Publications by authors named "Hassan Alzahrani"

25 Publications

  • Page 1 of 1

Trends in the surgical management of renal cell carcinoma in a contemporary tertiary care setting.

Urol Ann 2021 Apr-Jun;13(2):111-118. Epub 2021 Mar 4.

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Background: In the last three eras, the incidence of renal cell carcinoma (RCC) has increased, due to increased radiological studies. The expected 5-year survival rate has become better, associated with the identification of small size renal masses. However, this survival improvement may be secondary to improved surgical techniques and medical therapies for these malignancies.

Objectives: The objective was to report the trends of clinical presentation, peri-operative, oncological outcomes, and surgical management trends for RCCs over the period.

Methods: After Institutional Review Board approval, a retrospective study for adult patients was conducted, who presented with renal mass and were managed between 2008 and 2019. Variables, including demographics, perioperative and pathological outcomes analyzed using descriptive statistics for continuous variables reported as mean ± standard deviation and categorical variables values compared by Chi-square test. Survival Analysis calculated using the Kaplan-Meier method. The level of significance is set at P-value < 0.05.

Results: A total of 588 patients underwent surgical treatment for kidney cancer from January 2008 to January 2019. 237 (40.30%) were females and 351 (59.69%) males. The clinical presentation was higher as an incidental diagnosis of 58.67%. 71.25% of patients were from outside Riyadh city. Pathology was mostly clear cell RCC 61.22% and grade 2 (57.48%). Tumor size, surgery time, and length of hospital stay showed a significant difference between the three periods (both > 0.05). Robotic surgery performed more than open ( < 0.0001). There was no significant difference in the survival time, when compared to patients by the regions and when compared by the primary tumors (Log-Rank = 0.4821). Patients from the Riyadh region (median = 54.0) had a significantly higher recurrence time (Log-Rank < 0.0001).

Conclusion: There was a rising trend in the incidence of RCC associated with comorbidities and incidental diagnosis. In our study period we found increase in the trend of minimal invasive approach. The size of the tumor, blood loss and operative time decreases over the period of time. The Robotic assisted nephrectomy approach has become increased over the period of time duration in present study.
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http://dx.doi.org/10.4103/UA.UA_151_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210727PMC
March 2021

Metastasectomy of Sequential Asynchronous Metastatic Renal Cell Carcinoma to the Pancreas, Thyroid, Skin, Contralateral Kidney, and Lung with Cumulative Survival Beyond 10 Years: A Case Report and Clinicopathologic Review.

Am J Case Rep 2021 May 6;22:e931696. Epub 2021 May 6.

Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

BACKGROUND One-third of renal cell carcinoma cases present with an initial metastasis to various organs, emphasizing the tumor's unpredictable behavior. Prognosis is poor once metastasis is discovered. Multiple-organ involvement with metastatic lesions has a particularly dismal survival rate. Surgical resection alone of metastatic masses can extend patient survival with reasonable quality of life. CASE REPORT Here, we present the case of a healthy 46-year-old woman who initially presented with an incidental localized clear cell renal cell carcinoma. During the follow-up period, she presented with sequential asynchronous metastasis to the pancreas, thyroid, skin, contralateral kidney, and lung. She has no family history of malignancy. Her physical examination and laboratory investigations were normal even upon presentation of most of her metastatic organs. The first metastasis was in her sixth year of follow-up. She underwent consecutive metastasectomy of all the organs described above, excluding the lung. She eventually was started on sunitinib after non-resectable lung nodules were discovered. Her survival is now over 10 years since her first metastasectomy, with good performance status. CONCLUSIONS Metastasis to a single organ has a poor prognosis and dramatically affects survival. Nevertheless, our patient had multiple consecutive examples of metachronous metastasis, yet she has survived for over a decade since the occurrence of metastasis. Our case offers more information to fill the gaps in understanding the favorable role of surgical resection in advanced renal cell carcinoma metastasis.
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http://dx.doi.org/10.12659/AJCR.931696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112462PMC
May 2021

Postintubation Tracheal Perforation While on Long-Term Steroid Therapy: A Case Report.

J Emerg Med 2021 Mar 9;60(3):380-383. Epub 2020 Dec 9.

