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ABSTRACT: BACKGROUND: Previously, the authors demonstrated the feasibility of a pure transvesical natural orifice translumenal endoscopic surgery (NOTES) for uterine horn resection (UHR) using a rigid ureteroscope in swine as an appendectomy model. However, visualization was poor, and there was room for improvement. The authors have assessed the feasibility and safety of a revised technique that uses a 5-mm rigid laparoscope. METHODS: Eight operations on four female pigs (35-40 kg) were performed as a proof of concept study. Four right-side operations were performed in a survival model. The surgical procedure was similar to the original technique. However, the rigid ureteroscope was replaced by a 5-mm laparoscope after modification of the access system. In addition, the clipped metal threads used for bladder closure were easily placed with a long 13-gauge needle. In the survival model, a Foley catheter was placed for 1 day. RESULTS: The new technique provided considerably better visualization and operability than the original technique. The mean total operative time was 96.6 ± 18.2 min, and the mean estimated blood loss was 15.0 ± 13.5 ml. On postoperative day 3, pig 2 in the survival study died of peritonitis resulting from a small bowel injury. The lab results for the other pigs demonstrated no adverse events and tolerable immune responses. Necropsy showed complete healing of the vesicotomy. CONCLUSIONS: The revised transvesical NOTES UHR technique improved the outcomes and feasibility of the original technique. This approach may be translatable to human appendectomy procedures in the future.
Surgical Endoscopy 02/2013; · 4.01 Impact Factor
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ABSTRACT: Purpose To evaluate surgical outcomes of laparoscopic pyelolithotomy (LP) in relation to stone distribution within the kidney. Methods Between August 2008 and February 2012, 77 patients underwent LP as first-line treatment for renal stone(s). Cases were classified into four groups, depending on stone location: Group I (located in only renal pelvis), Group II (located only in renal calyx), Group III (located in renal pelvis and in one calyx), and Group IV (located in renal pelvis and in multiple calyces). Patient and stone characteristics, surgical outcomes, and complications were evaluated. Results Sixty-seven (81.8%) of cases were stone-free after LP for large renal stones. Stone-free rates in a single session decreased significantly with greater stone dispersion (P < 0.001). Mean hospital stay in group IV was significantly longer than in other groups (P = 0.038). However, there were no significant differences in mean operation times (P = 0.214), mean change in serum hemoglobin (P = 0.709), postoperative analgesics usages (P = 0.153), and number of analgesics used on an as-needed basis (P = 0.079). There were no complications of grade IIIb or of greater severity. One patient in group II received blood transfusion, and 1 in group III required percutaneous drainage due to perirenal urine collection. Conclusions LP is an effective and safe modality for managing renal stones diseases. Distribution of stone burden, as well as total stone burden, is an important predictor of surgical outcome of LP in renal stone diseases.
Journal of endourology / Endourological Society 12/2012; · 1.75 Impact Factor
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ABSTRACT: OBJECTIVE: To understand the nature and long-term fate of supranormal differential renal function (snDRF), analysis of a post-pyeloplasty database was performed. MATERIALS AND METHODS: Preoperative diethylenetriaminepentaacetic acid (DTPA) diuretic renal scans (DRS) identified 33 children with snDRF (>55%). Postoperatively, all showed improved hydronephrosis in ultrasound imaging or normalized drainage pattern in DRS during more than 5 years of follow-up. The fate of snDRF was described, and the nature of snDRF was speculated by associating it with clinical and ultrasound-related variables. RESULTS: Median age at operation was 22 months. Preoperative hydronephrosis was grade III in 27 patients (82%) and grade IV in 6 (18%). Hydronephrosis was normalized or improved, showing relief of obstruction. Overall fate of snDRF revealed significant reduction of DRF in 23 patients (70%), of whom 18 (81%) showed normalization during 5 years of follow-up. Stationary change of snDRF was seen in one-third of patients. Comparison of clinical and ultrasound-related variables revealed lower age, lower renal parenchyma thickness (RPT) increase, and higher preoperative DRF in the normalized group compared with the other group. The normalized group also showed a higher number in Society of Fetal Urology grade 4 hydronephrosis and lower RPT, although they reached borderline statistical significance. CONCLUSION: Long-term follow-up revealed that 70% of snDRF significantly decreased and normalized in most patients. The normalized group was younger and showed more hydronephrotic changes. Hydronephrotic change is suggested as a possible cause of snDRF.
