Akihiro Kawauchi

Shiga University of Medical Science, Ōtu, Shiga, Japan

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Publications (214)585.92 Total impact

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    ABSTRACT: Objectives To assess the effectiveness of soft coagulation in off-clamp laparoscopic partial nephrectomy.MethodsA total of 32 patients with renal tumors underwent laparoscopic partial nephrectomy with off-clamp using soft coagulation between May 2012 and September 2013. Tumor resection was carried out using a combination of bipolar forceps and a ball electrode using the soft coagulation system without hilar clamping. The outcomes of these patients were compared with those of 30 patients treated with hilar clamping.ResultsThis off-clamp procedure was successfully completed in 31 cases. No significant differences were observed in the mean age (60 vs 61 years), sex (male/female; 25/7 vs 20/10), mean RENAL nephrometry score (5.7 vs 5.8), mean body mass index (24.4 vs 23) or tumor size (15 mm vs 16 mm) between the two groups. No significant differences were noted in positive surgical margins (0 vs 0) or blood loss (104 vs 115 cc) as well. In contrast, a significant difference was noted in the total operative time (278 vs 238 min). Serum creatinine percentage changes at 3 months were 6.4 versus 7.3% in the off-clamp and hilum-clamp groups, respectively, which were not significantly different.Conclusions Off-clamp laparoscopic partial nephrectomy can be safely carried out by using a soft coagulation technique.
    International Journal of Urology 05/2015; DOI:10.1111/iju.12808 · 1.80 Impact Factor
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    ABSTRACT: Abstract Objective: To evaluate the feasibility of regional cramp in laparoscopic partial nephrectomy, we performed partial nephrectomy using a kidney grasper that enabled the application of ischemia to a limited region of the kidney. Materials and Methods: The subjects were 5 renal cell carcinoma patients. The mean tumor diameter was 15 mm. There were 2 male and 3 female patients. A transperitoneal approach was used in all cases. Following the standard procedure of laparoscopic partial resection, the hilum of the kidney was confirmed and treated to prepare for rapidly applying clamping with forceps. Tumor resection and suture were then performed under partial warm ischemia using a kidney grasper. Results: Surgery could be completed in 4 patients using this method. In the remaining patient, control of bleeding was considered difficult during tumor resection after applying partial ischemia, and so the procedure was switched to renal artery clamping using bulldog forceps. In the 4 patients in whom a kidney grasper was used, the mean partial warm ischemia time was 23.6 minutes (range, 23-25 minutes), and the mean blood loss was 110 mL (range, 20-260 mL). Conclusions: This procedure may be a useful option in ischemia for partial nephrectomy.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2014; 24(11). DOI:10.1089/lap.2014.0212 · 1.19 Impact Factor
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    ABSTRACT: Objectives To investigate the long-term outcomes of hand-assisted laparoscopic radical nephrectomy compared with those of open nephrectomy.Methods Hand-assisted laparoscopic radical nephrectomy was carried out in 132 patients with T1 renal cell carcinoma (between November 1999 and November 2008). Their outcomes were compared with those of 61 patients treated with open nephrectomy. The durations of follow up were 6–121 months (median 65 months) and 7–146 months (median 84 months) in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively.ResultsThe 7-year recurrence-free rates were 88.5 and 85.6% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively, showing no significant difference between the two groups. The 7-year cancer-specific survival rates were 92.3 and 91.4% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively, showing no significant difference between the two groups. Also, the 10-year recurrence-free rates were 85.4 and 78.1% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively. When changes in the recurrence-free rate were analyzed using the Kaplan–Meier method, no significant difference was observed between the two groups. The 10-year cancer-specific survival rates were 91.8 and 87.9% for hand-assisted laparoscopic radical nephrectomy and open nephrectomy, respectively, showing no significant difference between the groups.Conclusions Hand-assisted laparoscopic radical nephrectomy might be comparable with open nephrectomy with regard to long-term cancer control.
    International Journal of Urology 08/2014; 21(11). DOI:10.1111/iju.12551 · 1.80 Impact Factor
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    ABSTRACT: Androgen-independent prostate cancer is known as a hormone-refractory disease. Though the androgen receptor (AR) is considered to be a key regulator of androgen-independent prostate cancer progression, the mechanism through which AR gene expression is regulated is not well understood. Here, we showed that the AR gene was upregulated by paired box 2 (PAX2) in androgen-independent prostate cancer. When PAX2 upregulated AR gene expression, a decrease in DNA methylation of the AR gene locus was also observed. PAX2 was highly expressed and promoted cell growth in an androgen-independent prostate cancer cell line (22Rv1). The cell growth inhibition by PAX2 knockdown was rescued by AR overexpression in 22Rv1 cells. In a mouse xenograft model of androgen-independent prostate cancer, PAX2 knockdown inhibited tumor growth and AR gene expression and increased DNA methylation of the AR gene. Consistent with this, AR and PAX2 expression levels were positively correlated in prostate cancer patients. These findings suggested that PAX2 promoted cancer cell growth in androgen-independent prostate cancer by regulating AR gene expression through an epigenetic mechanism.This article is protected by copyright. All rights reserved.
