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ABSTRACT: Abstract Purpose: To assess the surgical efficacy and potential advantages of laparoendoscopic single-site adrenalectomy (LESS-AD) compared with conventional laparoscopic adrenalectomy (CL-AD) based on published literature. Methods: An online systematic search in electronic databasesM including Pubmed, Embase, and the Cochrane Library, as well as manual bibliography searches were performed. All studies that compared LESS-AD with CL-AD were included. The outcome measures were the patient demographics, tumor size, blood loss, operative time, time to resumption of oral intake, hospital stay, postoperative pain, cosmesis satisfaction score, rates of complication, conversion, and transfusion. A meta-analysis of the results was conducted. Results: A total of 443 patients were included: 171 patients in the LESS-AD group and 272 patients in the CL-AD group (nine studies). There was no significant difference between the two groups in any of the demographic parameters expect for lesion size (age: P=0.24; sex: P=0.35; body mass index: P=0.79; laterality: P=0.76; size: P=0.002). There was no significant difference in estimated blood loss, time to oral intake resumption, and length of stay between the two groups. The LESS-AD patients had a significantly lower postoperative visual analog pain score compared with the CL-AD group, but a longer operative time was noted. Both groups had a comparable cosmetic satisfaction score. The two groups had a comparable rate of complication, conversion, and transfusion. Conclusions: In early experience, LESS-AD appears to be a safe and feasible alternative to its conventional laparoscopic counterpart with decreased postoperative pain noted, albeit with a longer operative time. As a promising and emerging minimally invasive technique, however, the current evidence has not verified other potential advantages (ie, cosmesis, recovery time, convalescence, port-related complications, etc.) of LESS-AD.
Journal of endourology / Endourological Society 04/2013; · 1.75 Impact Factor
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ABSTRACT: OBJECTIVE: To identify the effects of diameter-axial-polar (DAP) scoring and other clinical variables on renal functional outcomes after partial nephrectomy (PN). MATERIAL AND METHODS: A total of 59 patients with complete radiographic, clinical and follow-up information were included for analysis. Technetium Tc 99m ((99)Tc(m))-diethylene-triamine-penta-acetic acid (DTPA) renal scintigraphy was used to determine the glomerular filtration rate (GFR) of both kidneys and each kidney individually. All cross-sectional images were reviewed by a single radiologist and a DAP score was assigned. RESULTS: The median decline in total GFR after PN was 13% at a median follow-up of 12 months (from 86.8 to 76.2 mL/min per 1.73 m(2), P < 0.001). The median GFR of the operated kidney showed a significant decrease peri-operatively (42.4 to 27.1 mL/min per 1.73 m(2), P < 0.001). The function of the contralateral kidney showed a significant increase (43.5 to 48.8 mL/min per 1.73 m(2), P < 0.001). On multivariate analysis, preoperative total GFR, ischaemia time and DAP sum score were independent predictors of absolute functional decline of the affected kidney (all P < 0.001), while only preoperative total GFR and DAP sum score were significantly associated with the total absolute GFR reduction (all P < 0.001). CONCLUSION: Preoperative renal function status and DAP score of renal tumours are the primary determinants of long-term functional outcomes after PN, but renal ischaemia damage to the operated kidney after PN is possibly masked by functional compensation of the contralateral healthy kidney if only overall renal function is assessed.
BJU International 04/2013; · 2.84 Impact Factor
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ABSTRACT: BACKGROUND: Chemokines and their receptors are known to play important roles in the tumorigenesis of many malignancies. The aim of this study was to evaluate the prognostic impact of the expression of the chemokine SDF-1 and its receptors CXCR4 and CXCR7 in patients with renal cell carcinoma. METHODS: The expression of CXCR4, CXCR7 and SDF-1 in specimens from 97 renal cell carcinoma patients was evaluated by immunohistochemistry on a tissue microarray. These results were correlated with the clinicopathological parameters and survival of the patients. RESULTS: CXCR4 and CXCR7 were expressed in all patients, whereas SDF-1 was expressed in 61 patients (62.9%). No association was observed between the expression of CXCR4, CXCR7 or SDF-1 and the clinical or pathological data except between SDF-1 expression and Fuhrman's grade (P = 0.015). Patients with high expression of CXCR4, CXCR7 and SDF-1 had shorter overall survival and recurrence-free survival than those with low expression. In a multivariate analysis, the high expression of CXCR4, CXCR7 and SDF-1 correlated with poor overall survival and recurrence-free survival independent of gender, age, AJCC stage, lymph node status, metastasis, histologic variant and Fuhrman's grade. CONCLUSIONS: High levels of CXCR4, CXCR7 and SDF-1 were associated with poor overall survival and recurrence-free survival in renal cell carcinoma patients. CXCR4, CXCR7 and SDF-1 may serve as useful prognostic markers and therapeutic targets for renal cell carcinoma.
