Publications by authors named "Noriyuki Makita"

17 Publications

  • Page 1 of 1

Two cases of immunoglobulin G4-related disease diagnosed by transvaginal urethral needle biopsy.

IJU Case Rep 2021 Sep 8;4(5):282-284. Epub 2021 Jun 8.

Department of Urology Kobe City Medical Center General Hospital Kobe Hyogo Japan.

Introduction: Immunoglobulin G4-related disease is a systemic disease characterized by multifocal systemic involvement. We report two cases of women diagnosed with immunoglobulin G4-related disease in the urethra.

Case Presentation: Case 1: A 67-year-old woman presented with discomfort around her perineum. Magnetic resonance imaging revealed a well-defined mass around the urethra. She underwent an ultrasound-guided core needle biopsy of the mass. The pathologic specimen showed immunoglobulin G4 positive cells. Steroid therapy was initiated, causing improvement of symptoms, decreased serum immunoglobulin G4 levels, and shrinking of the mass. Case 2: An 89-year-old woman was accidentally diagnosed with renal pelvic wall thickening on computed tomography. The pathologic specimen captured by ultrasound-guided needle biopsy showed immunoglobulin G4 positive cells. She had no symptoms and received no medical treatment.

Conclusion: The frequency of urethral mass formation in female patients with immunoglobulin G4-related disease may also be high, and an echo-guided transvaginal urethral biopsy may be performed as a definitive diagnostic tool for immunoglobulin G4-related disease.
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http://dx.doi.org/10.1002/iju5.12325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413223PMC
September 2021

[Risk Factors for Recurrence in Patients with Pathological Lymph Node-Positive Prostate Cancer after Extended Lymph Node Dissection in Laparoscopic and Robotic-Assisted Radical Prostatectomy].

Hinyokika Kiyo 2021 Mar;67(3):83-90

The Department of Urology, Kobe City Medical Center General Hospital.

From April 2007 to April 2018, we performed lymph node dissection in 305 cases of laparoscopic radical prostatectomy and 202 cases of robot-assisted radical prostatectomy at our hospital, and there were 68 cases with positive lymph node metastasis (pN1). Of these 68 cases, we examined retrospectively 62 cases in which extended lymph node dissection (ELND) was performed. The median number of removed lymph nodes was 25 (interquartile range [IQR] ; 18-34) and the median number of metastatic lymph nodes was 1 (IQR ; 1-3). Postoperative prostate-specific antigen (PSA) recurrence was observed in 40 of the 62 patients. The median time to PSA recurrence was 24 months. After univariate analysis, PSA at initial diagnosis (iPSA) of 10 ng/ml or more, pathological Gleason score (pGS) of 8 or more, total number of lymph node metastases of 2 or more, and positive surgical margin (RM+) were found to be riskfactors of PSA recurrence. In multivariate analysis, iPSA of 10 ng/ml or more, pGS of 8 or more and RM+ were independent riskfactors of PSA recurrence (p<0.05). In the cases without riskfactors such as iPSA≥10, pGS≥8, and RM+, immediate postoperative adjuvant therapy may be avoided even with pN1.
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http://dx.doi.org/10.14989/ActaUrolJap_67_3_83DOI Listing
March 2021

[Simple Methods to Prevent Postoperative Inguinal Hernia after Extraperitoneal and Transperitoneal Robot-Assisted Radical Prostatectomy].

Hinyokika Kiyo 2020 Oct;66(10):331-335

The Department of Urology, Kobe City Medical Center General Hospital.