    FEBS Journal 08/2014; 281(19). DOI:10.1111/febs.12959 · 3.99 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate our institution's experience in performing laparoscopic radical nephrectomy (LRN) and partial nephrectomy (PN) in patients with small renal masses.
    International Journal of Clinical Oncology 06/2014; DOI:10.1007/s10147-014-0714-2 · 2.17 Impact Factor
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    ABSTRACT: Purpose The Japanese Urological Association and Japanese Society of Endourology established a urological laparoscopic skills qualification system called the Endoscopic Surgical Skill Qualification (ESSQ) System in Urological Laparoscopy in 2004. The reliability of video assessments by referees was evaluated. Materials and Methods Videos of nephrectomies or adrenalectomies performed by the applicants were assessed by 2 referees selected among a pool of 42 referees. From 2004 to 2011, 1308 urologists applied and 60.2% were qualified after video assessments. The results of skills assessments on 1220 videos which had fixed points by 2 referees were analyzed statistically. Results The average number of videos which each referee assessed was 58.1, with a range of 16 to 87. The accordance rate of the results of the video assessment, pass or fail, by the two referees was 68.9%. The scores of the video assessment by each referee averaged 62.7+/-2.4(SD) (full score was set at 75 points and >=60 points was required to pass). There was statistically significant difference in the average video assessment score among the referees (p<0.001), and 5 referees showed significantly higher or lower average scores than the other referees. The percentage qualification of the final decision made by the referee committee on the videos originally assessed by each referee showed no significant differences among the 42 referees. The accordance rate of the results from the video assessment by each referee with the final decision by the committee showed a statistically significant positive correlation with the number of videos assessed by each referee (r=0.404, p=0.0080). Conclusions The ESSQ system showed moderate reliability for the video assessments by the referees. It was concluded that the video assessments by the referees were fair for all applicants, because the final qualification rates showed no significant differences among the referees.
    Journal of endourology / Endourological Society 05/2014; DOI:10.1089/end.2014.0092 · 2.10 Impact Factor
  • European Urology Supplements 04/2014; 13(1):e280. DOI:10.1016/S1569-9056(14)60275-X. · 3.37 Impact Factor
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    ABSTRACT: To compare the outcomes of laparoendoscopic single-site pyeloplasty versus those of conventional laparoscopic pyeloplasty. A total of 26 laparoendoscopic single-site pyeloplasty cases carried out in University Hospital: Kyoto Prefectural University of Medicine, Kyoto, Japan, from 2008 to 2013 were compared with a control group of 26 age-matched laparoscopic pyeloplasty cases carried out during the same study period. The mean age of the patients was 20.4 years (range 1-56 years). Laparoendoscopic single-site pyeloplasty was carried out on the right in nine cases and on the left in 17 cases. The operative time was 246 ± 68 min. Regarding the 14 pediatric patients, the mean age was 7.1 years (range 1-14 years). The operative time was 243 ± 49 min. As for the 12 adult patients, the mean age was 35.8 years (range 16-56 years). The operative time was 248 ± 86 min. The mean operative time of the control group in age-matched laparoscopic pyeloplasty was 239 ± 51 min. Times were 229 ± 54 min for the pediatric patients and 253 ± 45 min for the adult patients. There was no significant difference in the operative time between the control group and the laparoendoscopic single-site group for both adults and children. Blood loss was minimal, and no intraoperative and postoperative complications were observed in the 26 laparoendoscopic single-site pyeloplasty cases. The present findings suggest that laparoendoscopic single-site pyeloplasty can be used in both pediatric and adult patients, offering a superior cosmetic outcome than conventional laparoscopic pyeloplasty, and a lower degree of postoperative pain. A large-scale prospective, randomized study is required to confirm these findings, and to define the future role of laparoendoscopic single-site pyeloplasty.