World Journal of Surgical Oncology 10/2012; 10(1):212. · 1.12 Impact Factor
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Urology 06/2012; 80(2):328-9. · 2.43 Impact Factor
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ABSTRACT: To evaluate the 1-year efficacy and safety of single-port transvesical enucleation of the prostate (STEP) for voluminous benign prostatic hyperplasia (BPH).
Nine patients with moderate- to large-volume (83.8 ± 19.9 mL) BPH (mean age 71.9 ± 6.39 years, body mass index [BMI] 21.5 ± 3.25 kg/m(2)) were preoperatively evaluated by abdominal and transrectal ultrasonography, uroflowmetry, International Prostate Symptom Score (IPSS) and Quality of Life Index (QoL). The STEP procedures were performed by a single surgeon. All patients were followed up for a minimum of 12 months postoperatively by ultrasonography, uroflowmetry, IPSS, and QoL.
STEP was smoothly completed in 8 cases with 1 case of open conversion owing to failure of the single-port device insertion. The mean operative duration was 160.9 ± 30.24 minutes, and the estimated blood loss was 418.8 ± 282.76 mL. One intraoperative complication of bleeding occurred. Postoperative complications occurred for 2 patients, including one case each of acute epididymitis and urethral stricture. At the 12-month follow-up after surgery, the mean Q(max) of the entire cohort was 22.7 ± 4.62 mL/s (an increase of 12.9 mL/s), with an average postvoid residual volume of 36.1 ± 40.02 mL, an IPSS of 4.1 ± 1.36 (a decrease of 21 points), and a QoL of 1.4 ± 1.19 (a decrease of 3.2 points). No patients developed incontinence or bladder neck contracture.
In selected patients with voluminous BPH, STEP is a safe, feasible, and efficacious procedure with a promising outcome at 1-year follow-up in terms of Q(max), IPSS, and QoL.
Urology 06/2012; 80(2):323-8. · 2.43 Impact Factor
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ABSTRACT: Laparoscopic radical nephrectomy should be executed under the most fundamental principle of early ligature of the renal artery to prevent diffusion of cancerous cells. This is extremely true in the treatment of large renal tumors touching the main renal vasculature. Obviously, the concomitance of a duplicated inferior vena cava (IVC) with associated aberrant tributaries will significantly increase the surgical difficulty and the procedural risk of vascular injury. Herein we describe a transperitoneal left laparoscopic radical nephrectomy for a large hilar left renal tumor in the presence of a duplicated IVC with complicated anomalous tributaries by a transmesocolic approach.
Urology 05/2012; 80(1):e1-2. · 2.43 Impact Factor
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Urology 03/2012; 79(3):583-4. · 2.43 Impact Factor
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ABSTRACT: To assess the feasibility, safety, and efficacy of transperitoneal laparoendoscopic single-site (LESS) adrenalectomy and determine whether it shows any objective advantage compared with standard laparoscopy.
From August 2009 to May 2011, 13 transperitoneal LESS adrenalectomies were performed through a 2-3-cm skin incision using the TriPort access system. This cohort was compared with a contemporary 1:2 matched-pair group of 26 patients undergoing standard laparoscopic adrenalectomy by the same urologist. The perioperative outcomes, including cosmetic satisfaction scores, were statistically analyzed.
The 2 groups were comparable with respect to patient demographics, estimated blood loss, and postoperative hospitalization (P > .05). The LESS procedures had a longer mean operative time (148.5 vs 112.9 minutes, P = .032) but a significantly lower postoperative visual analog pain scale score (2.3 vs 3.7, P = .001), fewer patients requiring analgesics (30.8% vs 73.1%, P = .011), and an earlier resumption of oral intake (21.6 vs 26.0 hours, P = .002). The mean length of the scar in the LESS group was much smaller (2.3 vs 5.9 cm, P < .0001) with a statistically significant greater mean cosmetic satisfaction score (9.5 vs 9.1, P = .042).