Herein we present simple methods to prevent postoperative inguinal hernia (IH) after extraperitoneal and transperitoneal robot-assisted radical prostatectomy (RARP). Among 275 patients who underwent RARP between January 2014 and December 2016 at our institution, we evaluated 143 and 115 patients who underwent extraperitoneal-RARP (e-RARP) and transperitoneal-RARP (t-RARP), respectively, after excluding those with intraoperative detection of IH (17 patients). In the e-RARP group, all 143 patients (286 groins) underwent an IH prevention procedure. In the t-RARP group, the first 22 patients (44 groins) did not undergo an IH prevention procedure, whereas 29 patients (37 groins) with patent processus vaginalis (PPV) among the last 93 patients underwent the procedure. The IH prevention procedure during e-RARP included release of the vas deferens from the peritoneum and spermatic cord, and peritoneal dissection of the spermatic cord at the internal inguinal ring. The IH prevention procedure during t-RARP included release of the vas deferens from the peritoneum and spermatic cord, complete circumferential dissection of the peritoneum around the PPV at the level of the internal inguinal ring, and ligation of the PPV with a Hem-o- Loc○R clip. In the e-RARP group, postoperative IH occurred in 3 of the 143 patients (1.9%) during the follow-up period of 22.0±9.2 months. In the first subgroup of t-RARP, postoperative IH developed in 4 of the 22 patients (18%) during the follow-up period of 33.1±12.1 months, whereas in the last t-RARP group, postoperative IH developed in 3 of the 93 patients (3.3%) during the follow-up period of 20.1±8.6 months. Different IH prevention procedures performed in patients undergoing e-RARP and t-RARP were simple and effective in preventing postoperative IH.
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http://dx.doi.org/10.14989/ActaUrolJap_66_10_331DOI Listing
October 2020

Effect of Continued Perioperative Anticoagulant Therapy on Bleeding Outcomes Following Robot-assisted Radical Prostatectomy.

Urology 2021 Feb 25;148:151-158. Epub 2020 Nov 25.

Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan.

Objective: To assess the impact of continued perioperative anticoagulant drug administration on bleeding and complications in patients undergoing robot-assisted radical prostatectomy.

Methods: Between January 2014 and January 2020, 620 patients with prostate cancer underwent robot-assisted radical prostatectomies and were retrospectively reviewed. Fourteen patients who discontinued antithrombotic therapy were excluded. Among the 606 included patients, 31 continued anticoagulant therapy during the perioperative phase (anticoagulant group). The anticoagulant group outcomes were compared with those of patients who continued clopidogrel and prasugrel (thienopyridine group = 13), aspirin monotherapy (aspirin group = 61), and no chronic antithrombotic agent (control group = 501). The primary outcome was the incidence of bleeding complications requiring transfusion, additional intervention, or readmission. Secondary outcomes were the incidence of thrombotic complications, estimated blood loss, and overall complication rates.

Results: Among the 31 patients in the anticoagulant group, 20 (65%) used directed oral anticoagulants, 11 (35%) used warfarin, and 5 used combined aspirin. Only 1 (3%) patient in the anticoagulant group required postoperative transfusion, and none required additional interventions or readmission. No significant differences were detected between the anticoagulant and other groups (anticoagulant vs thienopyridine, aspirin, and control groups) regarding bleeding complications (3% vs 8%, P = .51; 0%, P = .34; 0.4%, P = .17, respectively), thrombotic complications (3% vs 0%, P = .70; 2%, P = .56; 0.2%, P = .11, respectively), estimated blood loss (200 vs 100 mL, P = .63; 175 mL, P = .64; 165 mL, P = .74, respectively), or other high-grade complications (6% vs 0%, P = .49; 2%, P = .26; 3%, P = .24, respectively).

Conclusion: Perioperative continuation of anticoagulant use is feasible for patients undergoing robot-assisted radical prostatectomy.
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http://dx.doi.org/10.1016/j.urology.2020.08.095DOI Listing
February 2021

[Necessity of Pelvic Drain Placement after Robot-Assisted Radical Prostatectomy].

Hinyokika Kiyo 2020 Sep;66(9):283-287

The Department of Urology, Kobe City Medical Center General Hospital.

