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

Learning Curve for Robot-Assisted Laparoscopic Radical Prostatectomy for Pathologic T2 Disease

PURPOSE: To investigate the learning curve for robot-assisted laparoscopic radical prostatectomy (RALP) for pathologic T2 disease, we examined differences in perioperative outcomes according to time period. MATERIALS AND METHODS: Between July 2005 and June 2008, a total of 307 consecutive patients underwent RALP for prostate cancer and 205 patients had pathologic T2 disease. Patients were grouped into 6-month time periods. We collected and examined the patient's perioperative data including age, body mass index (BMI), prostate-specific antigen (PSA), operation time, estimated blood loss, and positive surgical margin. RESULTS: There were no significant differences among the groups in age (p=0.705), BMI (p=0.246), PSA (p=0.425), or prostate volume (p=0.380). Operation time (p<0.001) and estimated blood loss (p<0.001) decreased significantly with time. The positive surgical margin rate also showed a decreasing trend, but this was not significant (p=0.680). CONCLUSIONS: Operation time and estimated blood loss had a steep learning curve during the early 24 cases and then stabilized. A positive surgical margin rate, however, did not have a significant learning curve, although the positive surgical margin decreased continuouslyope

Hybrid Transvaginal Gastro-Endoscopic Nephrectomy in a Porcine Model

This animal experimental study reports one case of hybrid transvaginal natural orifice transluminal endoscopic surgery (NOTES) for nephrectomy. We performed a nephrectomy through a transvaginal access and 2 additional 5 mm trocars in the abdomen by using the keyhole technique. The specimen was removed through the vaginal tract. The total procedure time was 102 minutes. There were no intraoperative complicationsope

Initial Clinical Experience with Robot-Assisted Laparoscopic Partial Nephrectomy for Complex Renal Tumors.

PURPOSE: Robot-assisted laparoscopic partial nephrectomy (RLPN) is gaining acceptance as an alternative to open partial nephrectomy and laparoscopic partial nephrectomy for small renal masses. However, it still remains a technically challenging procedure even for experienced laparoscopists. Endophytic tumors or renal hilar tumors pose an additional challenge. MATERIALS AND METHODS: We reviewed the medical records of 11 patients (mean age: 49.3 years; range: 31-67 years) who underwent RLPN for small, complex renal masses including hilar tumors and endophytic tumors. RLPN was performed with the Da Vinci(R) surgical system (Intuitive Surgical, Sunnyvale, USA) with three robot arms and intraoperative ultrasonography (Tile-pro(R) System). RESULTS: RLPN was performed successfully without complications in all cases. The mean tumor size was 3.2 cm (range, 1.1-8.0 cm). The mean operative time was 177 minutes (range, 150-260 minutes), and the mean warm ischemia time was 32 minutes (range, 25-41 minutes). The mean estimated blood loss was 177 ml (range, 50-350 ml), and the mean hospital stay was 4 days (range, 3-7 days). Pathology found four patients with clear cell type renal cell carcinoma, one with multilocular multicystic renal cell carcinoma, two with papillary type, one with chromophobe type, and three with angiomyolipoma. CONCLUSIONS: RLPN is a feasible and safe surgery for complex renal tumors. In our experiences, RLPN could be a nephron-sparing surgical option for patients with compromised renal function and it could be an alternative to open partial nephrectomy and laparoscopic partial nephrectomy for a select group of patients.ope

Correlation of Estimated Blood Loss and Calculated Blood Loss During Robot-Assisted Laparoscopic Radical Prostatectomy

Purpose: Due to the pneumoperitoneum, intraoperative bleeding is relatively limited during laparoscopic surgery. During robot-assisted laparoscopic radical prostatectomy (RLRP), after opening the bladder neck, the urine volume is usually incorporated in the estimated blood loss (EBL). The purpose of this study is to compare with EBL and calculated blood loss (CBL) after RLRP. Patients & Methods: Between July 2005 and April 2008, we performed 268 consecutive RLRP by single surgeon. Of these, 260 patients who did not receive blood transfusion became the subjects. We compared with EBL taken from the anesthesia report and CBL calculated from the following formula. EBV is the estimated blood volume and assumed to be 70cm3/kg. Hi and Hf are the preoperative haematocrit and the postoperative day one morning hematocrit. (3) Tu is the sum of autologous whole blood (AWB), packed red blood cells (PRBC), and cell saver (CS) units transfused. CBL=(EBV×(Hi-Hf)/((Hi+Hf)/2)+(500×Tu). Results: The mean (±SD) age and the mean operative time were 63.3±7.7 years and 204.8±38.1 minutes. The mean Hi and Hf were 42.0±4.3% and 36.1±5.4%. There were significant differences between Hi and Hf (p=0.000). The mean EBL and CBL were 327.4±220.8 mL and 748.5±757.4mL. There were significant differences between EBL and CBL (p=0.000). Conclusions: During RLRP, EBL estimated by anesthesiologists may underestimate CBL calculated by standard calculation. This discrepancy may be due to the hemodilution by intravenous fluid replacement postoperatively, and not by the actual postoperative hemorrhage after elimination of pneumoperitoneum.ope

Application of Robotic Surgery to Urologic Malignancy: A Single Center Experience

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Expression of heat shock protein 70 in rat kidney with partial ureteral obstruction.