The perioperative outcomes of transperitoneal LESS adrenalectomy for small adrenal tumors were comparable to those with the standard laparoscopic approach. It also provides better postoperative pain control, faster recovery of bowel function, and better cosmetic satisfaction than standard laparoscopy, albeit with a longer operative time.
Urology 03/2012; 79(3):577-83. · 2.43 Impact Factor
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ABSTRACT: Laparo-endoscopic single-site (LESS) renal surgery is steadily gaining momentum. LESS by itself is technically challenging, with a potentially increased procedural risk, and the presence of major vascular anomaly may increase the risk of intraoperative mishap. Here we present a case of left transperitoneal LESS radical nephrectomy that was successfully performed in the presence of double inferior vena cava with associated complex renal vascular anomalies. What is more important is to bring such an aberrant vascular anatomy to the attention of laparoscopic, especially LESS, surgeons.
Urology 03/2012; 79(3):e33-5. · 2.43 Impact Factor
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ABSTRACT: The aim is to report our 1-year experience in transumbilical Laparoendoscopic single-site (LESS) radical nephrectomy (LESS-RN) and assess its learning curve.
From September 2009 to December 2010, 18 consecutive patients with a solitary renal tumor underwent transumbilical LESS-RN. We grouped measured parameters on the basis of the first nine (group A) and last nine (group B) patients, and compared both subgroups with the control group (C), which was composed of the initial nine consecutive patients who underwent conventional laparoscopic RNs performed by the same surgeon.
There was one LESS patient converted to conventional laparoscopic surgery for intraoperative hemorrhage and transfused. The mean for measured parameters of the groups A, B, C were: age: 58.6, 57.2, and 59.2 years, respectively (P>0.05); American Society of Aneshesiologists score: 1.9, 2.0, and 2.0, respectively (P>0.05); body mass index: 25.2, 23.5, and 23.1 kg/m(2), respectively (P>0.05); lesion size at CT scan: 5.0, 4.6, and 6.2 cm, respectively (P=0.039); operative skin to skin time: 191.6, 123.9, and 122.2 minutes, respectively (P=0.000); estimated blood loss: 172.2, 246.7, and 116.7 mL, respectively (P>0.05); incision length: 5.6, 5.9, and 7.4 cm, respectively (P=0.000); hospital stay: 5.8, 5.8, and 5.8 days, respectively (P>0.05). At the latest follow-up, all patients did not present any local recurrence or metastasis.
In selected patients, the transumbilical LESS-RN can be safely performed with favorable outcomes. While a learning curve certainly exists, it appears to be short for an experienced laparoscopic surgeon.
Journal of endourology / Endourological Society 12/2011; 25(12):1859-65. · 1.75 Impact Factor
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ABSTRACT: The aim of this study is to compare the perioperative outcomes after transumbilical laparoendoscopic single-site (LESS) radical nephrectomy (LESS-RN) performed by a surgeon during his learning curve of this novel procedure with the outcomes after standard laparoscopic radical nephrectomy (LRN) for patients with a solitary renal tumor. Using this information, we examined whether LESS exhibits any objective advantages over standard laparoscopy.
Twenty patients who underwent LESS-RN for a solitary cT(1)N(0)M(0) renal mass (group 1) were matched and compared with 33 patients who underwent standard LRN (group 2) for tumors of similar sizes. Patient and surgical data, pathologic outcomes, and follow-up information, including patient responses regarding cosmetic satisfaction, were analyzed.
The minimum duration of follow-up was 6 months for both groups. Patients in group 1 had significantly (P<0.05) quicker recoveries of bowel function, shorter postoperative analgesic time, and lower pain scores during their hospital stay. At the time of the last follow-up, all patients remained symptom free, and no evidence of recurrence was detected. Compared with that of standard LRN patients, LESS-RN patients exhibited better cosmetic satisfaction scores postoperatively at least to 6 months (P=0.013).
Transumbilical LESS-RN is a feasible, safe, and efficacious procedure with favorable perioperative outcomes that results in significantly improved control of postoperative pain, more rapid recovery of bowel function, and increased cosmetic satisfaction. Additional research, including randomized controlled trials and long-term follow-ups, however, will be needed to draw solid conclusions regarding the relative efficacy of this procedure compared with standard approaches.