Sixty eight patients had robot-assisted radical prostatectomy (RARP) from January 2016 to April 2017 with estimated blood loss of less than 500 ml. We compared the postoperative complication rates and the length of hospital stay between 34 of these patients who had pelvic drain placement (PD group), and the remaining 34 patients who had no drain placement (ND group). The approach was intraperitoneal in 25 patients in each group. The PD and ND groups were comparable for age (69.5 vs 70 yrs, P=0.459), clinical Gleason Score (6/7/≧8) 2/17/15 vs 3/8/23 (P=0.077), clinical stage (1c/2/3) 3/25/6 vs 1/25/8 (p=0. 539), operative time (311 vs 309 min, P=0.868), and estimated blood loss (p=0.166). The PD group had significantly higher median PSA level than the ND group (8.01 vs 6.25 ng/ml, P=0.023). Incidence of 30- day overall complications in the PD group (35 events) was lower than that in the ND group (38 events). All complications were classified as Clavien Dindo grade I. The postoperative hospital stay was 8 days in the PD group and 7 days in the ND group, showing no prolongation in the ND group. Pelvic drainage may be omitted after RARP without increasing postoperative complications or prolonging the hospital stay.
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http://dx.doi.org/10.14989/ActaUrolJap_66_9_283DOI Listing
September 2020

Atypical oncologic failure after laparoscopic and robot-assisted radical cystectomy at a single institution.

Int J Clin Oncol 2020 Jul 18;25(7):1385-1392. Epub 2020 Apr 18.

Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.

Background: The incidence of atypical oncologic failure in patients with bladder cancer, including peritoneal carcinomatosis, and recurrences at the port site and soft tissue after laparoscopic and robot-assisted radical cystectomy are not well characterized.

Methods: We retrospectively reviewed the records of 52, 51, and 12 patients who underwent open, laparoscopic, and robot-assisted radical cystectomy, respectively, for bladder cancer from 2007 to 2018 at our institution. We identified techniques associated with atypical oncologic failure.

Results: The median follow-up period was 29 months. Among the 115 patients, 29 (25%) experienced oncological recurrences, and 7 (6%), 12 (10%), and 23 (20%) had atypical, local, and distant recurrences, respectively. The laparoscopic and robot-assisted radical cystectomy groups had significantly higher incidences of total atypical oncologic failure than the open radical cystectomy group (p = 0.013), including six, one, and two patients with peritoneal carcinomatosis, port site carcinomatosis, and soft tissue involvement, respectively. All 7 patients with atypical oncologic failure died of cancer; the median time from surgery to death was 9.3 months. All these patients were cT ≧ 3 and had grade 3 disease. In three patients (43%), the pathological tissue contained variants other than urothelial carcinoma. Five (71%) were among the initial twenty patients. Four patients (57%) had histories of intraoperative urine spillage or bladder perforation during transurethral resection.

Conclusions: Patients with cT ≧ 3 stage, with pathological variants other than urothelial carcinoma, and those undergoing procedures that lead to extravesical dissemination should avoid laparoscopic radical cystectomy when the procedures are first introduced.
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http://dx.doi.org/10.1007/s10147-020-01677-yDOI Listing
July 2020

Development and external validation of a preoperative nomogram for predicting pathological locally advanced disease of clinically localized upper urinary tract carcinoma.

Cancer Med 2020 06 6;9(11):3733-3741. Epub 2020 Apr 6.

Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.

Objective: To develop and validate a preoperative nomogram to predict pathological locally advanced disease (pLAD) of clinically localized upper urinary tract urothelial carcinoma (UTUC) treated with extirpative surgery.

Methods: In total, 1101 patients with cN0M0 UTUC (development cohort, n = 604; validation cohort, n = 497) from 2 independent academic databases were retrospectively analyzed. pLAD was defined as pT3/4 and/or pN+. Multivariate logistic regression was used to develop a nomogram. The accuracy of the nomogram was evaluated with a receiver operating characteristic curve, calibration plot, and decision curve analysis.