Intensive Care Unit, Security Forces Hospital, Riyadh City, Kingdom of Saudi Arabia.

Background: Endotracheal intubation is an essential basic skill for emergency physicians. The procedure can cause complications that should be recognized. Awareness and early identification of complications are needed to allow early intervention to optimize outcomes. The risk factors for tracheal perforation during intubation are typically related to the physician skill and experience and to the patient's comorbidities, including body habitus and chronic use of certain medications.

Case Report: We report a case of a 45-year-old man with renal transplant on tacrolimus and prednisolone for 16 years. He presented with decreased level of consciousness due to an acute intracranial hemorrhage and was intubated for airway protection. Post intubation, a significant subcutaneous emphysema was noted on the patient's neck and chest, which was subsequently determined to be caused by a tracheal perforation. The management of tracheal injury depends on the size and location of the tear, as well as the patient's clinical status and comorbidities. In this case, the tracheal perforation was treated conservatively and was successful. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case has been reported to increase awareness about this rare and potentially life-threatening event. The prevention of this rare injury can be difficult but use of a slightly smaller endotracheal tube in a high-risk patient can be of benefit. In addition, early consideration of this complication when there is an acute change in physiologic status will allow for rapid facilitated management.
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http://dx.doi.org/10.1016/j.jemermed.2020.11.001DOI Listing
March 2021

Tubulocystic renal cell carcinoma with poorly differentiated foci and loss of fumarate hydratase: A case report.

Urol Case Rep 2020 Nov 28;33:101236. Epub 2020 May 28.

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Tubulocystic renal cell carcinoma (RCC) is one of the newly recognized subtypes of RCC. It has a unique cystic morphology and indolent behavior. During the last decade, few studies have been published describing tubulocystic RCC with poorly differentiated foci. A subset of these cases are associated with loss of fumarate hydratase which is a characteristic feature of hereditary leiomyomatosis and renal cell carcinoma-associated RCC. However, these two entities represent two distinct subtypes of RCC in the recent WHO Classification of kidney tumors. Herein, we are describing a rare case of tubulocystic renal cell carcinoma with poorly differentiated foci and loss of fumarate hydratase.
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http://dx.doi.org/10.1016/j.eucr.2020.101236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573761PMC
November 2020

The potential mitigation effect of ZnO nanoparticles on [ L. Moench] metabolism under salt stress conditions.

Saudi J Biol Sci 2020 Nov 6;27(11):3132-3137. Epub 2020 Aug 6.

Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.

Salt stress is known to be momentous abiotic stress which treats agricultural lands and crop production throughout the world and effects the system of food security. The current study aims to investigate the effect of foliar application of 10 mg/l of zinc oxide (ZnO) as a bulk or as a green synthesized nanoparticle (ZnO-NPs) which were hexagonal and spherical in shape and at size 16-35 nm to alleviate the impact of salinity concentrations (0, 10, 25, 50, 75 and 100% SW) on Okra ( L. Moench cv. Hasawi) species. The results demonstrated a gradual decrease in the photosynthetic pigments (i.e., chlorophyll and b with total chlorophylls and carotenoids) with the growth of salinity conc. However, the sea water levels between 0 and 75% will led to increase in proline, total soluble sugar and activity of the antioxidant enzymes i.e., superoxide dismutase (SOD) and catalase (CAT) and then decrease at 100% SW. The addition of bulk ZnO or ZnO-NPs enhances the contents of the photosynthetic pigments, activity of both SOD and CAT and then lowers the accumulation of proline and total soluble sugar when equated with controls. Plants treated with ZnO-NPs showed the greatest results when compared with other treatments. The results of current study showed ZnO-NPs as an appropriate eco-friendly and low-cost application for plant growth under salinity which has an ability to moderate the salt stress effect of plants.
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http://dx.doi.org/10.1016/j.sjbs.2020.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569121PMC
November 2020

Patients' perceptions and preferences for physicians' attire in hospitals in south western Saudi Arabia.

J Family Med Prim Care 2020 Jun 30;9(6):3119-3123. Epub 2020 Jun 30.

Medical Intern, College of Medicine, King Khalid University, Abha, Saudi Arabia.