    International Journal of Urology 03/2014; 21(8). DOI:10.1111/iju.12427 · 1.80 Impact Factor
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    ABSTRACT: The objective of the present study was to evaluate the results of laparoendoscopic single-site (LESS) pyeloplasty and pyelolithotomy, which were performed concurrently in patients with pelviureteric junction obstruction (PUJO) and renal stones. Four patients with PUJO and renal stones underwent pyelolithotomy performed concurrently with LESS pyeloplasty. In 3 patients, a 2.5-cm incision was made in the umbilical region. In the fourth patient, the 2.5-cm vertical incision was made at a site 7 cm below the umbilical region because of a stone in the right lower calyx. After dissection of the pelviureteric junction, an incision of approximately 1 cm was made along the presumed transection line of the renal pelvis. The pyelolithotomy was performed using a 24F rigid nephroscope through a SILS port. Dismembered pyeloplasty was performed after extraction of the renal stones was completed. The mean operation time was 277 minutes (range, 225-373), and the mean lithotomy time was 31 minutes (range, 20-50). No intraoperative or postoperative complications were observed. For all 4 patients, discharge from the hospital was possible after a mean of 3.4 postoperative days (range, 3-4). All patients became stone free. Postoperative ultrasound revealed that hydronephrosis improved in all patients. In all patients, resolution of the symptoms was confirmed. LESS nephrolithotomy with pyeloplasty is a safe and effective procedure with a good cosmetic result for patients with PUJO and renal stones.
    Urology 10/2013; DOI:10.1016/j.urology.2013.08.051 · 2.13 Impact Factor
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    ABSTRACT: BACKGROUND: Metastasis is a consequence of many biological events, during which cancer stem cells are shifted into a malignant state. Among these events, invasion of prostate cancer cells into host tissues is possible to be assessed by means of an in vitro invasion model, and is thought to be coupled to altered expression of membrane proteins. Dysregulated functions of the factors regulating organogenesis during embryogenesis are known to facilitate metastasis of many types of cancers. PAX2 (paired box 2) is a member of the PAX transcription factor family, which regulates prostatic ductal growth and branching in organogenesis of mammalian prostates. However, the role of PAX2 in prostate cancer development remains to be determined. METHODS: PAX2 expression in human prostate cancers and normal prostate epithelium were examined by quantitative RT-PCR and immunohistochemistry. Matrigel invasion assay and a gene array analysis were performed using prostate cancer cell lines transfected with either control or PAX2 siRNA. RESULTS: In human prostate cancers, PAX2 was hyper-expressed in metastatic cancers, but was expressed at lower levels in non-metastatic cancers. Consistent with this, PAX2 knockdown repressed cell growth and invasion in a Matrigel invasion assay. Gene ontology analysis revealed that many cell membrane proteins were downregulated after PAX2 knockdown. CONCLUSIONS: Our data suggested that PAX2 hyper-expression promotes the development of the metastatic state in prostate cancer cells, presumably through upregulating the expression of cell membrane proteins. Prostate 9999: 1-10, 2013. © 2013 Wiley Periodicals, Inc.
    The Prostate 09/2013; 73(13). DOI:10.1002/pros.22687 · 3.57 Impact Factor
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    ABSTRACT: To evaluate the outcome of low-dose-rate permanent brachytherapy combined with anti-androgen deprivation therapy for intermediate-risk prostate cancer excluding biopsy Gleason score 4 + 3. Patients included in the intermediate-risk group were those presenting clinical stage T1c to T2c (by magnetic resonance imaging staging), Gleason score 3 + 4 or lower and/or prostate-specific antigen less than 20 ng/mL, whereas those with clinical stage T1c to T2a, Gleason score 3 + 3 and prostate-specific antigen less than 10 ng/mL represented the low-risk group, and were used as controls. In the intermediate-risk group, therapy with a luteinizing hormone-releasing hormone analog was continued for at least 6 months before and after permanent brachytherapy. A total of 147 low-risk group patients and 139 intermediate-risk group patients were included in the study. The median follow up was 51 and 52 months for the intermediate-risk group and low-risk group, respectively. The 5-year overall, cause-specific and distant-metastasis-free survival rates in the low-risk group and intermediate-risk group were 97.6/99.2, 100/100 and 100/100%, respectively. The 5-year biochemical disease-free survival in these groups were 95.9 and 92.5%, respectively (P = 0.18). There was no sexual activity and desire for erection before treatment in 50%, and in 46% of the patients in the low-risk group and intermediate-risk group, respectively. Overall satisfaction score at 2 years after permanent brachytherapy significantly improved, compared with pretreatment (P = 0.0399). In intermediate-risk prostate cancer, excluding biopsy Gleason score 4 + 3, permanent brachytherapy combined with androgen deprivation therapy for 6 months or more represents an effective treatment option in Japanese patients, based on a favorable prognosis, adverse event profile and quality of life analysis.
