With the recent advancement in the field of microvascular surgery, the demand for a microvascular prosthesis of 1-2 mm diameter has been increasing. The authors attempted to insert a Gore-tex graft of 1 mm inner diameter to the rat aorta and renal artery with different techniques and different suture materials. The telescoped technique was utilized for the anastomosis of the proximal part of the artery. They showed 80% patency of grafts up to 116 days with 10-0 ethilon and 83% patency up to 96 days with 7-0 silk in the rat aorta. In the rat renal artery, they showed 53.3% patency with 10-0 ethilon. These results showed that Gore-tex grafts of a 1 mm inner diameter could be used for microvascular reconstructions but further laboratory experimentation is needed before clinical application.
Angiography ; Animal ; Arteries/surgery* ; Polytetrafluoroethylene* ; Prostheses and Implants* ; Rats ; Rats, Inbred Strains

PURPOSE: Laparoscopic living donor nephrectomy (LLDN) has been reported to be as safe and effective as open surgery. We systematically evaluated the safety of video-assisted minilaparotomy surgery-living donor nephrectomy (VAMS-LDN) with use of the modified Clavien classification. MATERIALS AND METHODS: We retrospectively analyzed complications in 720 cases of VAMS-LDN conducted in our institute from 2003 to 2010 by use of the modified Clavien classification of surgical complications. RESULTS: The mean age of the donors was 39.3 years (range, 16 to 66 years) and their mean body mass index was 23.3 kg/m2 (range, 15.8 to 36.4 kg/m2). A total of 67 complications occurred (9.3%). Based on the modified Clavien classification, grade 1, 2a, and 2b complications occurred in 49 (6.8%), 16 (2.2%), and 2 (0.3%) of the donors, respectively. Most grade 1 complications involved mild vascular injuries that were immediately repaired with polypropylene sutures during the surgery. These did not cause any postoperative problems. The other grade 1 complications were wound dehiscence, not requiring secondary closure, and wound site pain in 11 (1.5%) and 5 (0.7%) cases, respectively. Grade 2a complications occurred in 16 (2.2%) cases: 9 (1.3%) involved postoperative transfusions and 1 (0.1%) involved a renal fossa hematoma. One grade 2b complication occurred; it was a lymphocele that resolved with placement of a pigtail catheter. No complications classified as grade 2c or worse occurred. CONCLUSIONS: According to the present analysis of complications, VAMS-LDN is a safe procedure with complication rates comparable to those of LLDN as evaluated in previous studies.
Body Mass Index ; Catheters ; Hematoma ; Humans ; Intraoperative Complications ; Laparotomy ; Living Donors ; Lymphocele ; Nephrectomy ; Polypropylenes ; Retrospective Studies ; Surgical Procedures, Minimally Invasive ; Sutures ; Tissue Donors ; Vascular System Injuries

PURPOSE: Percutaneous nephrolithotomy (PCNL) is conventionally conducted in the prone position. However, the prone position increases anesthesia-related morbidity and position changes lengthen the operation time. We report perioperative outcomes and the learning curve for flank PCNL on the basis of a single surgeon's experience. MATERIALS AND METHODS: This study investigated 53 cases of flank PCNL performed for renal stones at our institution from April 2008 to September 2010. We compared mean operative time, stone-free rate, drop in hemoglobin level, length of hospital stay, complications, and need for additional procedures after the surgery. The 53 cases were divided into three groups by case number to compare therapeutic effect, stability, and the learning curve for flank position PCNL. RESULTS: The mean operation time for the 53 patients was 97.3+/-43.1 minutes. The mean operation time gradually decreased as the surgeon accumulated experience. From the 36th case, the mean operation time showed a statistically significant decrease to 72.2+/-24.1 minutes (p=0.003). The overall stone-free rate was 64.2% for all procedures (range, 61.1-76.5%). There were no significant differences in the drop in hemoglobin level, stone-free rate, re-treatment, hospital stay, or complication rate. There was no injury to the bowel or renal vessels, and no other major complications occurred. CONCLUSIONS: Flank PCNL can be used to remove renal stones effectively while overcoming the disadvantages of the existing prone position PCNL. After 36 cases, the learning curve showed acquisition of surgical competence. The clinical experience reported here suggests that flank PCNL is a safe and feasible technique.
Hemoglobins ; Humans ; Kidney ; Kidney Calculi ; Learning ; Learning Curve ; Length of Stay ; Mental Competency ; Nephrostomy, Percutaneous ; Operative Time ; Prone Position