Purpose: Data regarding patients' perception and satisfaction about physicians providing the medical care based on their attires in Southern Region of Saudi Arabia are scarce and even lacking. The aim of this study was to assess the patients' opinion regarding the suitable attires of physicians.

Materials And Methods: A descriptive cross-sectional survey was performed on a random sample of patients from Aseer Central Hospital, Southern Military Hospital and Abha Maternity Hospital. The questionnaire collected data on their perception of physicians' attire as well as reflection of dress on trust and willingness to discuss personal issues.

Results: The study included 248 patients. The majority (81.9%) of the participants agreed on the importance for physicians to wear their medical attires. Also 84.3% of them confirmed that physician's appearance is important source of their confidence. Skirt plus lab coat was the most favored for female physicians (39.3%). As for male physicians, scrub plus lab coat was the most preferred (33.6%) attire.

Conclusion: Patients attending hospitals in southwestern Saudi Arabia preferred for their physicians to wear formal attire with white coats, rather than the Saudi national dress. Skirt plus lab coat was the most preferred for female physicians. As for male physicians, scrub plus lab coat was the most preferred attire. Patients approved the importance for physicians to wear their medical attires and confirmed that physician's appearance is important source for their confidence. The study recommends that physicians should adopt formal attire and the institutional dress code policy should be modified to fit these preferences.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_166_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491852PMC
June 2020

The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer.

Sci Rep 2020 08 10;10(1):13495. Epub 2020 Aug 10.

Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Flexible cystoscopy under local anaesthesia is standard for the surveillance of bladder cancer. Frequently, several reusable cystoscopes fail to reprocess. With the new grasper incorporated single-use cystoscope for retrieval of ureteric stents, we explored the feasibility of using it off-label for diagnosis and the detection of bladder cancer. Consecutive diagnostic flexible cystoscopies between Mar 2016 and Nov 2018 were reviewed comparing the reusable versus the disposable cystoscopes. A total of 390 patients underwent 1211 cystoscopies. Median age was 61.5 years (SD 14.2, 18.8-91.4), males 331 (84.9%) and females 59 (15.1%). Indication for cystoscopy was prior malignancy in 1183 procedures (97.7%), haematuria 19 (1.6%) or bladder mass 7 (0.6%). There were 608 reusable and 603 disposable cystoscopies. There was no significant difference between groups at baseline in age, sex, BMI, smoking status, or prior tumor risk category. There was no significant difference in positive findings (123/608, 20.2% vs 111/603, 18.4%, p = 0.425) or cancer detection rates (95/608, 15.6% vs 88/603, 14.4%, p 0.574) among the two groups, respectively. We conclude that the disposable grasper integrated cystoscope is comparable to reusable cystoscope in the detection of bladder cancer.
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http://dx.doi.org/10.1038/s41598-020-70424-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417573PMC
August 2020

Surgical and oncological outcome after laparoscopic versus open nephroureterectomy for non-metastatic, upper-tract urothelial carcinoma. A single-centre experience.

Saudi Med J 2020 Jan;41(1):25-33

Department of Urology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: We determined the surgical and oncological outcomes of laparoscopic nephroureterectomy (LNU) in comparison to open nephroureterectomy (ONU) and factors predicting bladder recurrence after nephroureterectomy. Methods: We retrospectively reviewed and compared the data of patients who underwent ONU or LNU for non-metastatic, upper-tract urothelial carcinoma from 2000 to 2016. The primary endpoint was to determine bladder cancer recurrence-free survival (BCRFS), cancer-specific survival (CSS), and overall survival (OS). The data were analysed using Student's t-test, Chi-square test, and Kaplan-Meier curve. Results: Total of 50 patients, of which 24 had LNU and 26 had ONU, met the inclusion criteria. Median durations of follow-up were 4.2 and 6.5 years (p=0.1070) in LNU and ONU, respectively. Operative time, blood loss and hospital stay were significantly lower in the LNU group than in the ONU group (p=0.0001, p=0.0001, p=0.0018). Cancer-specific survival rate in the LNU was 75% and ONU was 73.3% (p=0.1902), whereas BCRFS and CSS were not significantly different in both groups (log-rank test; BCRFS: p=0.809 and CSS: p=0.802). Patients who underwent ureteroscopy with biopsy (p=0.001), had multifocality (p=0.001) and previous history of (H/O) bladder cancer (p=0.020) were at significant risk for developing bladder cancer recurrence after nephroureterectomy.  Conclusion: Laparoscopic nephroureterectomy can benefit patients because of its minimal invasiveness, and oncologic outcomes are comparable to ONU. Preoperative ureteroscopy with biopsy, multifocality and previous H/O bladder cancer might be risk factors for bladder cancer recurrence.
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http://dx.doi.org/10.15537/smj.2020.1.24780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001069PMC
January 2020

