Ill Young Seo

Prognostic factors in Fournier gangrene

Aims: Fournier gangrene is a rapidly progressive necrotizing fasciitis involving the genitalia. It can be treated with antibiotics and immediate debridement along with treatment of the predisposing condition. We evaluated the prognostic factors, clinical characteristics and treatment of patients of the Fournier gangrene.

Operative Outcomes of Robotic Partial Nephrectomy: A Comparison with Conventional Laparoscopic Partial Nephrectomy

Purpose To determine the feasibility and safety of robotic partial nephrectomy (RPN), we compared the operative outcomes of patients who had undergone RPN with those of patients who had undergone laparoscopic partial nephrectomy (LPN). Materials and Methods Between February 2009 and June 2010, 13 patients underwent transperitoneal RPN (group 1) and 14 patients underwent transperitoneal LPN (group 2) by a single surgeon. The operative outcomes of the 2 groups were compared by using Mann-Whitney U and Fishers exact tests. Results All cases were completed successfully without conversion to open surgery. The mean operative time was 153.2±22.3 and 117.5±32.0 minutes in groups 1 and 2, respectively (p=0.003). The mean robotic console time of group 1 was 101.2±21.5 minutes, and the mean laparoscopic time of group 2 was 86.8±32.3 minutes (p=0.139). The mean warm ischemic time was 35.3±8.5 minutes and 36.4±6.8 minutes in groups 1 and 2, respectively (p=0.823). The mean estimated blood loss was 283.6±113.5 ml and 264.1±163.7 ml (p=0.382), respectively. The mean length of hospital stay was 6.1 and 5.3 days (p=0.290), respectively. The mean tumor size was 2.7±1.2 cm and 2.0±1.2 cm (p=0.035), respectively. The surgical margins were negative in all cases. Conclusions Although the operative time of RPN was longer than that of LPN, there were no significant differences in operative outcomes including robotic console time and laparoscopic time between the procedures.

Comparison of Laparoscopic Radical Nephrectomy and Open Radical Nephrectomy for Pathologic Stage T1 and T2 Renal Cell Carcinoma With Clear Cell Histologic Features: A Multi-institutional Study

OBJECTIVES To assess the oncologic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with clear cell renal cell carcinoma (RCC). METHODS We analyzed the data from 2561 patients who had undergone radical nephrectomy for RCC at 26 institutions in Korea from June 1998 to December 2007. The clinical data of 631 patients with clear cell RCC in the LRN group were compared with the clinical data of 924 patients in the ORN group. The patients with Stage pT3 or greater and those with lymph node or distant metastases were excluded to avoid a selection bias. To evaluate the technical adequacy and oncologic outcome, we compared the perioperative parameters and 5-year overall and disease-free survival rates. RESULTS The operative time was significantly longer in the LRN group than in the ORN group (219 ± 77 vs 182 ± 62 minutes, P < .001), but the estimated blood loss and complication rate were significantly lower in the LRN group than in the ORN group (P < .001 and P < .001, respectively). On univariate analysis, the LRN group had 5-year overall (93.5% vs 89.8%, P = .120) and recurrence-free (94.0% vs 92.8%, P = .082) survival rates equivalent to those of the ORN group. Even after adjusting for age, sex, T stage, tumor grade, and body mass index in a Cox proportional hazards model, statistically significant differences between the 2 groups were not found for the 5-year overall (hazard ratio 1.523, P = .157) and recurrence-free (hazard ratio 0.917, P = .773) survival rates. CONCLUSIONS Our large multi-institutional data have shown that LRN provides survival outcomes equivalent to those of ORN in patients with Stage pT1-T2 clear cell RCC.

Comparison of laparoscopic and open partial nephrectomies in t1a renal cell carcinoma: a korean multicenter experience.

Purpose 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). Materials and Methods 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. Results 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). Conclusions 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.

Congenital Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis

Purpose A seminal vesicle cyst in combination with ipsilateral renal agenesis is rarely encountered. We present cases of this disease entity with symptoms, which were treated with a laparoscopic approach as a minimally invasive surgical treatment. Materials and Methods We experienced 4 patients with seminal vesicle cysts and ipsilateral renal agenesis. The mean age was 45.8 years. Chief complaints were perineal pain and hematospermia. Seminal vesicle cysts and remnant ureters were excised by laparoscopic surgery with transperitoneal approaches. Results The mean operative time was 133.8 minutes. The mean hospital stay was 6.8 days. There were no operative complications or transfusions. Conclusion In our report, patients of congenital seminal vesicle cyst associated with renal agenesis are presented. Laparoscopy is considered a minimal invasive management of these combined anomalies, providing a good image and an easy approach.

