[Show abstract][Hide abstract] ABSTRACT: Assessing construct, face and content validity of the camera handling trainer (CHT), a novel low-fidelity training device for 30° laparoscope navigation skills.
We developed a custom-designed box trainer with clinically based graphic targets. A total of 117 participants, stratified according to their previous experience (novice, competent, expert), took part to a CHT session and subsequently were asked to fill out a survey to assess the impact of the CHT on their 30° laparoscope navigation skills. Sixty of them were also studied for task performance during a 1-h session, with multiple time measurements.
All participants, regardless of the previous experience, significantly improved their performance after the CHT session. Regarding construct validity, the mean task performance on the last measurement for novice group was found to be comparable to the mean first attempt of both competent (p = 0.12) and expert (p = 0.24) participants. All participants agreed that "the CHT is a valid training tool" and that "the CHT should be part of the regular dry laboratory training sessions", assessing both face and content validity. Limitations include the need for assessment of predictive validity.
The CHT is a valid training tool for 30° laparoscope navigation and thus should be considered as one of the fundamental exercises during basic laparoscopic hands-on training sessions for urologists.
World Journal of Urology 08/2015; DOI:10.1007/s00345-015-1657-6 · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract
Tumor-associated immune cells have been discussed as an essential factor for the prediction of the outcome of tumor patients. Lymphocyte-specific genes are associated with a favorable prognosis in colorectal cancer but with poor survival in renal cell carcinoma (RCC). Flow cytometric analyses combined with immunohistochemistry were performed to study the phenotypic profiles of tumor infiltrating lymphocytes (TIL) and the frequency of T cells and macrophages in RCC lesions. Data were correlated with clinicopathological parameters and survival of patients. Comparing oncocytoma and clear cell (cc)RCC, T cell numbers as well as activation-associated T cell markers were higher in ccRCC, whereas the frequency of NK cells was higher in oncocytoma. An intratumoral increase of T cell numbers was found with higher tumor grades (G1:G2:G3/4 = 1:3:4). Tumor-associated macrophages slightly increased with dedifferentiation, although the macrophage-to-T cell ratio was highest in G1 tumor lesions. A high expression of CD57 was found in T cells of early tumor grades, whereas T cells in dedifferentiated RCC lesions expressed higher levels of CD69 and CTLA4. TIL composition did not differ between older (>70 y) and younger (<58 y) patients. Enhanced patients’ survival was associated with a higher percentage of tumor infiltrating NK cells and Th1 markers, e.g. HLA-DR+ and CXCR3+ T cells, whereas a high number of T cells, especially with high CD69 expression correlated with a worse prognosis of patients. Our results suggest that immunomonitoring of RCC patients might represent a useful tool for the prediction of the outcome of RCC patients.
[Show abstract][Hide abstract] ABSTRACT: Members of the urokinase-type plasminogen activator (uPA) system including uPA, its receptor uPAR and the plasminogen activator inhibitor 1 (PAI-1) play an important role in tumour invasion and progression in a variety of tumour types. Since the majority of clear cell renal cell carcinoma (ccRCC) shows distant metastasis at time of diagnosis or later, the interplay of uPA, uPAR and PAI-1 might be of importance in this process determining the patients' outcome.
Corresponding pairs of malignant and non-malignant renal tissue specimens were obtained from 112 ccRCC patients without distant metastasis who underwent tumour nephrectomy. Tissue extracts prepared from fresh-frozen tissue samples by detergent extraction were used for the determination of antigen levels of uPA, uPAR and PAI-1 by ELISA. Antigen levels were normalised to protein concentrations and expressed as ng per mg of total protein.
Antigen levels of uPA, uPAR, and PAI-1 correlated with each other in the malignant tissue specimens (rs=0.51-0.65; all P<0.001). Antigen levels of uPA system components were significantly higher in tissue extracts of non-organ confined tumours (pT3+4) compared to organ-confined tumours (pT1+2; all P<0.05). Significantly elevated levels of uPAR and PAI-1 were also observed in high grade ccRCC. When using median antigen levels as cut-off points, all three uPA system factors were significant predictors for disease-specific survival (DSS) in univariate Cox's regression analyses. High levels of uPA and uPAR remained independent predictors for DSS with HR=2.86 (95%CI 1.07-7.67, P=0.037) and HR=4.70 (95%CI 1.51-14.6, P=0.008), respectively, in multivariate Cox's regression analyses. A combination of high antigen levels of uPA and/or uPAR further improved the prediction of DSS in multivariate analysis (HR=14.5, 95%CI 1.88-111.1, P=0.010). Moreover, high uPA and/or uPAR levels defined a patient subgroup of high risk for tumour-related death in ccRCC patients with organ-confined disease (pT1+2) (HR=9.83, 95%CI 1.21-79.6, P=0.032).