Gold nanoparticles immobilised in a superabsorbent hydrogel matrix: facile synthesis and application for the catalytic reduction of toxic compounds.

Chem Commun (Camb) 2020 Jan;56(8):1263-1266

Department of Chemistry, Britannia House, King's College London, London, SE1 1DB, UK.

Two methods are reported for the one-pot preparation of high concentrations of gold nanoparticles (AuNPs) embedded throughout sodium polyacrylate hydrogels; this stabilises the AuNP in even extremely high ionic strength environments, and enables them to act as effective catalysts for the hydride-reduction of nitrophenols and of dyes, with zero order kinetics.
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http://dx.doi.org/10.1039/c9cc07046jDOI Listing
January 2020

Operative outcomes of robotic partial nephrectomy. A report of the first 101 cases from a single center in Saudi Arabia.

Saudi Med J 2019 Jan;40(1):33-40

Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: To report robotic partial nephrectomy (RPN) outcomes from a single tertiary hospital in Saudi Arabia. Methods: We retrospectively reviewed consecutive cases of patients undergoing RPN at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of  Saudi Arabia, between January 2008 and January 2018. The study reports patient's demographics, tumor characteristics, operative details, and perioperative outcomes, using descriptive statistics of median and range values. Results: One hundred and one patients underwent RPN during the study period. Average tumor size was 3 (1.3-6.4) cm and average radius exophytic nearness anterior/posterior location (RENAL) score was 6 (4-10). Perioperative parameters were blood loss 200 (5-1500) ml and warm ischemia time 17 (8-40) minutes, excluding off-clamp surgery in 12 (11.9%); operative time was 166 (66-381) minutes. Conversion to open partial nephrectomy occurred in 9 (8.9%) patients, major complications in 3 (3%) patients, positive surgical margins in 5 (5%) patients, and the hospital stay was 4 (2-14) days. A total of 73 (73%) patients achieved a trifecta of freedom from any complication, negative surgical margins, and ischemia time ≤25 minutes. Study limitations included the retrospective design and small cohort size. Conclusions: The initial experience of robotic partial nephrectomy was associated with a surgical outcome comparable to that reported by higher-volume centers.
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http://dx.doi.org/10.15537/smj.2019.1.22782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452606PMC
January 2019

Imaging Approach to the Diagnosis of Acute Appendicitis in a Group of Teaching Hospitals With 24/7 In-house Availability of Ultrasound Technologist: Effect of Timing of Request on Imaging Modality.

Can Assoc Radiol J 2018 Aug 27;69(3):311-315. Epub 2018 Jun 27.

Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Purpose: The study sought determine effect of requisition timing on the initial-choice imaging modality in appendicitis evaluation.

Methods: This was an institutional review board-approved retrospective study, encompassing 3 University of Toronto teaching hospitals, offering 24/7 radiology coverage. All surgically proven appendicitis cases, from 2012-2014, were included and presurgical ultrasound (US) or computed tomography (CT) reports were analysed. Examinations were all requested by the emergency department, performed by the same technologists and reviewed or finalized by the same radiology group (residents fellows or attending). Two coverage categories, namely regular hours (8 am-5 pm, Monday-Friday) or after hours (5 pm-8 am, Monday-Friday and weekends) were compared. The percentage of the starting modality (US or CT), the rate of CT following an indeterminate US, and the sensitivity of each modality was compared between the 2 categories, utilising Mann-Whitney U and chi-square tests.