Urology 11/2012; · 2.43 Impact Factor
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ABSTRACT: We investigated prostate size and its correlation with final pathologic outcomes and prognosis.
From 1993 to 2009, 830 consecutive patients who underwent radical prostatectomy with follow-up duration of 12 months or more were included in this study. Patients were categorized according to prostate size as follows: group 1, prostate size ≤40 g (n=458), and group 2, prostate size >40 g (n=472). Preoperative parameters and postoperative pathologic outcomes were compared between groups. Multivariate analysis with Cox proportional hazards regression model was used to identify the pathologic and clinical factors affecting biochemical recurrence.
Patients in group 1 had higher pathologic T stage (pT2a=17.7% vs. 23.9%, pT2b=1.1% vs. 0%, pT2c=40.4% vs. 39.8%, pT3a=29.5% vs. 21.0%, pT3b=10.7% vs. 13.2%, p=0.003) and higher positive surgical margin (40.3% vs. 33.1%, p=0.033) than did patients in group 2. Pathologic Gleason score was not significantly different between the two groups. The 5-year biochemical-recurrence-free survival was 62.3% for patients in group 1 and 73.2% for patients in group 2 (p=0.005). Multivariate Cox regression analysis showed that prostate size of 40 g or less (hazard ratio [HR], 1.378; 95% confidence interval [CI], 1.027 to 1.848; p=0.032), extracapsular extension (HR, 1.592; 95% CI, 1.147 to 2.209; p=0.005), positive surgical margin (HR, 2.348; 95% CI, 1.701 to 3.242; p<0.001), and pathologic Gleason sum (HR, 1.507; 95% CI, 1.292 to 1.758; p<0.001) were independent predictors of biochemical recurrence.
Smaller prostate size was associated with increased risk of higher pT stage and positive surgical margin after radical prostatectomy. Also, prostate size less than 40 g was an independent prognostic factor for biochemical recurrence.
Korean journal of urology 07/2012; 53(7):463-6.
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Chang Wook Jeong,
Seong Jin Jeong,
Sung Kyu Hong, Seung Bae Lee,
Ja Hyeon Ku,
Seok-Soo Byun,
Hyeon Jeong,
Cheol Kwak,
Hyeon Hoe Kim,
Eunsik Lee,
Sang Eun Lee
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ABSTRACT: To develop and evaluate nomograms to predict the pathological stage of clinically localized prostate cancer after radical prostatectomy in Korean men.
We reviewed the medical records of 2041 patients who had clinical stages T1c-T3a prostate cancer and were treated solely with radical prostatectomy at two hospitals. Logistic regressions were carried out to predict organ-confined disease, extraprostatic extension, seminal vesicle invasion, and lymph node metastasis using preoperative variables and resulting nomograms. Internal validations were assessed using the area under the receiver operating characteristic curve and calibration plot, and then external validations were carried out on 129 patients from another hospital. Head-to-head comparisons with 2007 Partin tables and Cancer of the Prostate Risk Assessment score were carried out using the area under the curve and decision curve analysis.
The significant predictors for organ-confined disease and extraprostatic extension were clinical stage, prostate-specific antigen, Gleason score and a percent positive core of biopsy. Significant predictors for seminal vesicle invasion were prostate-specific antigen, Gleason score and percent positive core, and those for lymph node metastasis were prostate-specific antigen and percent positive core. The area under the curve of established nomograms for organ-confined disease, extraprostatic extension, seminal vesicle invasion and lymph node metastasis were 0.809, 0.804, 0.889 and 0.838, respectively. The nomograms were well calibrated and externally validated. These nomograms showed significantly higher accuracies and net benefits than two Western tools in Korean men.
This is the first study to have developed and fully validated nomograms to predict the pathological stage of prostate cancer in an Asian population. These nomograms might be more accurate and useful for Korean men than other predictive models developed using Western populations.