Results: The development and validation cohorts comprised 204 (33.8%) and 178 (35.8%) patients with pLAD, respectively. The multivariate analyses showed that the neutrophil-to-lymphocyte ratio (hazard ratio [HR], 2.27; P < .001), chronic kidney disease (HR, 1.56; P = .032), tumor location (HR, 1.60; P = .029), hydronephrosis (HR, 2.71; P < .001), and local invasion on imaging (HR, 8.59; P < .001) were independent predictive factors. After bootstrapping, a well-calibrated nomogram achieved discriminative accuracy of 0.77 in the development cohort. The decision curve analysis demonstrated improved risk prediction against threshold probabilities (≥8%) of pLAD. These results were consistent in the validation cohort.

Conclusion: Our novel nomogram allows for more highly accurate prediction of pLAD of UTUC. This nomogram integrates standard imaging and laboratory factors that help to identify patients who will benefit from preoperative chemotherapy, extended lymph node dissection, or both.
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http://dx.doi.org/10.1002/cam4.2988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286474PMC
June 2020

Laparoscopic Repair of Ureteral Diverticulum Caused by Ureterosciatic Hernia.

Urology 2020 Jun 21;140:e1-e3. Epub 2020 Mar 21.

Department of Urology, Kobe City Medical Centre General Hospital, Chuo-ku, Kobe 650-0047, Japan.

Ureterosciatic hernia and ureteral diverticulum are rare conditions. Only a few cases with surgical management for these conditions have been reported. We report a case of ureteral diverticulum due to ureterosciatic hernia in an 85-year-old woman admitted for septic shock. Computed tomography and retrograde ureterography revealed obstructive ureterosciatic hernia. During intraoperative laparoscopic mesh repair for the hernia after urosepsis treatment, we noted ureteral diverticulum that was also detected endoscopically at the herniated ureter wall. Suture plication was performed to prevent stricture and hernia mesh infection. To our knowledge, this is the first report on ureteral diverticulum due to ureterosciatic hernia.
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http://dx.doi.org/10.1016/j.urology.2020.03.017DOI Listing
June 2020

Surgical outcomes and learning curve of totally intracorporeal ileal conduit urinary diversion following laparoscopic radical cystectomy at a single institution.

Asian J Endosc Surg 2020 Oct 28;13(4):532-538. Epub 2020 Feb 28.

Department of Urology, Kobe City Medical Centre General Hospital, Kobe, Japan.

Introduction: Constant evaluation of the outcomes of laparoscopic intracorporeal urinary diversion is not yet established. This study aimed to describe surgical outcomes and learning curve of intracorporeal ileal conduit (ICIC) following laparoscopic radical cystectomy (LRC) at a single institution.

Methods: From June 2012 to February 2018, 38 patients with bladder cancer underwent LRC with ileal conduit at our institution. Surgical outcomes were compared between ICIC (n = 30) and extracorporeal ileal conduit (ECIC) (n = 8). The learning curve during ICIC with regard to the operative time and complication rate was compared.

Results: No significant differences in patient characteristics between the ICIC and ECIC groups were found. Comparison of outcomes between the ICIC and ECIC groups were as follows: median total operative time, 688 vs 713 minutes; urinary diversion time, 213 vs 192 minutes; and estimated blood loss, 450 vs 420 mL, respectively. The median time to walking and oral intake were similar in both groups. Rates of high-grade complications associated with urinary diversion (Clavien-Dindo grade ≥ III) were 3% in ICIC and 25% in ECIC. Although 25% of ECIC patients developed wound dehiscence (Clavien-Dindo grade IIIb), no patient in the ICIC group had postoperative wound infection. For the learning curve of ICIC (n = 30), urinary diversion time decreased significantly (27 minutes decrease per 10 cases, P = .02). Clavien-Dindo grade ≥ II complication did not occur after 20 cases.