Results: Presurgical US or CT studies of 494 patients, from February 2012-August 2014, were evaluated. Regular-hours and after-hours coverage demonstrated 174 (89:85 women:men) and 320 (141:179 women:men; P < .04) patients. The average age, 37.9 ± 17.1 women versus 35.2 ± 13.7 men was not statistically different (P = .8). Regular hours included 89 of 174 (51.1%) of US-only examinations, 50 of 174 (29%) of CT-only examinations, and 35 of 174 (20%) of US examinations followed by CT examinations. After hours included 147 of 320 (46%) of US-only examinations, 147 of 320 (46%) of CT-only examinations, and 26 of 320 (8%) of US examinations followed by CT examinations (P < .001). The total diagnostic sensitivities for US and CT were 86% (81% regular hours, 90% after hours; P = .041) and 99.2% (100% regular hours, 99% after hours; P > .05), respectively.

Conclusions: US was less utilised in acute appendicitis detection after hours, although its diagnostic sensitivity was better than regular-hours coverage.
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http://dx.doi.org/10.1016/j.carj.2018.03.002DOI Listing
August 2018

An ectopic intrathyroidal thymic tissue and intrathymic parathyroid tissue in a patient with Graves disease.

Gland Surg 2017 Dec;6(6):726-728

Department of Surgery, Division of Endocrine and Oncologic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.

Ectopic intrathyroidal thymic tissue, with coinciding intrathymic parathyroid tissue, is a very rare occurrence that is most often found incidentally in adults during surgery. We report a 23-year-old female who presented with Graves disease refractory to medical treatment. Radioactive iodine uptake demonstrated increased, diffuse uptake in the region of the thyroid. The patient underwent a total thyroidectomy and right inferior parathyroidectomy which was found enlarged intraoperatively. Histopathologically, surgical specimen demonstrated characteristics of intrathyroidal thymic tissue and intrathymic parathyroid tissue. Intrathyroidal thymic tissue can be identified preoperatively on ultrasonography, but the significance of this finding is unknown.
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http://dx.doi.org/10.21037/gs.2017.08.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750306PMC
December 2017

Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model.

Gland Surg 2017 Dec;6(6):611-619

Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA.

Background: Numerous new approaches have been described over the years to improve the cosmetic outcomes of thyroid surgery. Transoral approach is a new technique that aims to achieve superior cosmetic outcomes by concealing the incision in the oral cavity.

Methods: Transoral thyroidectomy through vestibular approach was performed in two institutions on cadaveric models. Procedure was performed endoscopically in one institution, while the robotic technique was utilized at the other.

Results: Transoral thyroidectomy was successfully performed at both institutions with robotic and endoscopic techniques. All vital structures were identified and preserved.

Conclusions: Transoral thyroidectomy has been performed in animal and cadaveric models, as well as in some clinical studies. Our initial experience indicates the feasibility of this approach. More clinical studies are required to elucidate its full utility.
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http://dx.doi.org/10.21037/gs.2017.10.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750317PMC
December 2017

The Risks of Renal Angiomyolipoma: Reviewing the Evidence.

J Kidney Cancer VHL 2017 16;4(4):13-25. Epub 2017 Oct 16.

Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Renal angiomyolipoma (RAML), though a rare benign tumor, may impose a significant morbidity or even mortality due to its unique characteristics and the complications subsequent to its treatment. The classic tumor variant is composed of smooth muscular, vascular, and fatty components. The most straightforward diagnosis is when the fat component is abundant and gives a characteristic appearance on different imaging studies. In fat-poor lesions, however, the diagnosis is difficult and presumed a renal cell carcinoma. Yet, some variants of RAML, though rare, express an aggressive behavior leading to metastasis and mortality. The challenge lies in the early detection of benign variants and identifying aggressive lesions for proper management. Another challenge is when the vascular tissue component predominates and poses a risk of hemorrhage that may extend to the retroperitoneum in a massive life-threatening condition. The predicament here is to identify the characteristics of tumors at risk of bleeding and provide a prophylactic treatment. According to the clinical presentation, different treatment modalities, prophylactic or therapeutic, are available that span the spectrum of observation, embolization, or surgery. Renal impairment may result from extensive tumor burden or as a complication of the management itself. Improvement of diagnostic techniques, super-selective embolization, nephron-sparing surgery, and late treatment with the mammalian target of rapamycin inhibitors have provided more effective and safe management strategies. In this review, we examine the evidence pertaining to the risks imposed by RAML to the patients and identify merits and hazards associated with different treatment modalities.
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http://dx.doi.org/10.15586/jkcvhl.2017.97DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644357PMC
October 2017

Robotic transaxillary parathyroidectomy.