High levels of uPA and uPAR in tumour tissue extracts are associated with a significantly shorter DSS of ccRCC patients without distant metastases.
BMC Cancer 12/2014; 14(1):974. DOI:10.1186/1471-2407-14-974 · 3.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present our first minilaparoscopic-assisted laparoendoscopic single-site bilateral nephrectomies (b-LESS-N) performed in a patient with bilateral atrophic kidney, right malignant renal tumor of 4.5 cm that developed in a native kidney after multiple bilateral renal transplantations and renovascular hypertension. The mean operative time was 233 minutes, with a mean blood loss of 180 mL. A single umbilical incision (5.5 cm) was performed to remove both kidneys. No significant difference in glomerular filtration rate was observed postoperatively. The postoperative recovery was uneventful with favorable short-term outcomes and high patient satisfaction. The 10-month follow-up showed effective arterial pressure improvement, absence of tumor relapse, and stable graft function. We believe that b-LESS-N for renal cancer after a renal transplantation can be performed without increased risks for the patients or for the transplanted kidney.
[Show abstract][Hide abstract] ABSTRACT: 2008) Sofort-und Spätfunktion des Transplantats nach laparoskopisch-handassistierter Donornephrektomie: Vergleich zur offenen Donornephrekto-mie. Tx Med 20: 13-17 Sofort-und Spätfunktion des Transplantats nach laparoskopisch-handassistierter Donor-nephrektomie: Vergleich zur offenen Donornephrektomie Einleitung: Die laparoskopische Donornephrektomie hat sich zum Verfahren der Wahl in der Lebendnieren-Transplantation entwi-ckelt. Längere Warm-Ischämiezeit und Anwendung des Pneumope-ritoneums ließen zuletzt Fragen über die Sofort-und Spätfunktion des Transplantats aufkommen. Wir berichten über unsere Erfahrun-gen mit laparoskopisch-handassistierter Donornephrektomie, ins-besondere betreffend der Transplantatfunktion verglichen mit offe-ner Donornephrektomie. Patienten und Methoden: Diese Studie ist eine retrospektive, nicht-randomisierte Single-center Analyse. Zwischen 1995 und März 2008 wurde bei 72 Patienten mit terminaler Niereninsuffi-zienz eine Lebendspende-Niere transplantiert. Davon waren 35 Donornieren offen-chirurgisch und 37 laparoskopisch-handassis-tiert entnommen. Erfasst wurden neben der Transplantat-Sofort-funktion die biochemischen Marker der glomerulären Filtrations-rate (GFR), Serum-Creatinin und Serum-Cystatin C 1 Jahr nach Transplantation. Ergebnisse: Sowohl die Rate der Transplantat-Sofortfunktion als auch die Nierenfunktionsparameter Serum-Creatinin und Serum-Cystatin C ein Jahr nach Transplantation zeigten in beiden Patien-tengruppen keinen statistisch signifikanten Unterschied. Schlussfolgerungen: Die laparoskopisch-handassistierte Donor-nephrektomie hatte verglichen mit offener Donornephrektomie kei-nen negativen Einfluss auf die Transplantatfunktion des Lebend-spende-Empfängers. Introduction: The laparoscopic donor nephrectomy has become the procedure of choice in the living related kidney transplantation. Longer warm ischemia time and application of pneumoperitoneum have raised questions about the early and late function of the trans-plant graft. We report on our experience with laparoscopic hand-assisted donor nephrectomy, in particular concerning the graft function compared with open donor nephrectomy.
[Show abstract][Hide abstract] ABSTRACT: Renal transplantation represents actually the most effective therapy in patients with end-stage renal failure as it is cost effective, allows for a normal life style and reduces the risk of mortality from dialysis related complications. Renal transplantation can be classified in deceased- donor or living-donor transplantation, depending on the source of the donor organ. The short-term results of transplants with kidneys from donors over 65 years old are almost similar to those with younger organs, but in these patients it is mandatory to reduce cold ischemia time. In the last years, the demand for kidney transplantation has increased dramatically, which has been associated with an increase in living-donor organ procurement, which presents several advantages. Moreover, new operative techniques have been recently developed in order to improve surgical outcomes and graft survival and to reduce the complications' rate after renal transplantation. The purpose of the present review is to evaluate the published literature regarding the technical aspects and the urological complications associated with renal transplantation.