Conclusions: LRC with ICIC could be performed safely with low incidence of severe wound infection compared with ECIC. The incidence and severity of complications also decreased with time.
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http://dx.doi.org/10.1111/ases.12793DOI Listing
October 2020

Absence of asymptomatic unruptured renal artery pseudoaneurysm on contrast-enhanced computed tomography after robot-assisted partial nephrectomy without parenchymal renorrhaphy.

Asian J Urol 2020 Jan 8;7(1):24-28. Epub 2019 Oct 8.

Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan.

Objective: To assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm (RAP) on contrast-enhanced computed tomography (CE-CT) after robot-assisted partial nephrectomy (RAPN) without parenchymal renorrhaphy.

Methods: From May 2016 to December 2017, 78 patients underwent RAPN for renal tumors. Inner suture was performed in the opened collecting system or renal sinus, whereas parenchymal renorrhaphy was not. For hemostasis, the soft coagulation system was used, and absorbable hemostats were placed on the resection bed. CE-CT was carried out within 7 days after surgery. Data on these patients were prospectively collected. A single radiologist determined the diagnosis of RAP.

Results: Median (range) data were as follows: Patient age, 65 (19-82) years; radiographic tumor size, 30 (12-95) mm; operating time, 166 (102-294) min; warm ischemic time, 16 (7-67) min; and blood loss, 15 (0-4450) mL. One patient (1.6%) required a perioperative blood transfusion. No patient required conversion to open surgery or nephrectomy. CE-CT was carried out at median 6 (3-7) days after surgery. CE-CT showed no RAP development in all 61 patients. Urinary leakage was not observed. One patient had acute cholecystitis, a postoperative complication classified as Clavien-Dindo grade higher than 3, which was treated with cholecystectomy. Positive surgical margin was identified in four patients (6.6%).

Conclusion: RAPN using soft coagulation and absorbable hemostats without renorrhaphy appears to be feasible and safe. Our technique could eliminate the risk of RAP.
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http://dx.doi.org/10.1016/j.ajur.2019.07.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962716PMC
January 2020

[Traumatic Adrenal Injury : A Single-Institution Experience].

Hinyokika Kiyo 2019 Jul;65(7):271-275

The Department of Urology, Kobe City Medical Center General Hospital.

Traumatic adrenal injury is quite rare. From January 2008 to March 2018, out of 287 patients with genitourinary trauma, 23 patients (8%) were diagnosed with traumatic adrenal injury at Kobe City Medical Center General Hospital. We retrospectively reviewed the medical records and assessed the traumatic category, image findings and outcome. All 23 patients were bluntly injured. The causes of traumatic adrenal injury were motor vehicle accident (11 patients : 48%) and falls (9 patients : 39%). The majority of injuries occurred on the right side (18 patients : 78%). Associated injuries occurred in all 23 patients, most frequently in the liver (57%) and ribs (57%). Extravasation of contrast materials was identified on computed tomography (CT) in 4 patients (17%). Although 22 patients (96%) were conservatively managed, only 1 patient was treated by transcatherter arterial embolization because of hypotension. One patient died of intraabdominal bleeding. To our knowledge, the present study is the largest on traumatic adrenal injury in Japan.
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http://dx.doi.org/10.14989/ActaUrolJap_65_7_271DOI Listing
July 2019

Comparison of perioperative outcomes of robot-assisted partial nephrectomy without renorrhaphy: Comparative outcomes of cT1a versus cT1b renal tumors.

Int J Urol 2019 09 30;26(9):885-889. Epub 2019 Jun 30.

Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.

Objectives: To assess the perioperative outcomes of robot-assisted partial nephrectomy without renorrhaphy for cT1b renal tumors compared with cT1a.