International Journal of Urology 05/2012; 19(9):846-52; author reply 853-4. · 1.75 Impact Factor
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Duck K. Choi,
Sung Kwun Chough,
Yi Kyun Kwon, Seung-Bae Lee,
Jusun Woo,
Imseong Kang,
Hyun Suk Lee,
Sang Min Lee,
Jang Won Sohn,
Young Jae Shinn,
Dong-Jin Lee
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ABSTRACT: The Taebaek Group (Cambrian-Ordovician) in the Taebaeksan Basin comprises mixed carbonate-siliciclastic sequence and is exposed
well in the Seokgaejae section located in the central-eastern part of the Korean Peninsula. The group in the Seokgaejae section
consists of in ascending order the Myeonsan, Myobong, Daegi, Sesong, Hwajeol, Dongjeom, Dumugol, Makgol, Jigunsan and Duwibong
formations. This study describes in detail the well-exposed outcrop sections of the Taebaek Group in the Seokgaejae Pass in
order to refine the lithostratigraphy of the lower Paleozoic strata in the Taebaeksan Basin, Korea. The refined lithostratigraphy
delineates clearly the lithologic boundary between the Myobong and Daegi formations, the Hwajeol and Dongjeom formations,
the Dumugol and Makgol formations, and the Makgol and Jigunsan formations. The preliminary information on trilobite faunal
assemblages suggests that the Cambrian-Ordovician boundary can be placed within the lowermost part of the Dongjeom Formation.
Geosciences Journal 04/2012; 8(2):125-151. · 0.74 Impact Factor
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Jung Kwon Kim,
Sung Yong Cho,
Chang Wook Jeong, Seung Bae Lee,
Ja Hyeon Ku,
Sung Kyu Hong,
Seok-Soo Byun,
Cheol Kwak,
Hyeon Hoe Him,
Sang Eun Lee,
Hyeon Jeong
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ABSTRACT: Study Type - Prognosis (cohort series) Level of Evidence 2b. What's known on the subject? and What does the study add? This study reports that patients aged 70 years or older have a higher possibility of locally advanced cancer than younger patients. Instead of conservative management, radical eradication of clinically localized prostate cancer should be actively considered in well-selected healthy patients older than 70 years.
• To analyse the differences in the clinicopathological results between two groups of Korean patients aged younger or older than 70 years with clinically localized prostate cancer.
• A cohort of consecutive male patients who underwent radical prostatectomy was retrospectively analysed. In total, 995 patients (74.6%) were younger than 70 years, and 338 patients (25.4%) were 70 years or older. • Biochemical recurrence (BCR) -free survival was evaluated in the patients, who were followed up for more than 24 months. • The Kaplan-Meier method was used to calculate survival estimates for BCR-free survival. Multivariate Cox proportional hazard regression analysis was performed to predict non-organ-confined status and BCR.
• Mean preoperative prostate-specific antigen (PSA) levels and biopsy or pathological Gleason scores showed no differences between the two age groups. • Older patients, aged more than 70 years, displayed significantly higher risk of locally advanced prostate cancer and BCR than younger patients. • Subgroup analysis showed that the risk of the presence of locally advanced disease was significantly increased in patients of 70 years or older when we compared the proportion of locally advanced disease only in patients with PSA <4 ng/mL. • Multivariate analysis showed that old age, high PSA and high Gleason score were significantly associated with non-organ confined status and BCR.
• Patients aged 70 years or older had a higher possibility of locally advanced cancer than younger patients. • Radical eradication of clinically localized prostate cancer should be actively considered in well-selected healthy patients older than 70 years.
BJU International 02/2012; 110(4):505-9. · 2.84 Impact Factor
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Chang Wook Jeong,
Jong Jin Oh,
Murad Abdullajanov,
Jaeseung Yeon,
Hahn-Ey Lee,
Seong Jin Jeong,
Sung Kyu Hong,
Seok-Soo Byun, Seung Bae Lee,
Hyeon Hoe Kim,
Sang Eun Lee
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ABSTRACT: Because of size limitation, the lack of reliable instruments, and bladder closure methods, transvesical natural orifice translumenal endoscopic surgery (NOTES) is still in its infancy. The porcine uterine horn is similar to the human vermiform appendix. Therefore, the resection of the porcine uterine horn is an established animal model for the human appendectomy. In this study, we evaluated the feasibility of a pure transvesical NOTES approach to uterine horn resection in a porcine model.