Journal of endourology / Endourological Society 10/2011; 26(6):676-81. · 1.75 Impact Factor
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ABSTRACT: To report a case and the surgical techniques of transperitoneal laparoscopic partial nephrectomy (LPN) in a patient with a small left renal mass and an aberrant left-sided inferior vena cava (IVC).
An otherwise healthy 49-year-old man with a body mass index of 23.1 kg/m(2) was diagnosed with a 5 × 6-cm mass in the left kidney. A transperitoneal LPN was performed in the presence of a left-sided IVC. The procedure was completed using standard laparoscopic instruments. The left renal vein was identified, with the gonadal vein used as an anatomic landmark. Slightly rostral to the location where the renal vein emptied into the left-sided IVC, 2 renal arteries were dissected and clamped individually using laparoscopic bulldog clamps. A standard LPN was then completed.
The duration of the surgery was 182 minutes, and there was an estimated blood loss of 100 mL. The warm ischemic time was 31 minutes. The postoperative recovery was uneventful, and the patient was discharged to his home on postoperative day 7. A pathologic examination revealed a renal oxyphilic adenoma, which is a benign lesion. At the follow-up visits that were 1 month and 3 months after surgery, the patient was determined to be clinically healthy.
The anomaly of a left-sided IVC is not an impediment to performing a transperitoneal LPN; however, the correct identification of the anatomical landmarks and the use of meticulous intraoperative techniques are of paramount importance during this procedure.
Urology 06/2011; 78(2):469-73. · 2.43 Impact Factor
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ABSTRACT: The outcome of thulium laser urethrotomy for patients with urethral stricture had not been reported. The purpose of this study was to evaluate outcome of endourethrotomy with the thulium laser as a minimally invasive treatment for urethral stricture.
Twenty-one consecutive patients with urethral stricture were evaluated by retrograde uroflowmetry, International Prostate Symptom Score (IPSS), and quality of life preoperatively at a single academic center. All patients were treated with thulium laser urethrotomy. All patients were followed up for 12-24 months postoperatively by uroflowmetry and by retrograde with voiding cystourethrogram every 3 months. And all patients were followed up by mailed questionnaire, including IPSS and quality of life.
Retrograde endoscopic thulium laser urethrotomy was performed in all 21 patients. Most patients (N = 16; 76.2%) did not need any reintervention. Five patients developed recurrent strictures, of them two patients were treated by another laser urethrotomy, one patient was treated by open urethroplasty with buccal mucosa and the other two patients' reintervention were treated by urethral dilation. No intraoperative complications were encountered, although in 9.5% (N = 2) of patients, a urinary tract infection was diagnosed postoperatively. No gross hematuria occurred. Including two patients treated with repeat laser urethrotomy, 17(81.0%) showed good flow of urine (Q(ave)>16.0 ml/second) and adequate caliber urethra in retrograde urethrogram (RGU) 12 months after operation. Three (14.3%) patients showed narrow stream of urine (Q(ave)<8.0 ml/second) and urethral dilation was done every month or 2 months. There was one patient whose Q(ave) was between 8.0 and 16.0 ml/second. And this patient was treated by neither urethral dilation nor another laser urethrotomy.
The thulium laser urethrotomy was a safe and effective minimally invasive therapeutic modality for urethral stricture.
Lasers in Surgery and Medicine 09/2010; 42(7):620-3. · 2.75 Impact Factor
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ABSTRACT: Renal cell carcinoma (RCC) shows organ-specific metastasis. This may be attributed to the fact that the CXCR4 G protein coupled receptor on RCC cells mediates chemo-attraction toward stromal-derived factor (SDF)-1 secreted by target organs. SDF-1 binding to CXCR4 initiates many internal signaling cascades as well as internalization of the receptor complex. Here we show that SDF-1 binding localized CXCR4 to the nucleus in A-498 renal carcinoma cells over a 24 h period. CXCR4 nuclear localization in A-498 cells associated with increased Matrigel matrix invasion, a metastatic trait. Comparing histological sections of primary and metastatic human RCC, we found that CXCR4 localized to the nucleus only in metastatic RCC lesions. In conclusion, SDF-1 binding of CXCR4 not only induces immediate signaling via signaling cascades, but also a slower response via nuclear localization of the receptor complex. CXCR4 nuclear localization may be responsible for certain metastatic changes in cancer cells and can be used to distinguish metastatic RCC cells. These findings may be applied to the search for ways to inhibit RCC, as well as to many other questions that involve CXCR4 such as normal hematopoiesis, tissue regeneration, stem cell research and HIV infection.