Diagnostic Efficacy of Contrast-Enhanced Ultrasound for Small Renal Masses

Purpose Ultrasound (US) is highly sensitive in the detection of renal masses. However, it may not be able to differentiate benign and malignant lesions in smaller masses. The purpose of this study was to determine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) for small renal masses. Materials and Methods From January 2011 to December 2013, a total of 85 patients underwent CEUS for evaluation of renal masses. Of these patients, CEUS findings were retrospectively analyzed for small renal cell carcinoma (RCC) cases (n=38) and angiomyolipoma (AML) cases (n=11). The tumor echogenicity and enhancement patterns and degrees were evaluated. The diagnostic efficacy of CEUS in differentiating the two diseases was compared. Results On CEUS, the findings of diffuse heterogeneous enhancement (observed in 78.9% of RCCs and 27.3% of AMLs, p=0.003), washout from hyperenhancement or iso-enhancement to hypoenhancement in late phase (73.7% of RCCs and 18.2% of AMLs, p=0.001), and perilesional rim-like enhancement (57.9% of RCCs and 9.1% of AMLs, p=0.006) were significantly different between AML and RCC cases. The corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.8% (33/38), 63.6% (7/11), 89.2% (33/37), 58.3% (7/12), and 81.6% (40/49), respectively. Conclusions Our results suggest that the characteristic CEUS features could have diagnostic value in the evaluation of small renal mass. CEUS showed a higher diagnostic efficacy than conventional US for differentiating RCC and AML.

Laparoendoscopic single-site nephroureterectomy for upper urinary tract urothelial carcinoma: outcomes of an international multi-institutional study of 101 patients

LESS‐NU may be an alternative minimally‐invasive treatment option for patients eligible to undergo laparoscopic surgery for upper urinary tract urothelial carcinoma. The true benefits of LESS‐NU remain to be determined and require randomized control trials in the future. Despite encouraging early findings, clinical trials still are warranted before this procedure is adopted widely, and longer follow‐up is needed to determine its oncological durability.

Paratesticular mucinous cystadenocarcinoma : Metastasis from pancreatic cancer

Abstract  We experienced a case of a paratesticular mucinous adenocarcinoma from primary pancreatic cancer. A 67‐year old man presented with a scrotal mass. Scrotal ultrasound showed a cystic mass on the testis. Radical orchiectomy was performed and the tumor was revealed as a mucinous cystadenocarcinoma separated from epididymis and testis. Metastatic cancer was suspected and abdominal computed tomography showed pancreatic cancer. We report this rare case of metastatic paratesticular cystoadenocarcinoma.

Bilateral Robotic Single-Site Partial Nephrectomy

We performed bilateral robotic single-site partial nephrectomy on a 51-year-old man with bilateral renal tumors. Left partial nephrectomy without renal arterial clamping and right partial nephrectomy with a warm ischemic time of 29 minutes were performed through a single umbilical port and one additional port. The total operative time was 350 minutes including 238 minutes of robotic console time. There were no operative complications and no open conversions. Follow-up exams over a 12-month period showed no tumor recurrence. Our report shows the technical feasibility of bilateral robotic single-site partial nephrectomy.

How many cases are necessary to develop competence for laparoscopic radical nephrectomy

PURPOSE We evaluated the number of cases necessary to develop competence for performing laparoscopic radical nephrectomy (LRN) by chronologically analyzing the results of 150 cases. PATIENTS AND METHODS 150 patients were included in this study, each of whom had had pure transperitoneal LRNs between March 2003 and February 2008 performed by three surgeons who were all novices in laparoscopic surgery. Each surgeon performed 50 LRNs. These were divided into 10 groups chronologically, with five cases in each group (individual-group). Subsequently, we combined the data of the three surgeons, with 15 cases assigned to each group (combined-group). We identified the groups that demonstrated a statistically significant difference in operative time, compared with the most recent group. Based on this finding, we divided the cases into two groups: The novice group and the competent group. The complication rate, transfusion rate, and estimated blood loss were then compared between the two groups. RESULTS The total average operative time was 187.6 +/- 46.56 minutes; from group 4 onward, there was no significant decrease in the operative time. Therefore, groups 1 to 3 were defined as the novice groups, and groups 4 to 10 as the competent groups. Incidence of intraoperative complications was six (13.3%) in the novice group and nine (8.6%) in the competent group. There were 14 cases with postoperative complications--4 (8.9%) in the novice group and 10 (9.5%) in the competent group. There were significant differences in the estimated blood loss and transfusion rate between the novice and competent groups (236.4 +/- 41.85 mL vs 191.5 +/- 21.9 mL, 17.8% vs 4.8%, respectively). CONCLUSIONS Our results suggest that 15 cases are needed for a novice surgeon to achieve competence in LRN. Surgical outcomes and morbidity can be improved once this learning curve has been overcome.