We performed five operations on three female pigs (30-35 kg) under general anesthesia in the Trendelenburg position. The laparoscope at the umbilicus was used only for the purpose of documentation. We used a rigid ureteroscope and a customized access system that prevented gas leakage and facilitated in-and-out passage of the instruments. A vesicostomy was created on the posterolateral bladder wall by using a needle knife through the channel of the ureteroscope. The uterine horn resection was performed by using an electric needle knife, hot forceps, and a polypectomy snare through the access system placed in vesicostomy. Bladder closure was performed with extracorporeal ties using metal clip tagged threads and a knot-pusher.
We successfully performed the pure transvesical NOTES uterine horn resections. The mean total operative time was 141.8 (± 58.7) min, and blood loss was minimal in all cases. No leakage was observed at the bladder repair sites after filling with normal saline. The removed uterine horns were approximately 6-12-cm long and 0.6-0.8 cm in diameter. On final inspection, the urethras were not damaged.
This study demonstrates the feasibility of a pure transvesical NOTES uterine horn resection in a porcine model. To the best of our knowledge, this is the world's first report on a pure transvesical NOTES with a therapeutic purpose. This study shows the potential for adoption of the transvesical approach in NOTES procedures.
Surgical Endoscopy 02/2012; 26(2):558-64. · 4.01 Impact Factor
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ABSTRACT: We performed laparoendoscopic single-site (LESS) partial nephrectomy in a porcine model with the objectives of overcoming the technical challenges of this surgery and exploring its feasibility.
Six partial nephrectomies were performed on a pig aged 5 months, three cases on each kidney, by four surgeons: two urologists with much experience in laparoscopic surgery (E1, E2) and two less-experienced urologists (B1, B2). While under general anesthesia, the swine was placed in a lateral flank position. Umbilical placement of an Octoport was done with a 2.5 cm incision. After dissection of the renal hilum and Gerota's fascia, a bulldog clamp was applied on the renal artery and parenchymal resection was done. Renorrhaphy was then performed with interrupted sutures with the use of a sliding knot technique.
All six partial nephrectomies were performed successfully after repair of the vascular and collecting system at the resection margin and renorrhaphy without the need to introduce any additional ports. There were no noticeable intra- or postoperative complications. The mean warm ischemic time was 42 minutes (range, 30-60 minutes). The shortest warm ischemic time, 30 minutes, was achieved by using the early unclamping technique during renorrhaphy. The longest warm ischemic time was 60 minutes. The average number of renorrhaphy stitches was 3.2 (range, 2-5).
LESS partial nephrectomy was successfully performed in a porcine model but resulted in a longer ischemic time than that of conventional laparoscopic surgeries. Therefore, further laboratory disciplinary efforts are needed to decrease the warm ischemic time and to improve this surgical technique.
Korean journal of urology 01/2011; 52(1):44-8.
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ABSTRACT: Palaeontological data of extinct groups often sheds light on the evolutionary sequences leading to extant groups, but has failed to resolve the basal metazoan phylogeny including the origin of the Cnidaria. Here we report the occurrence of a stem-group cnidarian, Cambroctoconus orientalis gen. et sp. nov., from the mid-Cambrian of China, which is a colonial organism with calcareous octagonal conical cup-shaped skeletons. It bears cnidarian features including longitudinal septa arranged in octoradial symmetry and colonial occurrence, but lacks a jelly-like mesenchyme. Such morphological characteristics suggest that the colonial occurrence with polyps of octoradial symmetry is the plesiomorphic condition of the Cnidaria and appeared earlier than the jelly-like mesenchyme during the course of evolution.
Nature Communications 01/2011; 2:442. · 7.40 Impact Factor
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Hongzoo Park,
Seok-Soo Byun,
Hyeon Hoe Kim, Seung Bae Lee,
Tae Gyun Kwon,
Seung Hyun Jeon,
Seok Ho Kang,
Seong Il Seo,
Tae Hee Oh,
Youn Soo Jeon,
Wan Lee,
Tae-Kon Hwang,
Koon Ho Rha,
Ill Young Seo,
Dong Deuk Kwon,
Yong-June Kim,
Yunhee Choi,
Sue Kyung Park
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ABSTRACT: We analyzed a series of patients who had undergone laparoscopic partial nephrectomies (LPNs) and open partial nephrectomies (OPNs) to compare outcomes of the two procedures in patients with pathologic T1a renal cell carcinomas (RCCs).