Methods: From February 2015 to May 2018, 100 robot-assisted partial nephrectomy patients who underwent robot-assisted partial nephrectomy without renorrhaphy for renal tumors were included. We retrospectively reviewed the medical records, and compared the perioperative outcomes of 66 and 34 patients for cT1a and cT1b tumors, respectively. Inner suture was carried out in the opened collecting system or renal sinus, whereas parenchymal renorrhaphy was not. For hemostasis, the soft-coagulation system was used, and absorbable hemostats were placed on the resection bed.

Results: The median tumor size and RENAL nephrometry score were significantly different between the two groups (cT1a vs cT1b: 23.5 vs 45 mm, P < 0.001, 6 vs 8, P < 0.001). The median operating time and warm ischemic time were significantly longer in the cT1b group than in the cT1a group (154 vs 184 min, P < 0.001; 14 vs 21 min, P < 0.001). The median blood loss was not significantly different (2.5 vs 50 mL, P = 0.109). The positive surgical margin rate was 4.5% versus 11.7% (P = 0.22). Postoperative complications classified as Clavien-Dindo grade III or higher were port-site herniation (one patient), acute cholecystitis (one patient) and pseudoaneurysm (one patient) in the cT1b group. Urinary leakage was not observed in the two groups.

Conclusions: Robot-assisted partial nephrectomy without renorrhaphy using the soft-coagulation system and absorbable hemostats appears to be feasible for renal or cT1b tumors. However, longer warm ischemic time and a high rate of complications can be expected compared with cT1a tumors.
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http://dx.doi.org/10.1111/iju.14046DOI Listing
September 2019

[A Case of Systemic Polyarteritis Nodosa Presenting with Scrotal Pain].

Hinyokika Kiyo 2019 Apr;65(4):127-131

The Department of Urology, Kobe City Medical Center General Hospital.

A 76-year-old man with a history of hypertension was admitted with high fever and left scrotal pain. Laboratory findings revealed high serum C-reactive protein levels. The left epididymis appeared to be swollen on computed tomography. The patient was diagnosed with bacterial epididymitis and treatment with antibiotics was initiated. Despite treatment, his left scrotal pain and fever did not improve. Additionally, he developed right scrotal and posterior neck pain. For histopathological diagnosis, a left high orchiectomy was performed and the findings revealed thickened arteriolar walls with infiltration of inflammatory cells around the testis, leading to a final diagnosis of systemic polyarteritis nodosa. Treatment with steroids led to complete resolution of the patient's systemic pain and inflammation.
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http://dx.doi.org/10.14989/ActaUrolJap_65_4_127DOI Listing
April 2019

A case of Ewing sarcoma family tumor of the kidney treated with robotic-assisted partial nephrectomy.

Urol Case Rep 2019 Jul 2;25:100900. Epub 2019 May 2.

Department of Urology, Kobe City Medical Center General Hospital, 2-2-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan.

Ewing sarcoma family tumors (ESFTs) of the kidney represents less than 1% of all renal tumors. A 45-year-old Japanese woman presented with right abdominal pain. Contrast-enhanced computed tomography showed a 12 × 8-cm right cystic renal mass. The mass was diagnosed as cystic renal cell carcinoma (RCC) and right partial nephrectomy was performed. Immunohistochemical studies showed that the tumor was positive for CD99 (membranous staining in tumoral cells), indicating ESFT. The patient is doing well without further therapy after 1 year of follow-up. To our knowledge, this is the first report of renal ESFT mimicking cystic RCC on diagnostic imaging.
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http://dx.doi.org/10.1016/j.eucr.2019.100900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6512745PMC
July 2019

En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy: A single-institution experience.

Int J Urol 2019 03 3;26(3):363-368. Epub 2018 Dec 3.

Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.

Objective: To report the outcomes of laparoscopic radical nephrectomy with inferior vena cava thrombectomy for right renal cell carcinoma at Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.

