No abstract available.

PURPOSE: Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. MATERIALS AND METHODS: We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique. RESULTS: Mean follow-up was 47.7+/-29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location, estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452). CONCLUSION: Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.
Adult ; Aged ; Carcinoma, Renal Cell/mortality/*surgery ; Female ; Humans ; Kidney Neoplasms/mortality/*surgery ; Laparoscopy/instrumentation/*methods ; Laparotomy/instrumentation/*methods ; Male ; Middle Aged ; Nephrectomy/instrumentation/*methods ; Retrospective Studies ; Treatment Outcome ; Video-Assisted Surgery/instrumentation/*methods

PURPOSE: We report a new method of tumor exposure through a minilaparotomy window and cold ischemia using a LapSac(R) 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(R). 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 follow-up 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(R). This technique for partial nephrectomy by VAMS might be an effective, safe modality.
Carcinoma, Renal Cell ; Cold Ischemia ; Cold Temperature ; Creatinine ; Follow-Up Studies ; Humans ; Kidney ; Laparotomy ; Lung ; Neoplasm Metastasis ; Nephrectomy ; Operative Time ; Recurrence ; Retrospective Studies ; Video-Assisted Surgery

PURPOSE: We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution. MATERIALS AND METHODS: Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases. RESULTS: Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma. CONCLUSIONS: Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.
Adrenalectomy ; Cystectomy ; Follow-Up Studies ; Gloves, Surgical ; Humans ; Intraoperative Complications ; Kidney ; Laparoscopy ; Nephrectomy ; Operative Time ; Orchiectomy ; Postoperative Complications ; Prospective Studies ; Robotics ; Surgical Procedures, Minimally Invasive ; Ureter ; Urologic Diseases

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.
Gloves, Surgical ; Intraoperative Complications ; Kidney ; Laparoscopy ; Nephrectomy ; Operative Time

The liver fluke, Clonorchis sinensis is an important human parasite and is endemic in Eastern Asia including Korea, China, and Japan. Patients acquire the infestation by eating raw or undercooked freshwater fish. Radiologic examinations usually reveal dilated peripheral intrahepatic bile ducts and normal extrahepatic bile duct. The diagnosis of clonorchiasis may sometimes be difficult and a presentation as an obstructive mass at the common hepatic duct is a rare event. Here we report a case of clonorchiasis of 54-year-old woman presented with epigastric pain. Endoscopic retrograde cholangiography revealed a mass at the common hepatic duct with dilatation of the intrahepatic ducts mimicking cholangiocarcinoma. Using an endoscopic basket, muddy, sludge-like materials were extracted through the papillary orifice. We report this case with a review of literatures.
Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; China ; Cholangiocarcinoma ; Cholangiography ; Cholestasis ; Clonorchiasis* ; Clonorchis sinensis ; Diagnosis ; Dilatation ; Eating ; Far East ; Fasciola hepatica ; Female ; Fresh Water ; Hepatic Duct, Common* ; Humans ; Japan ; Korea ; Middle Aged ; Parasites