    International Journal of Urology 08/2013; 21(3). DOI:10.1111/iju.12245 · 1.80 Impact Factor
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    ABSTRACT: To report an international, multi-institutional series of laparoendoscopic single-site pyeloplasty (LESS-P) with analysis of functional outcomes. LESS-P cases performed between October 2007 and June 2012 at 7 institutions worldwide per individual institutional protocols, entry criteria, and techniques were included. Patient characteristics, operative indications, perioperative outcomes, and postoperative follow-up were retrospectively collected and analyzed. The study included 140 adult patients (age 39.9 ± 15.7 years; body mass index 24.8 ± 4.2 kg/m(2); 15% with previous abdominal surgery) who underwent unilateral LESS-P, most of whom (94.3%) had dismembered reconstructions. Mean operative time was 202.1 ± 47 minutes with an estimated blood loss of 61.2 ± 44.6 mL. Robotic laparoendoscopic single-site surgery was applied in 31 patients (22.1%). A single 2-3 mm accessory port was used in 44 patients (31.4%) and a single 5-12 mm accessory port was added in 9 patients (6.4%), whereas 10 patients (7.1%) were converted to conventional multiport laparoscopy. No patients required conversion to open surgery, nor were any intraoperative complications reported. Length of hospitalization was 2.4 ± 1.6 days. The overall 90-day postoperative complication rate was 18.6%, mostly low-grade complications (Clavien I-II). With a mean follow-up of 14.0 ± 10.8 months, 93.4% had resolution of symptoms and 94.4% had radiographic evidence demonstrating resolution of ureteropelvic junction obstruction. Assessment of drainage with diuretic nuclear renal scan provided evidence of improvement in 86.5% of patients on their first postoperative renal scan. This study highlights the most comprehensive experience with LESS-P reported to date. Outcome measures parallel those of large published series of conventional laparoscopic pyeloplasty. Despite these encouraging findings, longer follow-up is needed to determine the efficacy and durability of this approach for the treatment of ureteropelvic junction obstruction.
    Urology 06/2013; 82(2). DOI:10.1016/j.urology.2013.04.047 · 2.13 Impact Factor
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    ABSTRACT: Purpose: The aim of this study was to assess the screenees' knowledge on prostate cancer and attitude to PSA screening using the Fact Sheet from one district, Kyoto, Japan. Methods: A PSA screening program is offered to people aged more than 54 years since 1995. The Fact Sheet consists of several chapters, as follows: (1) possibility of diagnosing prostate cancer in terms of the PSA threshold, and future morbid risk, (2) benefit and harm of biopsy, (3) necessary examinations after the diagnosis of prostate cancer and risk for overdiagnosis and overtreatment, and (4) comorbidity of main treatments such as surgery and radiation therapy. Each screenee was asked how well the Fact Sheet was understood. Results: Of the 330 men, 288 read the Fact Sheet for the first time. Of those, 59 and 75% did not know that biopsy indication was determined based on the PSA value and the concept of overdiagnosis, respectively. Furthermore, 68% did not know that active surveillance is established as one option for prostate cancer treatment. However, the screenee's knowledge in the 42 men who read the Fact Sheet previously improved substantially. Conclusions: The degree of comprehension of examinees is currently insufficient, and repeated enlightenment is required.
    Urologia Internationalis 04/2013; 91(1). DOI:10.1159/000346327 · 1.15 Impact Factor
  • The Journal of Urology 04/2013; 189(4):e799. DOI:10.1016/j.juro.2013.02.2368 · 3.75 Impact Factor
  • The Journal of Urology 04/2013; 189(4):e85. DOI:10.1016/j.juro.2013.02.1586 · 3.75 Impact Factor
  • European Urology Supplements 03/2013; 12(1):e552. DOI:10.1016/S1569-9056(13)61035-0 · 3.37 Impact Factor
  • Y. Naitoh, A. Kawauchi, K. Kamoi, J. Soh, T. Miki
    European Urology Supplements 03/2013; 12(1):e414-e415. DOI:10.1016/S1569-9056(13)60899-4 · 3.37 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate the hemostatic effect of newly developed medical adhesive in animal partial nephrectomy models. MATERIALS AND METHODS: A total of 30 experimental rabbits were used in the first study. After clamping the renal vessels, partial nephrectomy was performed up to the opening of the calices. Bioglue was applied to the resection stumps using the new glue (group 1, n = 10) or fibrin glue (group 2, n = 10) for 2 minutes, and the blood loss was measured after unclamping the vessels. Simple unclamping without glue (group 3, n = 10) was also evaluated. For the second study, we used 9 dogs with blood pressure monitoring. After preparation similar to that for the first study, the new glue was applied in 3 dogs (group 4), fibrin glue in 3 dogs (group 5) and no glue in 3 dogs (group 6). Histologic evaluation was performed at 7 days and 1 month after surgery. RESULTS: The mean blood loss was significantly less in group 1 (1.45 g) than in groups 2 (6.59 g) and 3 (19.77 g; P <.001 for both). It was also significantly less in group 4 (12.5 g) than in group 5 (182.5 g; P <.001). Group 4 maintained their initial blood pressure throughout the study, but a significant decrease was observed in group 5. No hematoma was observed at day 7. CONCLUSION: The new glue showed acceptable hemostasis when applied to the resection stumps after partial nephrectomy in both the rabbit and the dog models. These findings indicate that it could be useful for hemostasis after partial nephrectomy.
