Figures of personhood

Conceptualizing Linguistic Difference: Perspectives from Linguistic Anthropolog

Laparoendoscopic Single-Site Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Transitional-Cell Carcinoma: Technical Details Based on Oncologic Principles

Purpose: To describe our technical details of laparoendoscopic single-site (LESS) nephroureterectomy with bladder cuff excision for the management of upper urinary tract transitional-cell carcinoma (TCC) based on oncologic principles. Patients and Methods: Two patients underwent LESS nephroureterectomy for upper urinary tract TCC. In both cases, we used a homemade single-port device that consisted of a wound retractor and a surgical glove. Using the flexible laparoscopic instruments, nephrectomy was performed using procedures similar to those of conventional laparoscopic nephrectomy. Bladder cuff excision was performed laparoscopically using the same procedure with open technique. Results: All procedures were completed successfully without conversion to conventional laparoscopic or open surgery and without additional extraumbilical trocars or incisions. LESS nephreoureterectomy with bladder cuff excision was performed in 385 and 285 minutes with estimated blood loss of 100 and 350 mL, respectively. Both patients were discharged on postoperative day 3 without perioperative complications. Conclusions: LESS nephroureterectomy with bladder cuff excision for upper urinary tract TCC is a minimally invasive technique that may reproduce the open surgical technique and adhere to oncologic principles.White WM, 2009, UROLOGY, V74, P801, DOI 10.1016/j.urology.2009.04.030Desai MM, 2009, UROLOGY, V74, P805, DOI 10.1016/j.urology.2009.02.083Ponsky LE, 2009, UROLOGY, V74, P482, DOI 10.1016/j.urology.2009.06.002Park YH, 2009, J ENDOUROL, V23, P833, DOI 10.1089/end.2009.0025STOLZENBURG JU, 2009, WORLD J UROL 0801Brown JA, 2005, UROLOGY, V66, P1192, DOI 10.1016/j.urology.2005.06.086ELFETTOUH HA, 2002, EUR UROL, V42, P447Shalhav AL, 2000, J UROLOGY, V163, P1100Gill IS, 1999, J UROLOGY, V161, P430CLAYMAN RV, 1991, J LAPAROENDOSC SURG, V1, P343MCDONALD HP, 1952, J UROLOGY, V67, P804

Yonsei Experience in Robotic Urologic Surgery - Application in Various Urological Procedures

PURPOSE: The da Vinci robot system has been used to perform complex reconstructive procedures in a minimally invasive fashion. Robot-assisted laparoscopic radical prostatectomy has recently established as one of the standard cares. Based on experience with the robotic prostatectomy, its use is naturally expanding into other urologic surgeries. We examine our practical pattern and application of da Vinci robot system in urologic field. PATIENTS AND METHODS: Robotic urologic surgery has been performed during a period from July 2005 to August 2008 in a total of 708 cases. Surgery was performed by 7 operators. In our series, radical prostatectomy was performed in 623 cases, partial nephrectomy in 43 cases, radical cystectomy in 11 cases, nephroureterectomy in 18 cases and other surgeries in 15 cases. RESULTS: In the first year, robotic urologic surgery was performed in 43 cases. However, in the second year, it was performed in 164 cases, and it was performed in 407 cases in the third year. In the first year, only prostatectomy was performed. In the second year, partial nephrectomy (2 cases), nephroureterectomy (3 cases) and cystectomy (1 case) were performed. In the third year, other urologic surgeries than prostatectomy were performed in 64 cases. The first robotic surgery was performed with long operative time. For instance, the operative time of prostatectomy, partial nephrectomy, cystectomy and nephroureterectomy was 418, 222, 340 and 320 minutes, respectively. Overall, the mean operative time of prostatectomy, partial nephrectomy, cystectomy and nephrourectectomy was 179, 173, 309, and 206 minutes, respectively. CONCLUSION: Based on our experience at a single-institution, robot system can be used both safely and efficiently in many areas of urologic surgeries including prostatectomy. Once this system is familiar to surgeons, it will be used in a wide range of urologic surgeryope

Initial Experience with Laparoendoscopic Single-Site Surgery by Use of a Homemade Transumbilical Port in Urology

Purpose: We present our initial experience with laparoendoscopic single-site surgery (LESS) by a single surgeon in the urologic field. Materials and Methods: From May 2009 to April 2010, 30 consecutive patients underwent LESS including seven cases of nephrectomy, five cases of nephroureterectomy with bladder cuff excision, four cases of ureterolithotomy, eight cases of marsupialization, and six cases of varicocelectomy. We performed a retrospective analysis of the medical records of the above patients. The single port was made with a surgical glove and an Alexis?? wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). The wound retractor was put into the peritoneal space through an umbilical incision, and a laparoscopic triangle was secured by crossing both instruments. All operations were performed by the transperitoneal approach. Results: Mean patient age was 54.8 years. Mean operative time was 171.2??109.1 minutes. Mean estimated blood loss was 265.0??395.5 ml. Mean incision length was 3.2??1.4 cm. Mean length of hospitalization was 5.2??2.9 days. There was one laparoscopic conversion and two open conversions. There were two cases of transient ileus that improved with conservative treatment. Mean visual analogue pain scales on the operative day and first postoperative day were 6.3/10 and 3.1/10, respectively. Conclusions: In our experience, LESS for urologic surgery is feasible, safe, and clinically applicable. We consider the homemade single-port device to be a relatively cost-effective and convenient device. If surgical instruments for LESS and appropriate ports specified for LESS are developed, LESS would be a surgical treatment technique that could be used as an alternative to the conventional types of laparoscopic surgery. ?? The Korean Urological Association, 2010

