Supoj Ratchanon

Remote telesurgical mentoring: feasibility and efficacy

We report our experience in performing telesurgically-mentored procedures from Baltimore, MD to Thailand, Austria, Italy and Singapore. We additionally report on a case of remote robotic manipulation using a robot designed for Percutaneons Access of the Kidney (PAKY). Telementoring was performed using a video teleconferencing platform including audio, video, real-time video telestration and remote control of the AESOP robotic arm that manipulates the laparoscopic camera. The international telementoring was achieved over 3- ISDN lines (384 Kilobytes/sec). The robotic arm and PAKY robot were controlled over a separate analog POTS line. Telecommunications links were successfully established to these remote locations that ranged in distance from approximately 4,500-11,000 miles. There was no perceptible impact of time delay on the surgical procedures. All procedures were successfully completed without additional complications. Multiple laparoscopic surgeries to include varicocelectomy (4), nephrectomy (4), adrenalectomy (1) and cholecystectomies (2) were demonstrated. Remote robotic percutaneous access to the kidney was successfully conducted within fifteen minutes from Baltimore, Maryland to Rome, Italy.

International Surgical Telementoring Using a Robotic Arm: Our Experience

To determine the clinical utility of delivering remote subspecialty surgical care using a novel telesurgical mentoring system with current telemedicine technology. A personal computer-based system ...

Increased oxidative DNA damage seen in renal biopsies adjacent stones in patients with nephrolithiasis.

Urinary excretion of 8-hydroxydeoxyguanosine (8-OHdG), a marker of oxidative DNA damage, is significantly higher in nephrolithiasis patients than in healthy individuals, indicating that these patients have higher degree of oxidative stress. In the present study, we investigated 8-OHdG expression in renal biopsies of patients with nephrolithiasis and in renal tubular cells (HK-2 cells) exposed to calcium oxalate monohydrate (COM). We performed immunohistochemical staining for 8-OHdG in renal biopsies adjacent stones obtained from 28 patients with nephrolithiasis. Controls were noncancerous renal tissues from nephrectomies of patients with renal cancer. 8-OHdG was overexpressed in the nucleus of renal tubular cells in patients with nephrolithiasis compared with controls. Only one nephrolithiasis biopsy was negative for 8-OHdG, whereas in 19 cases 8-OHdG was highly expressed. The level of expression of 8-OHdG among patients with calcium oxalate (mostly mixed with calcium phosphate) and uric acid stones was not significantly different. Increased leukocyte infiltration was observed in renal tissues from patients with nephrolithiasis. Exposure of HK-2 cells to COM caused increased intracellular reactive oxygen species and nuclear expression of 8-OHdG. To our knowledge, this is the first report of increased 8-OHdG expression in renal tubular cells of patients with nephrolithiasis. In vitro, COM crystals were capable of inducing oxidative damage of DNA in the proximal renal tubular cells.

Living-donor kidney transplantation across ABO barriers: the first case in Thailand

Background: Transplantation among ABO blood group incompatibility was considered an absolute contraindication until recent development of successful protocols. A living-donor across ABO barriers may provide another option for end-stage kidney disease patients. Objective: To report the first case of ABO-incompatible living-donor kidney transplantation (ABOi-LKT) in Thailand. Patients and method: The kidney transplantation across ABO barriers was performed following the Japanese recommended protocol. The kidney recipient was a thirty-four years old woman with blood group-O, whereas the kidney donor was her brother with blood group A. To reduce anti-donor (anti-blood group-A antibody) blood levels, the patient underwent double filtration plasmapheresis and received an intravenous anti-CD20 monoclonal antibody. A maintenance immunosuppressive regimen was similar to the one of ABO-compatible setting. Results: The kidney allograft had immediate good function. The transplantation was uneventful, and the patient went home within two weeks. Kidney allograft biopsies were performed on a protocol-driven basis at time-zero, the first and sixth month post-transplantation. Histologic studies showed unremarkable findings. The patient is now twelve months after transplantation and has achieved excellent kidney function. Conclusion: ABOi-LKT provides an alternative treatment for end-stage kidney disease patients. A multi-center study of ABOi-LKT in Thailand is ongoing, and this may change the national policy of organ donation in the near future.

Brief communication (Original). Predictive factors for postoperative complications in radical nephrectomy for renal cell carcinoma

Abstract Background: Radical nephrectomy is the treatment of choice for large renal cell carcinoma (RCC). Objectives: To describe the complications after radical nephrectomy for suspected or proven RCC and analyze the risk factors. Materials and methods: We retrospectively reviewed medical records from 110 patients who underwent radical nephrectomy for RCC in our institution between January 2007 and December 2013. The clinicopathological data of all patients were recorded and complications were graded using modified Clavien classification. Univariate and multivariate analysis was made of the predictive factors for complications. Results: Fifty postoperative complications occurred in 34 patients (31%) within 30 days, including 11% transfusion related complications. There were 22% minor complications (6% grade 1, 16% grade 2) and 9% major complication (5% grade 3, 2% grade 4, and 2% grade 5). The most common complications were transfusion-related, re-laparotomy because of bleeding, and prolong ileus. In univariate analysis, pathological T-stage (P = 0.001), American Society of Anesthesiologists (ASA) score (P = 0.007), tumor size (P = 0.01), and tumor diameter >4 cm (P = 0.03) were significant predicting factors. Major Charlson comorbidity index (CCI >2) was the only significant factor for major complications (P = 0.04). In multivariate analysis, ASA score was a significant independent predictor for overall complications (odds ratio 4.83, P = 0.01). Conclusions: ASA score was a significant predictive factor for overall postoperative complications. Comorbidities was also a predictor for major complications in radical nephrectomy. Preoperative risk stratification for complications should be considered during decision-making and for proper counseling of patients.