    Urology 02/2013; 81(5). DOI:10.1016/j.urology.2013.01.002 · 2.13 Impact Factor
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    ABSTRACT: We report our experience of extraperitoneal nerve-sparing laparoscopic retroperitoneal lymph node dissection after chemotherapy. Six patients were diagnosed with non-seminomatous germ cell tumor after orchiectomy and clinical stage IIB disease. Nerve-sparing laparoscopic retroperitoneal lymph node dissection was carried out for residual retroperitoneal tumors after cisplatin-based chemotherapy. The median tumor diameter was 2.95 cm before chemotherapy and 1.95 cm after chemotherapy. A modified left (n = 1), right (n = 1) and bilateral (n = 4) template for the dissection area was used. Surgery was successfully completed in all patients and no conversion to open surgery was necessary. Median operative time was 394 min (range 212-526 min). Median blood loss was 75 mL (range 10-238 mL). The overall complication rate was 33.3% (2/6). Two patients had prolonged lymphatic leakage (grade I), which was managed conservatively. Antegrade ejaculation was preserved in all six patients. The histopathological findings showed that two patients had mature teratoma and four patients had necrotic tissue. After a median follow up of 30 months (range 24-36), no recurrence of disease was observed. We can conclude that extraperitoneal nerve-sparing laparoscopic retroperitoneal lymph node dissection for residual tumors after chemotherapy is a feasible operation. The oncological outcomes need to be confirmed in a certain number of patients with longer follow up.
    International Journal of Urology 01/2013; 20(8). DOI:10.1111/iju.12072 · 1.80 Impact Factor
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    ABSTRACT: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is endogenously expressed in immune cells and contributes to immunosurveillance for cancer. TRAIL induces apoptosis preferentially in various cancer cells, including renal cell carcinoma (RCC) cells. In this study, the serum TRAIL level was examined using an enzyme-linked immunosorbent assay in 52 healthy controls and in 84 RCC patients prior to surgery and its significance as a biomarker was evaluated. The median serum TRAIL level was lower in RCC patients compared to the healthy controls (55.9 vs. 103.1 pg/ml; P=0.019). RCC with lymph node metastasis (N1-2), distant metastasis (M1), stage III-IV, or microscopic venous invasion was associated with decreased serum TRAIL levels (P=0.032, 0.067, 0.020 and 0.011). When comparing serum TRAIL levels in the same RCC patients prior and subsequent to surgery (n=11), the levels were significantly higher after surgery (P=0.031). The cause-specific survival rate was significantly higher in RCC patients with high serum TRAIL levels compared to those with low serum TRAIL levels (P=0.0451). TRAIL was estimated to contribute 64 and 13% of the lymphocyte-mediated cytotoxicity against human RCC ACHN and Caki-1 cells, respectively. These data suggest that the serum TRAIL level may be useful as a prognostic biomarker in RCC patients.
    Molecular and Clinical Oncology 01/2013; 1(1):69-74. DOI:10.3892/mco.2012.35

Publication Stats

2k Citations
585.92 Total Impact Points

Institutions

  • 2014
    • Shiga University of Medical Science
      Ōtu, Shiga, Japan
  • 1988–2014
    • Kyoto Prefectural University of Medicine
      • Department of Urology
      Kioto, Kyōto, Japan
  • 2007
    • Kyoto Prefectural University
      Kioto, Kyōto, Japan
  • 2004
    • Fukushima Medical University
      • Department of Neurophysiology
      Hukusima, Fukushima, Japan