Oncology Reports 12/2009; 22(6):1333-9. · 1.84 Impact Factor
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ABSTRACT: The chemokine receptor CXCR4 is involved in the metastasis of many cancers. Recent evidence suggests that CXCR4 may be also involved in the metastasis of renal cell carcinoma. We analyzed the expression of CXCR4 in primary carcinomas, metastatic tissues and normal tissues using immunohistochemistry. We further investigated the migration of renal carcinoma cells in response to stimulation by CXCL12 in vitro. We also studied the subcellular localization of CXCR4 in renal cell carcinoma cells in response to CXCL12 by confocal microscopy. We observed the highest percentage of CXCR4 expression in renal cell carcinoma metastases compared with that in renal cell carcinomas and normal renal tissues. We further found that CXCR4 was localized predominantly in the membrane in primary renal cell carcinomas and predominantly in the cytoplasm in renal cell carcinoma metastases. Moreover, we found that CXCR4 was translocated from the cytoplasmic membrane to the cytoplasm upon stimulation by its ligand CXCL12. Renal cell carcinoma metastasis was associated with higher expression of CXCR4 and interaction of CXCR4 and its ligand CXCL12 resulted in the internalization of CXCR4 from the cytoplasmic membrane. These findings implicate the CXCR4-CXCL12 axis in the metastasis of renal cell carcinoma.
Clinical and Experimental Metastasis 10/2009; 26(8):1049-54. · 3.52 Impact Factor
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ABSTRACT: To evaluate the clinical therapeutic effects of retroperitoneal laparoscopic radical nephrectomy for T1 renal cell carcinoma (RCC).
A total of 352 patients with T1 RCC underwent radical nephrectomy in our study, and they were randomly divided into two groups, including 185 cases of retroperitoneal laparoscopic radical nephrectomy and 167 cases of open radical nephrectomy through an extraperitoneal 11th rib flank incision. All operations were performed by the same platoon doctors. There were no statistically significant differences in age, sex ratio, tumor stage, and serum creatinine between the two groups. The operation time, blood loss during operation, hospital stay, and postoperative complications were analyzed and compared. All cases were followed up for 25 +/- 4 months (6-42 months) and the survival rates, wound healing, and carcinoma metastasis were recorded.
The operation time in retroperitoneal laparoscopic radical nephrectomy group versus open radical nephrectomy was 75.6 +/- 11.2 min (55-130 min) versus 68 +/- 10.6 min (50-140 min), without statistically significant difference (p > 0.05). The blood loss was 110.6 +/- 32.3 mL (50-1200 mL) versus 160.8 +/- 38.1 mL (50-1500 mL), with statistically significant difference (p < 0.05); narcotic was required in 8 cases versus 132 cases between the two groups (p < 0.05); the fasting period was 1.3 +/- 0.5 days (1-2 days) versus 2.9 +/- 1.2 days (2-5 days), and hospital stay was 4.6 +/- 1.2 days (3-7 days) versus 8.9 +/- 1.6 days (7-14 days), with statistically significant differences (p < 0.05).
Compared with open radical nephrectomy, retroperitoneal laparoscopic radical nephrectomy is associated with less blood loss, narcotic requirement, and complications; shorter hospital stay; and earlier resumption of routine activities. Therefore, retroperitoneal laparoscopic radical nephrectomy is a better therapy for T1 RCC.
Journal of endourology / Endourological Society 09/2009; 23(9):1509-12. · 1.75 Impact Factor
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ABSTRACT: To describe a method of using rotary mutiflaps from scrotum, penis, and mons pubis to reconstruct large skin defect after local wide excision of penoscrotal extramammary Paget's disease (EMPD).
We reviewed our databases for the period between 1997 and 2005, and identified 5 cases of penoscrotal EMPD, all male aged between 56 to 69 (mean 63.2 years), who underwent local wild excision with subsequent reconstruction by rotary multiflaps.
All flaps survived with satisfactory functional and aesthetic results. No signs of recurrent disease or metastasis occurred during the follow-up period ranging from 5 to 36 months (mean 20 months).
Rotary mutiflaps is a safe and effective procedure for the reconstruction of large defect in penoscrotal EMPD.
Urologic Oncology 02/2008; 26(6):600-3. · 3.22 Impact Factor