From January 1998 to May 2009, 417 LPNs and 345 OPNs were performed on patients with small renal tumors in 15 institutions in Korea. Of the patients, 273 and 279 patients, respectively, were confirmed to have pT1a RCC. The cohorts were compared with respect to demographics, peri-operative data, and oncologic and functional outcomes.
The demographic data were similar between the groups. Although the tumor location was more exophytic (51% vs. 44%, p=0.047) and smaller (2.1 cm vs. 2.3 cm, p=0.026) in the LPN cohort, the OPN cohort demonstrated shorter ischemia times (23.4 min vs. 33.3 min, p<0.001). The LPN cohort was associated with less blood loss than the OPN cohort (293 ml vs. 418 ml, p<0.001). Of note, two patients who underwent LPNs had open conversions and nephrectomies were performed because of intra-operative hemorrhage. The decline in the glomerular filtration rate at the last available follow-up (LPN, 10.9%; and OPN, 10.6%) was similar in both groups (p=0.8). Kaplan-Meier estimates of 5-year local recurrence-free survival (RFS) were 96% after LPN and 94% after OPN (p=0.8).
The LPN group demonstrated similar rates of recurrence-free survival, complications, and postoperative GFR change compared with OPN group. The LPN may be an acceptable surgical option in patients with small RCC in Korea.
Korean journal of urology 07/2010; 51(7):467-71.
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ABSTRACT: To investigate the distributive pattern of nerves surrounding the prostate by analyzing specimens from non-nerve-sparing radical retropubic prostatectomy (RRP).
We histologically analyzed specimens from 95 cases of non-nerve-sparing RRPs performed at our institution by examining 12 representative slides from each case. We reconstructed images from scanning the slides and prepared them for analysis by placing them on a circle divided into 12 designated zones. The number of total nerves and ganglionated nerves on the outside of the prostatic capsule was determined manually for each zone. We assessed the locations of ganglionated nerves separately, and also assessed the localization of vessels and nerve trunks in the posterolateral region of the prostate along with the actual shape of the neurovascular bundle (NVB).
Significant proportions (19.9%-22.8%) of total nerves counted were located on the anterior side of the prostate. Ganglionated nerves, present in posterolateral sectors in all cases, were also located on the anterior side of the prostate in some cases (21.1%). We observed NVB in a relatively round, bundle-like formation in 51.6%, whereas NVB was more spread anteriorly, rather than having a rounded structure, in 48.4%.
Anatomic variation exists regarding the periprostatic distribution of nerves, including the formation of NVB. We observed a significant proportion of periprostatic nerves, particularly ganglionated nerves, on the anterior side of the prostate. Thus, further investigation is needed regarding the actual role of these observed nerves not included in NVB.
Urology 09/2008; 72(4):878-81. · 2.43 Impact Factor
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ABSTRACT: The missisquoiids are among the most important trilobites in the Cambrian–Ordovician boundary interval of Laurentia and Gondwana. This study deals with a systematic review of the family Missisquoiidae based on a cladistic analysis and explores their palaeobiogeographical history. A total of 22 missisquoiid species were selected for cladistic analysis. The cladistic results demonstrate that the family Missisquoiidae includes Parakoldinioidia, Pseudokoldinioidia, Tangshanaspis, and Tasmanocephalus; Lunacrania and Hardyia are included with reservation. The well-known genus Missisquoia is treated as a junior synonym of Parakoldinioidia. Based on the distribution of the missisquoiids, six palaeogeographical areas are recognised: Sino-Korea, Yangtze, Australia, southern Laurentia, northwestern Laurentia, and northeastern Laurentia. Palaeogeographical analyses show that the missisquoiids originated in Gondwana and continued to expand their geographical range within the continent and eventually expanded into the Laurentia. Optimisation results of geographical area transitions demonstrate that there were transitions between the two continents, and evolution of the Laurentian missisquoiids appears to have been strongly influenced by the Gondwanan counterparts. We suggest that dispersal of non-fossilised egg stage probably transported by oceanic currents may have been responsible for these inter-continental transitions.
Palaeogeography Palaeoclimatology Palaeoecology 260:315-341. · 2.39 Impact Factor