PURPOSE: This is a report of the surgical treatment and prognosis of retroperitoneal liposarcoma (RPLS) in Koreans. MATERIALS AND METHODS: Nineteen patients treated for RPLS between July 1, 1984, and March 31, 2009, were included. Patient demographics, histopathologic subtypes, survival rate, disease recurrence rate and interval, and adjuvant therapy were reviewed and analyzed. RESULTS: Of the 19 patients diagnosed with RPLS, 26.3% presented with well-differentiated RPLS, 10.5% with dedifferentiated RPLS, 15.8% with myxoid/round cell type, and 47.4% with mixed-type liposarcoma. The mean follow-up period was 66.8 months (range, 6 to 165 months). Primary RPLS was treated in 17 patients. Nine patients (52.9%) had recurrent disease, and recurrence developed at a mean of 47.7 months after primary or repeated surgical treatment. The overall survival rate was 84.2% during a mean follow-up of 66.8 months. The 3- and 5-year survival rates were 86.9%, and the 10-year survival rate was 69.5%. The recurrence interval was significantly shorter in recurrent RPLS cases (p=0.023). The mean growth rate of locally recurrent tumors was 0.34 cm per month. CONCLUSIONS: The survival rates reported here were higher than in previous studies. Locally recurrent tumors presented with a low growth rate, which may have contributed to the relatively high survival rate. A high prevalence of mixed-type RPLS was also noted, and its cause and prognosis require further research.
Demography ; Follow-Up Studies ; Humans ; Liposarcoma ; Prevalence ; Prognosis ; Recurrence ; Retroperitoneal Neoplasms ; Sarcoma ; Survival Rate

PURPOSE: This study aimed to comparatively evaluate the cost-effectiveness of four different types of radical nephrectomy (RN) techniques: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgery (VAMS). MATERIALS AND METHODS: Among patients who were diagnosed with renal cell carcinoma and underwent RN, 20 patients were selected who received open, laparoscopic, robot-assisted laparoscopic, or VAMS RN between January 2008 and December 2010. Their medical fees were divided into four categories: procedure and operation, anesthesia, laboratory test, and medical supply fees. The medical costs of the patients were also divided into insured and uninsured costs. RESULTS: The total direct cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN were 2,023,791+/-240,757, 2,024,246+/-674,859 (p=0.998), 3,603,557+/-870,333 (p<0.01), and 8,021,902+/-330,157 (p<0.01) Korean Won (KRW, the currency of South Koea), respectively. The total insured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 1,904,627+/-231,957, 1,798,127+/-645,602 (p=0.634), 3,039,769+/-711,792 (p<0.01), and 899,668+/-323,508 (p<0.01) KRW, respectively. The total uninsured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 119,163+/-24,581, 226,119+/-215,009, 563,788+/-487,798 (p<0.01), and 7,122,234+/-56,117 (p<0.01) KRW, respectively. Medical supply fees accounted for the largest portion of the costs and amounted to 33.43% of the VAMS cost. CONCLUSIONS: VAMS RN is as cost-effective as open surgery. Furthermore, it is comparatively more cost-effective than laparoscopic and robot-assisted laparoscopic RN.
Anesthesia ; Carcinoma, Renal Cell ; Costs and Cost Analysis ; Fees and Charges ; Fees, Medical ; Humans ; Laparotomy ; Medically Uninsured ; Nephrectomy ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative

PURPOSE: To identify size criteria for complex cystic renal masses that can distinguish renal cell carcinoma from benign cysts supplementing the Bosniak classification. MATERIALS AND METHODS: We reviewed the records of 97 patients who underwent surgery for complex cystic renal masses from January 2001 to April 2010. The pathological results were compared with the lesion sizes measured by preoperative computed tomography and other radiological features (contrast enhancement, irregularities of cyst walls and septa, and calcification) were also obtained for categorization according to the Bosniak renal cyst classification. RESULTS: Malignancy was significantly associated with cyst size (>2 cm), male gender, and younger patient age (<50 years). According to the Bosniak classification, there was no category I cyst, and all 8 category II cysts were benign. However, 3 of 18 (17%) category IIF cysts, 21 of 39 (54%) category III cysts, and 29 of 32 (90%) category IV cysts were malignant. All category IIF cysts were benign in patients older than 50 years of age. CONCLUSION: Many complex cystic renal masses smaller than 2 cm were benign. We suggest that lesion size should be taken into account when formulating treatment plans for complex cystic renal masses.
Adolescent ; Adult ; Age Factors ; Aged ; Carcinoma, Renal Cell/diagnosis/radiography ; Child ; Child, Preschool ; *Diagnosis, Differential ; Female ; Humans ; Infant ; Kidney Diseases, Cystic/*diagnosis/radiography ; Kidney Neoplasms/*diagnosis/radiography ; Male ; Middle Aged ; Sex Factors ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: In a group of surgery patients diagnosed with renal cell cancer, those who underwent dialysis were compared with those who received a kidney transplant. MATERIALS AND METHODS: The 43 subjects included in this study were patients who had been undergoing dialysis because of end-stage renal disease or had undergone kidney transplantation. The patients were diagnosed with renal cell carcinoma (RCC) during follow-up and underwent radical nephrectomy from May 1996 to December 2010. Their medical records were retrospectively analyzed as part of the study. RESULTS: In the transplantation group, the renal replacement therapy period averaged 54 months, and the period from transplantation to RCC averaged 119 months (range, 0 to 264 months). In the dialysis group, RCC was observed after an average of 124 months (range, 2 to 228 months) of dialysis, and nephrectomy was then conducted. Acquired cystic kidney disease (ACKD) was found more frequently in the dialysis group, and it had a statistically relevant effect on the occurrence of RCC by comparison with the transplantation group (p<0.01). CONCLUSIONS: Although the incidence rate of ACKD was significantly higher in the dialysis group among patients undergoing surgery for RCC, cancer was found even without ACKD development in some transplant recipients. Considering that the transplant recipients also underwent dialysis, an informative prospective study will be necessary to determine whether other immunosuppressive agents besides ACKD may function as a cancer risk factor.
Carcinoma, Renal Cell ; Dialysis ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Diseases, Cystic ; Kidney Failure, Chronic ; Kidney Transplantation ; Medical Records ; Nephrectomy ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Transplants