Method: A retrospective review of the clinical records of five patients who underwent laparoscopic radical nephrectomy with inferior vena cava thrombectomy for right renal cell carcinoma between 2013 and 2017 was carried out. The surgical procedure included ligation and cutting of the right renal artery, followed by kidney mobilization. The left renal vein, and the caudal and cephalad sides of the inferior vena cava thrombus were clamped using laparoscopic vascular clamps, and the inferior vena cava was incised. The free kidney and tumor thrombus were placed en bloc in a retrieval bag. Subsequently, the inferior vena cava was laparoscopically closed using a continuous suture.

Results: The median operative time, pneumoperitoneum time, blood loss and postoperative hospital stay were 316 min, 266 min, 400 mL and 7 days, respectively. The median clamp time was 28 min (range 13-105 min). One patient (20%) required a perioperative blood transfusion. The surgical margin was negative in all patients. Only one patient experienced a major complication (Clavien-Dindo grade ≥3), namely a postoperative hemorrhage requiring transarterial embolism.

Conclusion: En bloc laparoscopic radical nephrectomy with inferior vena cava thrombectomy is a challenging yet feasible procedure for experienced surgeons in carefully selected patients. Further studies of this surgical procedure are required for standardization and safe application.
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http://dx.doi.org/10.1111/iju.13873DOI Listing
March 2019

[Off-Clamp, Non-Renorrhaphy Robot-Assisted Partial Nephrectomy : An Initial Experience in a Single Institution].

Hinyokika Kiyo 2018 Aug;64(8):323-327

The Department Of Urology, Kobe City Medical Center General Hospital.

We report the surgical procedures and perioperative outcomes of off-clamp, non-renorrhaphy robotassisted partial nephrectomy (RAPN) in 7 out of 76 patients who underwent RAPN with off-clamp and nonrenorrhaphy between February 2015 and August 2017. The approach was chosen depending on the location of the tumor. Tumor enucleation was performed by using sharp incision and blunt dissection. For hemostasis, the soft-coagulation system was used and TachoSil○R was placed on the resection bed. As a rule, renorrhaphy was not performed. Median (range) patient age was 67 years (40-79), tumor size ; 14 mm (12-18), operative time ; 139 minutes (102-166), console time ; 51 minutes (41-75), estimate blood loss ; 10 ml (0-100). No patients required a perioperative blood transfusion. Median (range) tumor intraparenchymal depth was 10.4 mm (4.3-15.5) and distance from urinary collecting system was 9.3 mm (4.1-13.0). Pseudoaneurysm and urine leakage were not observed. No complications classified as Clavien-Dindo grade higher than grade 1 appeared. No cases had a positive surgical margin. Median (range) estimated glomerular filtration rate (eGFR) change rate at 3 months after surgery was 0% (-12.7-14.5). Off-clamp, non-renorrhaphy RAPN with the soft-coagulation system and TachoSil® is a feasible and safe procedure for patients carefully selected among those with superficial tumors.
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http://dx.doi.org/10.14989/ActaUrolJap_64_8_323DOI Listing
August 2018

[A Case of Chromophobe Renal Cell Carcinoma Associated with Birt-Hogg-Dubé Syndrome].

Hinyokika Kiyo 2018 Mar;64(3):107-110

The Department of Urology, Kobe City Medical Center General Hospital.

A 61-year-old man with a left renal mass, which was detected by ultrasound during a routine health examination, was referred to our department. The patient had a surgical history of two pneumothorax operations, and the patient's brother also had a history of pneumothorax surgery. A case of Birt-Hogg-Dubé (BHD) syndrome was suspected based on patient history. The pathological diagnosis of the resected tumor, which used robot-assisted laparoscopic partial nephrectomy, was determined to be chromophobe renal cell carcinoma (grade 2, pT1a). BHD syndrome was confirmed by genetic testing, where a nonsense mutation of exon 9 in the FOLLICULIN (FLCN) gene was detected. The patient is currently alive 10 months after surgery.
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http://dx.doi.org/10.14989/ActaUrolJap_64_3_107DOI Listing
March 2018
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