Gland Surg 2017 Aug;6(4):410-411

Department of Surgery, Tulane University School of Medicine, New Orleans, USA.

We recently reported on the safety and feasibility of robotic transaxillary approaches for parathyroid surgeries with benefit of avoiding a visible cervical scar. Herein, we demonstrate our technique with utilization of intraoperative nerve monitoring and indocyanine green (ICG) imaging. The patient was discharged a few hours after the surgery.
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http://dx.doi.org/10.21037/gs.2017.04.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566671PMC
August 2017

Gasless trans-axillary robotic thyroidectomy: the technique and evidence.

Gland Surg 2017 Jun;6(3):236-242

Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.

Robot assisted thyroid surgery has the advantage of a superior field vision and technical advancements of robotic technology that have permitted novel remote access thyroid surgical approaches. Gasless trans-axillary robot-assisted thyroidectomy has been proved to be among the most current feasible approaches. This approach offers an excellent cosmetic outcome, with comparable outcomes to conventional surgical approaches. This review aims to provide details of this specific remote access technique for thyroid resection with most recent evidences in the literature.
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http://dx.doi.org/10.21037/gs.2017.06.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503928PMC
June 2017

Neuroendocrine tumor of the appendix inside an incarcerated Amyand's hernia.

Int J Surg Case Rep 2015 5;14:152-5. Epub 2015 Aug 5.

Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City (KAMC), Riyadh 11426, Saudi Arabia.

Amyand's hernia is a rare type of hernia where the vermiform appendix is within an inguinal hernia sac. Tumors of the appendix are quite uncommon. The coincidence of an Amyand's hernia with neuroendocrine tumor of the appendix, as in our case, is even more rarely reported. We report the case of an 81-year-old male who presented with an incarcerated right inguinal hernia. After resuscitation, the clinical diagnosis was confirmed by computed tomography. It showed an incarcerated right inguinal hernia which contained the distal ileum, cecum, thickened appendix, as well as a small amount of fluid. Subsequently, the patient was prepared for emergency surgery. During the operation, the hernia sac was found and opened. The appendix was swollen. Therefore, appendectomy was performed. The inguinal defect was repaired using the Modified Bassini Technique. The patient had an uneventful postoperative recovery and surprisingly the histopathology of the appendix revealed a 1.5cm well-differentiated low grade neuroendocrine tumor (carcinoid) of the appendix tip. An incidental finding of neuroendocrine tumor of the appendix in a patient with s hernia is extremely rare. A high index of suspicion is the key to diagnose such a coincidence in order to safely and optimally treat such a condition.
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http://dx.doi.org/10.1016/j.ijscr.2015.07.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573861PMC
September 2015

Cervical thymic cyst in an adult.

Case Rep Surg 2014 4;2014:801745. Epub 2014 May 4.

Department of Surgery, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia.

Cervical thymic cysts (CTCs) are unusual lesions, representing only 1% of cystic cervical masses. Diagnosis of this condition in adults is even rarer. We report a 34-year-old female who presented with asymptomatic progressively growing left-sided neck swelling. Neck ultrasound (US) showed a large cystic lesion with septation, compressing the ipsilateral vessels. Magnetic resonance imaging (MRI) confirmed the US findings. Surgical excision was performed which subsequently showed findings consistent with CTC. CTC in adult is extremely rare, with few reported cases identified in the literature. Thymic gland anomalies in the neck are the consequences of an arrest in the descent of the gland, sequestration of the thymic tissue, or failure of involution. The diagnosis of this condition is rarely done prior to surgical excision. The clinical presentation, radiologic imaging, surgical findings, and histologic appearance are all essential components to make the correct diagnosis of this very rare differential diagnosis of cystic lateral neck swelling.
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http://dx.doi.org/10.1155/2014/801745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024415PMC
May 2014

Gallbladder agenesis with a primary choledochal stone in a patient with situs inversus totalis.

Am J Case Rep 2014 2;15:185-8. Epub 2014 May 2.

Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Patient: Female, 68 FINAL DIAGNOSIS: Gallbladder agenesis with situs inversus totalis Symptoms: Epigastric pain • jaundice

Medication: - Clinical Procedure: - Specialty: Surgery.

Objective: Rare disease.

Background: Situs inversus totalis is an inherited condition characterized by the mirror-image transposition of thoracic and abdominal organs. Gallbladder agenesis, which has normal bile ducts, is a rare congenital condition that occurs in 13 to 65 people out of 100 000. A common bile duct (CBD) stone or choledocholithiasis in patients with gallbladder agenesis is even rarer.

Case Report: We report the case of a 68-year-old woman who presented with epigastric pain and jaundice. She was not known to have situs inversus totalis. Abdominal ultrasound showed a large stone in the CBD, which could not be extracted by endoscopic retrograde cholangiopancreatography (ERCP), necessitating exploration. The gall-bladder and cystic duct were found to be absent. Incisional exploration of the CBD was performed, and a large stone was removed. A choledochoscope was used to identify the remnants and exclude the presence of ectopic gallbladder, and a T-tube was placed into the CBD.

Conclusions: Gallbladder agenesis in a patient with situs inversus totalis is extremely rare, with no single reported case identified in the literature. In addition, our case showed a rare complication of ERCP - a failure to extract the CBD stone - and illustrates a way to overcome this complication.
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http://dx.doi.org/10.12659/AJCR.890523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010620PMC
May 2014

Robotic partial cystectomy for lymphangioma of the urinary bladder in an adult woman.

Can Urol Assoc J 2012 Feb;6(1):E8-E10

Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh Saudi Arabia; and Professor of Urology, Faculty of Medicine, Suez Canal University, Ismailia Egypt;

Lymphangioma of the urinary bladder is a very rare tumour in adulthood. Robotic partial cystectomy is evolving for treatment of a limited number of bladder tumours. We describe a case of an adult woman with a bladder dome lymphangioma for which robotic partial cystectomy was carried out.
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http://dx.doi.org/10.5489/cuaj.10103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289710PMC
February 2012

Changing trends in presentation, diagnosis and management of renal angiomyolipoma: comparison of sporadic and tuberous sclerosis complex-associated forms.

Urology 2008 Nov 21;72(5):1077-82. Epub 2008 Sep 21.

Department of Urology, Suez Canal University Faculty of Medicine, Ismailia, Egypt.

Objectives: To evaluate the changing management of sporadic renal angiomyolipoma and renal angiomyolipoma associated with the tuberous sclerosis complex (TSC) during the past 16 years.

Methods: We retrospectively reviewed the charts of 60 patients with angiomyolipoma seen at our institutions.

Results: The median age at presentation was 45 years (range 7-78). The presentation was pain in 30 patients and hematuria in 13; it was incidentally discovered in 17 patients. Of the 60 patients, 43 were females. TSC was present in 14 patients. The median tumor size was 4 cm (range 0.3-40, mean 6.5 +/- 1.1). Of the 60 patients, 31 were followed up expectantly. Surgery or intervention was needed for 29 patients to control hemorrhage or relieve pain or because of the suspicion of malignancy. Of these 29 patients, 12 underwent nephrectomy, 11 partial nephrectomy, and 6 embolization. The patients treated for hemorrhage had a median tumor diameter of 11 cm (range 2-21). Patients were followed up for a mean of 39.3 +/- 5.4 months. The lesions grew an average of 4.7 +/- 3.4 cm for TSC tumors and 0.6 +/- 0.2 cm for sporadic angiomyolipoma tumors. None of the patients developed renal impairment. Patients with TSC presented at a younger age, had larger and bilateral lesions, and were more symptomatic during follow-up. In the past 6 years, a significant trend was seen toward finding tumors in asymptomatic patients and toward the use of conservative or interventional (embolization) treatment.

Conclusions: Renal angiomyolipoma has a slow growth rate. The preservation of renal function was noted in all our patients. A recent shift was noted toward finding smaller tumors in asymptomatic patients and the use of conservative and interventional treatment.
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http://dx.doi.org/10.1016/j.urology.2008.07.049DOI Listing
November 2008
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