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: In donor nephrectomy, it is important to understand the exact anatomy of the blood vessels during minimally invasive surgery. We prospectively analyzed the accuracy of the vessel structures obtained by use of 64-row multi-detector computed tomography (MDCT) angiography compared with the actual vessel structure observed during surgery. MATERIALS AND METHODS: We analyzed 238 patients who underwent donor nephrectomy from July 2007 to August 2010. Before the operation, MDCT angiography was performed, and after the operation, the surgeons themselves wrote the protocol. The ipsilateral artery, the number of veins, the association with the run of the hilar vessel, and other vascular anomalies in computed tomography (CT) angiography and in the donor protocol were summarized. RESULTS: Among 238 patients, nephrectomy was performed on the left side in 199 patients. The accuracy of MDCT for the artery and the vein was 93.3% and 92.4%, respectively. Accuracy did not differ significantly on the left and right sides (artery: p=0.124; vein: p=0.174). In 199 patients, the CT findings for the lumbar vein were compared with the surgical findings. The overall accuracy was shown to be 84.9%, and the accuracy of the group drained to the inferior vena cava (54%) was significantly different (p<0.01) from that of the group drained to the renal vein (98.6%). Thus, it may be necessary to pay close attention to the interpretation of the findings for the lumbar vein. CONCLUSIONS: MDCT angiography is important for understanding the exact anatomy of blood vessels before minimally invasive surgery. We showed that 64-channel MDCT has high accuracy in the main vessel and hilar vessels. However, close attention to the interpretation of the CT findings for the lumbar vein may be required.
Angiography ; Arteries ; Blood Vessels ; Glycosaminoglycans ; Humans ; Kidney ; Kidney Transplantation ; Living Donors ; Nephrectomy ; Prospective Studies ; Renal Artery ; Renal Veins ; Tissue Donors ; Tomography, Spiral Computed ; Veins ; Vena Cava, Inferior

PURPOSE: To perform a prospective analysis of the clinical outcomes of prophylactic antibiotic treatment before the standard surgical modality of living donor nephrectomy (LDN) without postoperative antibiotic treatment. MATERIALS AND METHODS: From November 2005 to June 2010, a total of 470 patients underwent LDN at our medical institution, and 280 of these patients were injected with 1 g cephalosporin 30 minutes before the operation. The group receiving prophylactic antibiotics was compared with a control group composed of 190 patients who received injections of 2 g cephalosporin per day for 5 days after the operation. The presence of fever, incidence of blood transfusion, and period of drainage use were compared between the two groups. RESULTS: There were no significant differences in gender, age, body mass index, incidence of blood transfusion after the operation, fever over 38degrees C 3 days after the operation, or period of drain insertion between the single-dose group and the control group. The follow-up was conducted for 1 month after the operation, and 1 case of surgical site infection (SSI) was observed in each group (p=0.783). CONCLUSIONS: Of 280 patients in the single-dose group, 1 contracted SSI. In comparison with the control group, which was dosed with prophylactic antibiotics for 5 days after the operation, the single-dose group did not have a significantly different occurrence of SSI. We found that the incidence rate of SSI did not increase, even though prophylactic antibiotics were not used after standard and conventional open surgeries, such as video-assisted minilaparotomy surgery.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Blood Transfusion ; Body Mass Index ; Contracts ; Drainage ; Fever ; Follow-Up Studies ; Humans ; Incidence ; Laparotomy ; Living Donors ; Nephrectomy ; Prospective Studies ; Surgical Wound Infection ; Tissue Donors ; Video-Assisted Surgery