate was 44.1% in 145 upper ureteral stones and 69.4% in 183 lower ureteral stones. Transverse stone diameter, longitudinal stone diameter, ureteral diameter, and the ratio of ureter-to-stone diameter were significantly lower in patients with ureteral stone expulsion in upper ureteral stones and lower ureteral stones (P < .001 for all parameters). Logistic regression analysis revealed that only longitudinal stone diameter was a significant predictor of stone expulsion in patients with upper ureteral stones (odds ratio 0.580, P = .040) and lower ureteral stones (odds ratio 0.415, P = .012). CONCLUSION: Longitudinal stone diameter was a significant predictor of stone expulsion in patients with upper ureteral stones and lower ureteral stones after medical expulsive therapy. Measurement of stone diameters in coronal reconstruction may help to better choose a patient who is suitable for medical expulsive therapy.ope

Robot Assisted Radical Prostatectomy: Ways to Minimize Postoperative Urinary Incontinence

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The feasibility of solo-surgeon living donor nephrectomy: initial experience using video-assisted minilaparotomy surgery.

BACKGROUND: Today, many kinds of surgery are being conducted without human assistants. Living donor nephrectomy (LDN) using video-assisted minilaparotomy surgery (VAM) has been performed by solo-surgeon using Unitrac® (Aesculap Surgical Instrument, Germany). We examined the results from VAM-solo-surgeon living donor nephrectomy (SLDN) and conventional VAM-human-assisted living donor nephrectomy (HLDN). METHODS: Between July 2007 and April 2008, 82 cases of VAM-LDN were performed by two surgeons. From these cases, we randomly assigned 35 cases to undergo solo-surgery (group I) and the other 47 cases to undergo surgery with one human assistant (group II). All VAM-LDN procedures were performed in the same manner. Only the roles of a first assistant were substituted by the Unitrac® in group I. We compared the perioperative and postoperative data, including operative time, estimated blood loss, and hospital stay, between the two groups. We also investigated cases that developed complications. RESULTS: There were no significant differences in the patient demographic data between the two groups (P > 0.05). The mean operative time was 201.9 ± 32.9 min in group I and 202.4 ± 48.3 min in group II (P = 0.954), whereas mean blood loss was 209.7 ± 167.3 ml in group I and 179.6 ± 87.8 ml in group II (P = 0.294). Postoperative hospital stay were 5.4 ± 1.1 days in group I and 5.5 ± 1.6 days in group II (P = 0.813). The incidence of perioperative complications was not significantly different between the two groups. CONCLUSIONS: Our study demonstrates that VAM-SLDN can be performed safely, is economically beneficial, and is comparable to VAM-HLDN in terms of postoperative outcomes.ope