Robot-Assisted Radical Prostatectomy:Modified Ultradissection Reduces pT2 Positive Surgical Margins on the Bladder Neck

The purpose of this study was to compare the positive surgical margin (PSM) rates of 2 techniques of robot-assisted radical prostatectomy (RARP) for pT2 (localized) prostate cancer. A retrospective analysis was conducted of 361 RARP cases, performed from May 2005 to September 2008 by a single surgeon (KHR) at our institution (Yonsei University College of Medicine). In the conventional technique, the bladder neck was transected first. In the modified ultradissection, the lateral border of the bladder neck was dissected and then the bladder neck was transected while the detrusor muscle of the bladder was well visualized. Perioperative characteristics and outcomes and PSM rates were analyzed retrospectively for pT2 patients (n＝217), focusing on a comparison of those undergoing conventional (n＝113) and modified ultradissection (n＝104) techniques. There was no difference between the conventional and modified ultradissection group in mean age, BMI, PSA, prostate volume, biopsy Gleason score, and DʼAmico prognostic criteria distributions. The mean operative time was shorter (p＜0.001) and the estimated blood loss was less (p＜0.01) in the modified ultradissection group. The PSM rate for the bladder neck was significantly reduced by modified ultradissection, from 6.2% to 0% (p＜0.05). In conclusion, modified ultradissection reduces the PSM rate for the bladder neck

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 continuously. ?? the Korean Urological Association, 2010

Single quantum dot selection and tailor-made photonic device integration using nanoscale focus pinspot

Among the diverse platforms of quantum light sources, epitaxially grown semiconductor quantum dots (QDs) are one of the most attractive workhorses for realizing various quantum photonic technologies owing to their outstanding brightness and scalability. There exist various material systems for these QDs based on their appropriate emission bandwidth; however, only a few material systems have successfully grown single or low-density QDs, which are essential for quantum light sources. In most other material systems, it is difficult to realize low-density QDs, and the mesa-etching process is usually undergone in order to reduce their density. Nevertheless, the etching process irreversibly destroys the medium near the QD, which is detrimental to in-plane device integration. In this study, we apply a nondestructive luminescence picking method termed as nanoscale focus pinspot (NFP) using helium ion microscopy to reduce the luminous QD density while retaining the surrounding medium. Given that the NFP can precisely manipulate the luminescence at nanoscale resolution, a photonic device can be deterministically fabricated on the target QD matched from both spatial and spectral points of view. After applying the NFP, we extract only a single QD emission out of the high-density ensemble QD emission. Moreover, the photonic structure of a circular Bragg reflector is deterministically integrated with the selected QD, and the extraction efficiency of the QD emission has been improved 27 times. Furthermore, this technique does not destroy the medium and only controls the luminescence. Hence, it is highly applicable to various photonic structures, including photonic waveguides or photonic crystal cavities regardless of their materials.Comment: 16 pages, 5 figure

A Unique Instrumental Malfunction during Robotic Prostatectomy

Over the past decade, the introduction of robotics in the field of medicine has provided a new approach to patients requiring surgery, and both its advantages and disadvantages are currently under study by many groups worldwide. The use of robotics has especially been considered by the urological community as a treatment option in radical prostatectomy. The current case report is one in which the da Vinci Surgical System™, with fourth arm use was employed in radical prostatectomy. This case presents a unique occurrence in which a bolt of the Prograsper forcep became loose during an operation, leading to diminished device functionality and later impedance of its removal. A circumstance such as this has not previously been reported, so we introduce for other robotic surgeons our unique instrumental malfunction case during a robotic prostatectomy

Prognostic Impact of Peripelvic Fat Invasion in pT3 Renal Pelvic Transitional Cell Carcinoma

Renal pelvic transitional cell carcinoma (TCC), which invades beyond muscularis into peripelvic fat or the renal parenchyma, is diagnosed as stage pT3 despite its structural complexity. We evaluated the prognostic impact of peripelvic fat invasion in pT3 renal pelvic TCC. Between 1986 and 2004, the medical records on 128 patients who were surgically treated for renal pelvic TCC were retrospectively reviewed. Sixty patients with pT3 disease were eligible for the main analysis. The prognostic impact of various clinicopathological factors was analyzed using univariate and multivariate analyses. On univariate analysis, sex, age, concomitant bladder tumors, concomitant ureter tumors, lymphadenectomy, adjuvant chemotherapy, tumor grade, multiplicity, renal parenchymal invasion, and carcinoma in situ did not influence the disease-specific survival (p>0.05). By contrast, peripelvic fat invasion, lymph node invasion, and lymphovascular invasion were each significantly associated with disease-specific survival (p<0.05). Multivariate analysis showed that peripelvic fat invasion (p=0.012) and lymph node invasion (p=0.004) were independent prognostic factors. In conclusion, peripelvic fat invasion is a strong prognostic factor in pT3 renal pelvic TCC. Thus, systemic adjuvant therapy should be considered in the presence of peripelvic fat invasion, even if the lymph nodes are not involved