의학과/석사[한글] 부분요관폐색은 비뇨기과 영역에서 흔히 불 수 있는 폐색성 요로 질환이다. Heat shock proteins (HSPs)은 물리적, 생화학적 자극에 의한 손상에 대해 세포를 보호하고 세포의 항상성을 유지 시켜주며, 특히, heat shock protein 70 (HSP70)은 신장 조직 내에 분포하여 신장 조직의 손상을 최소화하는데 기여하는 것으로 알려져 있다. 이에 저자는 일측 요관 부분 폐색을 일으킨 흰쥐의 신장에서 세포내 변화를 확인하기 위해 면역조직화학염색을 이용한 HSP70의 발현을 확인함으로써 일측 부분 요관 폐색이 신장 세포 손상에 미치는 영향을 알아보고자 하였다. 250-300g의 수컷 Spraque-Dawley 흰쥐의 좌측 신장을 이용하였고, 부분 요관 폐색 시킨 군을 실험군 (n=20)으로, sham 수술을 시행한 군을 대조군 (n=20)으로 하였다. 각 군에 대하여 술 후 7일째 좌측 신장을 적출하여 면역조직화학염색을 시행하였고, 염색된 조직은 영상분석기 (Multiscan, USA)를 이용하여 HSP70의 염색 강도를 측정하였다.대조군에서 HSP70의 발현은 사구체와 세뇨관 영역에서 약하게 발현되었으나, 실험군에서는 사구체 영역과 세뇨관 영역 모두에서 대조군보다 강하게 발현되었다. 사구체에서 측정한 대조군에서의 면역강도의 평균값은 182.1±11.9였고, 실험군에서는 189.6±7.9로 통계학적 유의성이 있었다 (p<0.05).대조군보다 일측 부분 요관 폐색이 있었던 군에서 HSP70의 발현이 더 증가된 것을 통하여 HSP70이 부분 요관 폐색에 의한 세포 손상에 대한 유용한 지표가 될 수 있을 것으로 생각된다. [영문] Partial ureteral obstruction is a common clinical finding. Heat shock proteins(HSPs) maintain homeostasis and protect cells from various injuries by physical and biochemical stresses. Particularly, heat shock protein 70 (HSP70) is contained within renal tissue and attributed to minimizing injuries of renal tissue. We tried to understand the effect of renal cellular injuries due to unilateral partial ureteral obstruction (UPUO). This was done by determining the expression of HSP70 using immunohistochemical staining to identify intracellular changes in the rat kidney with UPUO. The left kidney of the male Sprague-Dawley rats (250-300gm) were used, the UPUO group was assigned to UPUO operation (n=20) and the control group was assigned to sham operation (n=20). A left nephrectomy was done 7 days after the operation in both groups. The intensity of HSP70 in the stained tissue by immunohistochemical staining was measured using image analyser (Multiscan, USA).In the control group, expression of HSP70 was weak in the glomerular area. In the UPUO group, however, expression of HSP70 was stronger than that of control group in the glomerular area. The mean intensity of the UPUO group (182.1 11.9) was significantly higher than the control (189.6 7.9) (p<0.05).The stronger expression of HSP70 in the UPUO group than the control group suggest that HSP70 may be the useful indicator for the cellular damage caused by partial ureteral obstruction.ope

Comparison of laparoscopic radical nephrectomy and open radical nephrectomy for pathologic stage T1 and T2 renal cell carcinoma with clear cell histologic features: a multi-institutional study

OBJECTIVES: To assess the oncologic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with clear cell renal cell carcinoma (RCC). METHODS: We analyzed the data from 2561 patients who had undergone radical nephrectomy for RCC at 26 institutions in Korea from June 1998 to December 2007. The clinical data of 631 patients with clear cell RCC in the LRN group were compared with the clinical data of 924 patients in the ORN group. The patients with Stage pT3 or greater and those with lymph node or distant metastases were excluded to avoid a selection bias. To evaluate the technical adequacy and oncologic outcome, we compared the perioperative parameters and 5-year overall and disease-free survival rates. RESULTS: The operative time was significantly longer in the LRN group than in the ORN group (219 ± 77 vs 182 ± 62 minutes, P < .001), but the estimated blood loss and complication rate were significantly lower in the LRN group than in the ORN group (P < .001 and P < .001, respectively). On univariate analysis, the LRN group had 5-year overall (93.5% vs 89.8%, P = .120) and recurrence-free (94.0% vs 92.8%, P = .082) survival rates equivalent to those of the ORN group. Even after adjusting for age, sex, T stage, tumor grade, and body mass index in a Cox proportional hazards model, statistically significant differences between the 2 groups were not found for the 5-year overall (hazard ratio 1.523, P = .157) and recurrence-free (hazard ratio 0.917, P = .773) survival rates. CONCLUSIONS: Our large multi-institutional data have shown that LRN provides survival outcomes equivalent to those of ORN in patients with Stage pT1-T2 clear cell RCC.ope

Robot Assisted Radical Prostatectomy: Ways to Minimize Postoperative Urinary Incintinence

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복강경 수술의 교육 및 훈련을 위한 환자 장기 모델을 이용한 초기 수술 시뮬레이션 개발

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